Reimbursement medical insurance, what to consider.
Reimbursement health insurance offers the possibility of going to a center or professional outside the company’s medical directory, but it is essential to understand how they work.
Reimbursement medical insurance offers a series of coverages and the possibility that the insured receive part or all of the cost of the service. That is, the patient pays the medical expense (consultation, test, treatment…) and the insurer returns a part of this income . Depending on the agreement reached with the company, the insured may receive the entire cost or a percentage.
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One of the most characteristic advantages of this type of insurance is that it allows the insured person to go to any center or professional they prefer , regardless of whether they are part of the company’s medical chart or not.
This is not a detail to overlook, since when insurance is taken out, the most normal thing is that the insured has to adhere to the insurer’s medical chart. Reimbursement health insurance allows more freedom of choice . In addition, this type of policy is less limited in terms of coverage.
Incorporation of reimbursement in other policies
In addition to being health insurance itself, the ability to pay for reimbursement services can also appear in other policies . Normally, the insured person can reach an agreement with the company to go to centers or professionals outside the medical list and pay for it with the reimbursement option.
In this case, the reimbursement usually appears in the policy as a module with the possibility of being added or eliminated, depending on what the company and the interested party agree on.
If the reimbursement service does not cover 100%, 80% is usually covered, although it all depends on the agreement in the policy.
There could be 2 and even 3 different return percentages , depending on the service to be covered or the previous conditions imposed by the company.
Generally, in the reimbursement insurance modality we can find 2 possibilities :
Mixed insurance
This type of insurance in turn offers 2 types of coverage. On the one hand, insurance without copays and, on the other, the reimbursement option . The difference with normal copay or reimbursement insurance is that the monthly premium is usually lower.
Pure reimbursement insurance
The difference of this modality is that the insured cannot access any specific medical chart. Every time you go to the doctor, you must pay the price of the service and the insurer will return part of the income. This coverage is cheaper than mixed insurance
Emergency reimbursement insurance
The reimbursement method is applicable both for an emergency situation and for receiving healthcare abroad. For these cases, reimbursement health insurance coverage is applicable, but it is also limited. In other words, the service to be covered may not exceed an amount specified in the policy.
Once this amount is exceeded, it is the insured who will have to bear the remaining expense.
There is also another variant for these cases: the duration of the stay abroad . Many companies cover the medical expenses of a stay outside of Spain for 3 months. After this time, the company could stop ### any emergency that occurs. The time that each company covers the insured during their stay abroad may vary according to the policy and the company.
Dental insurance in the reimbursement modality
Dental insurance is included in many insurances that include it as part of their offer , whether they are reimbursed or not. Mainly, this insurance is usually a supplement, but, in turn, it is another type of insurance. Taking this into account, dental insurance can have its peculiarities and be managed in a different way from the rest of the coverage of a policy.
Managing dental insurance through the reimbursement modality allows the insured certain freedoms. How to choose the center and the specialist you want. The company would be in charge of returning the request the entry of the assumed expense is simpler than in the rest of the coverage. You just have to give the insurer the completed application where the bill from the dental clinic appears. Most companies usually respond within 7 business days.
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