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Beyond Body

Why You Need a Health Insurance

By: Raissa Claire R. Falgui article_14

If you are a Filipino citizen, you are automatically entitled to health insurance coverage through PhilHealth. It only costs a small percentage of your paycheck, if you are employed. If you are retired, you are still covered given that you have contributed to the fund for at least ten years. PhilHealth pays out benefits for a hospital stay and the most costly essential medical procedures and medications. While it doesn’t give full coverage for most of these, it helps to reduce your expenses.

For those who are young and generally in excellent health, PhilHealth coverage may seem sufficient, along with SSS or GSIS, which also provide some medical coverage. Of course, nobody expects to have a major illness or accident, but most Filipinos expect that the eventuality is unlikely and in any case, they can rely on their network of family and friends to help them out if ever they do unexpectedly have a costly health condition.

There’s a reason, though, that the word “sure” is found in insure. Purchasing a good health insurance policy allows you to make sure that you will be able to pay for any medical expenses that unexpectedly arise. While many employers provide additional health policies for their employees as an additional benefit, knowing that these give more financial aid than PhilHealth, these have limitations too as decided by the employer. You would be better off still in choosing a policy tailored to your needs. Under a good health insurance policy, many of your medical expenses may be free or greatly minimized.

Quite simply, you need health insurance in addition to PhilHealth because of the possibility of the following occurrences.

1. An unexpected ailment or accident.

Nobody wants to think that they will get sick or hurt, but it can happen. And in some cases health care expenses can be quite high and if you have no insurance will drain your savings and the funds of your relatives. Or you may have to end up taking out loans with high interest, which will cost you more in the long run. On the other hand, with health insurance, you will end up paying less or even nothing. Tina Panotes, a Sun Life insurance agent, notes: “Depending on the amount of health insurance coverage and the terms of the health insurance plan one avails of, the person who has health insurance may actually not pay anything for any medical and hospital expenses he incurs in the treatment of his illness or injury. The health insurance company will pay for the medical treatment and hospital stay.

2. The need for a health procedure to prevent a health problem from getting worse.

How many people do you know avoid going to the doctor when they’re ill because they can’t afford it at the moment? Very often, delaying treatment for a simple health problem can lead to greater risks. Putting off buying expensive antibiotics for a persistent cough may lead you to get bronchitis or life-threatening pneumonia. In many other cases, a health problem might not be a life-and-death situation, for instance, if you need a dental procedure. But delaying treatment until you have the funds for it may cause a problem to get more serious, and you might end up paying more for stopgap solutions in the long run. For instance, if you put off getting a root canal, which can cost several thousands of pesos, you might need to keep buying pain medication, and the infection will grow worse. If you end up with an unsightly tooth, you would want to have an expensive cosmetic treatment or denture later. And in the meantime, you have had to struggle with the pain and risks of your infection. If you have the health insurance to take care of expenses, you will not be tempted to put off treatment until your condition becomes too bad to ignore.

3. Different members of your family needing health care all at once.

If you have young children, you’ll have to go to the doctor monthly while they are in infancy for check-ups and vaccinations. It’s also usual in families with young children to get more contagious diseases that spread to every member, as children tend to have less resistance to disease and take less care to avoid infection or prevent passing it on. While shots prevent most serious childhood diseases now, you can still be inconvenienced by catching illnesses such as colds, sore eyes, and the itchy, fever-inducing hand, foot, and mouth disease. Preventing other family members from getting the disease that one gets is usually futile, as in most cases contagion is possible even before symptoms become obvious. More than one member of the family may also be infected if there are dengue-carrying mosquitoes in your area. Your retired parents, as they get older, may also have more health problems, right along with your young kids. 

Having multiple members of your family get sick at once may seem like a curse. But it happens, and you’re only really cursed if you have not prepared for such a situation by getting insurance for yourself and your dependents. If you have health insurance only as a rider on your life insurance, this may still not be enough to cover day-to-day health expenses. 

“The illnesses covered by the health care rider in a life insurance are usually limited to serious and life-threatening illnesses,” says Panotes. If you don’t have coverage from your employer that can help out with your family’s collective health needs, it’s best for you to get health insurance that can help you with the frequent doctor’s consultations, medications, dental care, possible hospitalization, and other health needs of your family. 

4. Wanting more options for health treatments.

You can keep health expenses lower by using public health services, but government hospitals are usually overcrowded, understaffed, and may have outdated facilities and equipment. While the same may be said of some private hospitals too, you can have a wider range of choice of health care outlets with a health plan. Panotes explains, “There are health insurance plans provided by Health Maintenance Organizations (HMO). This type of plan usually limits coverage to care from doctors who are accredited and have contracts with the HMO. Except in emergency cases, the HMO will not cover out-of-network care. The HMO usually has a tie-up with different hospitals and doctors and the insured has to go to one of these hospitals and be treated by one of these doctors so the HMO will pay for the medical treatment. The HMO, through its representative, will deal directly with and take care of the professional fees of the doctors and the expenses of treatment in the hospitals.” Health plans allow you to consult with a wide range of accredited health professionals. Sometimes you can even get coverage for necessary treatment by a non-accredited doctor.

Knowing that you definitely need health insurance, study plans before purchasing to make sure they are right for your needs. You can then rest easy, assured that your health expenses won’t break the bank if and when the time comes.


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Keywords: health plan, health maintenance organization, life insurance, dependents, accident, unexpected ailment, health insurance plan, health insurance coverage, Philhealth, health insurance   
  
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