Sorry, You’re Not Covered – Why You May Hear Those Dreaded Words and how to Avoid it

Sorry, You’re Not Covered – Why You May Hear Those Dreaded Words and how to Avoid it

5th February, 2015

You have taken out an international health insurance plan. You have had the misfortune of requiring healthcare. You don’t worry about the finances, after all your policy should cover you. However, when you contact your health insurance provider you hear the words ‘sorry, you’re not covered’. Your heart sinks, especially if the medical bill is an extortionate one. You feel cheated. You wonder why you aren’t covered.

Unfortunately this is a scenario that can happen. It usually arises when the person insured has not fully understood the terms and conditions of their policy. This is why it is imperative to read every single word of your health insurance plan. Keeping that in mind, let’s take a look at the various different reasons why your global medical insurance policy may not cover you and how to avoid this from happening.


You are still in the ‘waiting period’ phase of your policy

There are some health care benefits that are subject to a waiting period. If you are still in the waiting period phase your insurer will not cover your treatment. Maternity care is a prime example of this. Almost all insurers will place a waiting period on maternity care, which is typically between ten months and twelve months. This means that they will only cover any maternity care and treatment once you have had your policy for this length of time. Therefore, if you have only had your policy for five months and you require maternity care you will need to fund it yourself until the waiting period is over. The reason they do this is to make sure that you don’t merely fall pregnant and then take out a global health insurance plan to cover the maternity costs. If you are planning to start a family you need to make sure you take out health insurance prior to falling pregnant. Maternity care is not the only benefit that is subject to a waiting period. A lot of insurers place a six to nine month waiting period on dental care too.


You have exceeded a limit that has been applied to a certain benefit

All international health insurance policies have limits in place across various different benefits. Once you have exceeded a limit for a certain benefit, you will need to cover all healthcare and treatment expenses for the remainder of the year.  For instance, you may have had a physiotherapy benefit which covers up to 30 sessions per year.  If you were to claim for any more than 30 sessions, you would not be covered.  It is also common for there to be a monetary limit such as ‘Up to USD 25,000 per period of cover’.  Under these circumstances, you need to be aware how much you have claimed in any one year so you don’t exceed it.


You have not declared everything on your application

Some people are tempted not to disclose the whole truth about their medical history on their application. Sometimes, people with pre-existing conditions may purposely exclude some or all information so that they will be covered.  Some people even lie about their age so that they can secure lower premiums. Nevertheless if you lie, there is an extremely high chance that the truth will come out and if this happens, the insurance company has the right to not pay your claims and even cancel your plan.

You have received healthcare or treatment for a pre-existing condition that is not covered in your policy

Some international health insurance providers cannot cover people that have pre-existing conditions. If your policy does not cover your pre-existing condition and you have had any sort of healthcare or treatment that relates to your condition you will have to fund it yourself.  As touched upon in the former point, it is imperative to be honest about any pre-existing conditions you have. A lot of insurers elect to provide a health insurance plan that excludes the pre-existing condition. If you agree to this you will of course still have to fully fund any care or treatment related to your condition.

You haven’t paid the policy excess amount

An excess is the sum of money you need to pay before your insurer will cover you. For example, if you have chosen a USD 100 excess, you will have to pay USD 100 towards the medical bill before your insurer covers the rest. This could either be USD 100 per treatment or USD 100 per year depending on the specifics of your policy.  If you make a claim for treatment has is less than the excess amount, the insurer will not pay your expenses.

The treatment you need isn’t a covered

When selecting a worldwide medical insurance plan, one of the key decisions you need to make is the level of cover you require. Generally speaking you can choose between low cover policies, intermediate cover policies and high cover policies. No matter what policy you opt for, it is vital to be fully aware of what you are covered for and what you are not. Just because you have a high cover policy does not mean you are going to be covered for literally every type of treatment. By simply assuming you are covered you could find yourself in a position where you have a treatment that isn’t covered in your health plan without even realising.

Hopefully you now have a better understanding of the main reasons why you may hear the dreaded words ‘sorry, you’re not covered’. To ensure this never happens, make sure you are fully aware of everything your policy entails, from benefit limits to waiting periods. Moreover, always tell the truth on your application; if you don’t it is extremely likely that it will come back to haunt you.

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Alison Massey

Group Marketing Director

Now Health International

Alison Massey is a 15-year digital marketing veteran, who has spent the last seven years using social media to help expats and soon to be expats find out what to expect from a life overseas. An expat living in Hong Kong herself, Alison is the Group Marketing Director of Now Health, the award-winning international health insurance provider.

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