Health insurance explained in an FAQ

What is a policy?

This is a contract which lists the cover you have bought and explains how you claim should you be injured or fall ill. Unfortunately, although the contract is simple in principle, it’s often written in complicated language. This can make it difficult to understand. If in doubt, ask for clarification.

What should you do before buying?

Read the policies offered to you. If there’s anything you do not understand, ask what they mean. Look at the terms on pre-existing conditions, and for anything that limits the cover or your right to claim.

What is a pre-existing condition?

This is anything actually affecting your heath at the time you make the application. Under current law, it can be any medical condition, even something trivial, and it’s often used by insurers to refuse cover. The Affordable Care Act is changing that as from 2014. Insurers will be required to take on children, and adults will be allowed to buy health insurance through the high-risk pools to be set up by each state.

How long does it take to get the policy?

Unless there’s a problem, you should get the policy within a few days. If more than a month passes after you make payment, contact the company and ask what’s wrong. If the insurer does not reply within a reasonable period of time, contact your local Insurance Commissioner.

How long does it take for the insurer to pay out?

Once you have submitted all the evidence in support of your claim, you should find the claim met within six weeks. This does not mean every claim will be paid. An insurer who believes there’s something wrong with the claim is entitled to ask for more information or to investigate. If you think an insurer is delaying for no good reason, you have a right to complain to your local Insurance Commissioner.

Can your insurer cancel the policy?

Sadly, every insurer has the right to cancel the policy if you are in breach of any of its more important terms. The most common reason is the insurer discovering you were less than honest about your health or lifestyle when you made the application for the policy. This is not the same as refusing to renew when the term of the policy runs out. Always read the policy before buying to find out whether it is guaranteed renewable.