Understanding Inpatient and Outpatient Cover Options in Health Insurance

When choosing health insurance, it's essential to understand the difference between "Inpatient Only" cover and "Inpatient with Outpatient" cover. Here’s a breakdown to help you decide which option best suits your needs.

Inpatient Only cover provides insurance for treatments and procedures that require an overnight stay in the hospital. This includes major surgeries, emergency admissions, and other treatments where hospitalization is necessary.

What’s Covered?

• Hospital admission costs, room and board
• Necessary treatments and procedures performed during hospitalization
• Specialist fees, diagnostic tests, and surgery costs while you are an inpatient

Ideal For: Those who are mainly concerned with covering the high costs associated with emergency situations or major surgeries, where hospital admission is essential. It’s typically a more affordable option, as it focuses on critical health issues that demand hospital stays.

Inpatient with Outpatient cover includes everything in the Inpatient Only plan, but extends to medical treatments and consultations that do not require a hospital stay.

What’s Covered?

• All inpatient treatments as described above
• Outpatient visits to specialists, GP consultations, and follow-up appointments
• Diagnostic tests, lab work, scans, and prescribed medications that can be done without admission

Ideal For: Those who seek a more comprehensive plan, covering both emergency hospital treatments and routine medical care, allowing flexibility to address a range of health needs.

Key Takeaway: If you prefer to limit coverage to major incidents and emergencies, Inpatient Only might be sufficient. For broader coverage, including regular consultations and tests, Inpatient with Outpatient offers peace of mind across your healthcare needs.

Let us know if you’d like further assistance in selecting the best option for you.

Pre-existing Conditions

A pre-existing condition is any medical issue or illness that you have experienced or been treated for prior to applying for health insurance. This includes conditions for which you have received a diagnosis, treatment, or medication, or even symptoms that you were aware of but may not have sought medical advice for.

When applying for health insurance, it is crucial to disclose everything that is explicitly asked for on the application form. Insurers base their underwriting decisions on the information provided, so accurate and complete answers ensure your policy is valid and claims can be processed smoothly. However, it’s equally important to only provide the information requested by the insurer—avoid volunteering additional details that are not relevant to the application questions. This approach ensures you meet your disclosure obligations while avoiding unnecessary complications.

If you have many pre-existing conditions, you may wish for us to look at providers who offer "Moratorium" underwriting - see next question.

Moratorium Underwriting

Moratorium underwriting is a simplified method of obtaining health insurance where you do not need to provide detailed medical history upfront. Instead, the insurer excludes coverage for pre-existing conditions for a specified period, typically the first 2 years of the policy.

Key Points:

• A pre-existing condition is generally any medical condition you sought advice for, received treatment for, or experienced symptoms of before the policy start date.
• If you remain symptom-free and treatment-free for the specified moratorium period, the condition may then be covered.

This approach allows quicker approval compared to full medical underwriting, but it’s important to understand the exclusions and eligibility criteria for pre-existing conditions after the moratorium period.

Moratorium underwriting can be particularly beneficial if you have multiple pre-existing conditions, as it simplifies the process of obtaining cover without requiring a detailed medical history upfront. However, it's important to note that premiums may be higher compared to other underwriting methods, as the insurer factors in the potential risk. Additionally, this approach can sometimes lead to delays in processing claims, as the provider will need to "underwrite" the specific condition or treatment at the point of claim rather than during the initial application. This means they will assess whether the condition is eligible for coverage based on the policy terms and the moratorium period criteria.

Deductibles

A deductible is the amount you agree to pay out-of-pocket towards a claim before your health insurance policy starts covering costs. For example, if your policy has a $500 deductible, you will need to pay the first $500 of eligible medical expenses, after which the insurer will cover the remaining costs, subject to policy terms.

Choosing a higher deductible often reduces your premium, but it means you take on more financial responsibility in the event of a claim. Deductibles can apply per claim, per policy year, or in other ways, depending on your plan.