Table of contents:
- How do I know what is covered by health insurance at the hospital?
- Make sure to read the policy
- What is not covered by health insurance?
Health insurance plays an important role when you are sick. Without health insurance, you have to spend a lot of money out of your personal pocket. Both private and public insurance (BPJS Kesehatan) have their own facilities. This facility determines what actions are financed and what are not. So, to find out what actions are covered by health insurance, how do you do it? What will be covered and must pay personally? Check it out below.
How do I know what is covered by health insurance at the hospital?
Actually, to find out what details will be covered by insurance, this will depend on the agreement or policy that has been agreed upon. Before using it further, you can fully consult your insurance company regarding the product you choose.
Ask for a detailed explanation of the conditions that will be covered and not covered in the hospital. If you are still confused, you have the right to ask for examples of each case to explain in more detail.
Each private insurance usually has special cooperation with several hospitals or other health service places. This is where there is a mutual agreement between the hospital and insurance regarding what will be covered if an insurance participant comes.
In addition, before taking action in the hospital, you can also contact the insurance company to determine whether an action is covered or not. In essence, good communication is needed between the client and the insurance provider.
If you use BPJS for health, usually the hospital itself will confirm to the BPJS what actions were taken. If you are covered, you don't need to pay again.
Make sure to read the policy
After you officially have health insurance and get a policy, then you must understand all the contents of the policy, including the part of the exclusion clause.
For example in the exclusion clause it says things like this:
- Critical illnesses such as coronary heart disease and other critical illnesses attached can be claimed after 6 months of premium payment. Well, that way if there is coronary heart disease before 6 months you cannot claim it, it will take 6 months to 1 year before you can claim it back to insurance according to applicable regulations.
- For pre-existing diseases (eg congenital diseases), this will not be covered by the insurance company. Well, if you want to seek treatment for congenital disease conditions, it will not be covered by insurance.
The contents of this exclusion clause are the exclusion measures that prevent you from claiming insurance. From this you can also tell there are some actions that are not covered.
Similar to private insurance, in public insurance, namely BPJS health, there are also some exceptions for action. With this exception, outpatients and inpatients cannot use BPJS insurance in these circumstances.
What is not covered by health insurance?
There are some diseases and actions that are not covered by insurance. Diseases that are not covered such as:
- HIV / AIDS
- Microcephaly, which is a rare neurological condition that causes a baby's head to be smaller than children his age.
- Other diseases caused by disasters and epidemics. The insurer will not be responsible for this condition. Examples of diseases such as polio, cholera, ebola.
Examples of actions that are not covered by health insurance:
- Straighten teeth
- Operations that are aesthetic or aesthetic in nature
- Operations due to self-harm, for example exposure to taps, addiction to illegal drugs
