Health insurance terms: Know what you&39re paying for

Some policy terms may affect your claims. find out exactly what they are.

Health insurance rarely covers 100% of your medical costs. Most policy features, like deductibles and coinsurance, help keep your premiums affordable. this means you will have to pay some medical expenses out of pocket.

Reading: When do i have to pay my health insurance deductible

so make sure you know exactly what and how much is covered.

know what you are paying for

Start by learning about policy terms that may affect your coverage and claims:


The payment to maintain your health insurance is known as a premium. it can be a lump sum (single premium) or in smaller amounts (regular premiums) each month, quarter or year.

Health insurance premiums typically increase with age, are not guaranteed, and are subject to change. Insurers may choose not to renew a plan or charge a higher premium when there are too many claims.

Before you buy a policy, make sure you can afford the premiums over the long term. If you are unable to pay your premiums, your policy may lapse and you will lose coverage.

deductibles and coinsurance

A deductible is the initial amount you must pay toward your medical expenses before your health insurance makes a payment. You generally only need to pay the deductible once in a policy year.

Plans with lower premiums tend to have higher deductibles. after you pay your deductible, you may still have to pay coinsurance or copayment.

coinsurance is how much you have to co-pay or split the cost with the insurer after you pay the deductible. It is usually expressed as a percentage. for example, if you have 10% coinsurance, you’ll pay 10% of the cost after the deductible.

You can use medisave up to the current limits to pay the deductible and coinsurance not paid by your insurance policy.

claim limits

See also: How Much Insurance Coverage Should I Have? (Part 1): PIP | The Poole Law Group

There are limits to what you can claim under a policy. for example, limits can be included for all claims, as well as for each illness, disability, per month, year or lifetime.


For health insurance, having more policies doesn’t necessarily give you more benefits, since you can only claim up to your actual medical expenses. at no time will your combined policies pay you more than 100% of your actual medical expenses.

age limit

There is no age limit to the life of medishield. It covers you for life, and there is no age limit to enter the scheme.

There is also no upper age limit for joining careshield life when it is introduced in 2020. However, the minimum age of coverage for careshield life is 30 as it is intended to provide basic coverage for severe disabilities in the old age. once enrolled, careshield life also covers you for life.

Private insurance plans may have an age limit and may not be available to you once you reach a certain age. Some health insurance policies provide coverage for a lifetime, while others cover for a fixed period or up to a certain age. choose a product that suits your needs.

policy exclusions

medishield life is universal and has no exclusions. careshield life, when introduced, is also universal (has no exclusions) for cohorts born in 1980 or later.

On the other hand, all private health insurance policies contain some exclusions. exclusions are conditions or circumstances under which benefits will not be paid. Pre-existing conditions, illnesses, or disabilities you had before you got private health insurance are generally excluded.

You must provide details of any illness, disability or medical condition you have or have had in your application. the insurer will then decide whether to cover that medical condition.

the insurer may charge a higher premium (charge). Your coverage may also be restricted due to a health condition or due to occupational exposure. That’s why you should buy health insurance while you’re young and healthy.

Exclusions vary from policy to policy. In addition to pre-existing conditions, look for other exclusions. Please read your policy document carefully to find out exactly what is covered.

waiting period

Most health insurance policies impose a waiting period of between 30 and 90 days from the approval of coverage. benefits will not be paid for illnesses arising or treatments carried out during the qualifying period.

defer period

A ‘deferred period’ means that benefits can only be paid after you have been disabled or sick for more than a certain number of days.

See also: Life and Health Insurance License | StateRequirement

Before purchasing a health insurance policy, check the scope of coverage and the waiting or deferred period, if applicable.

policy clauses

A rider can be added to an existing policy, providing additional coverage. if the rider accelerates the benefit of the base policy, the policy may expire after the rider is paid.

passenger benefits include:

  • deductible and coinsurance coverage, which helps pay the deductible and coinsurance subject to limits. for passengers adhered to integrated shield plans (ips), all new passengers from march 2018 must incorporate a copayment (what you pay) of 5% or more.
  • Daily hospital benefit, which pays a certain amount of cash for each day you are under guardianship.
  • critical illness benefit, which pays a lump sum upon diagnosis of any of the critical illnesses covered by the policy.
  • policy renewal

    Always ask about the policy renewal conditions. some health insurance policies:

    • guarantees that your coverage stays in force as long as you pay your premiums on time (eg ips). Even so, the insurer may modify the benefits, premiums or conditions when the renewal is due.
    • They are short-term and cover you for a limited period only. for example, staff medical benefits that end when you leave the employer.
    • If renewal is not guaranteed, the insurer may decide not to renew the policy after a major medical loss. It is essential to check if your product covers you for the time you need and if the renewal is guaranteed. read the terms and conditions of the policy before you buy it.

      trial period

      insurance companies grant at least a free trial period of 14 days. ips has a free trial period of 21 days. starts from the date you receive your policy documents. During this period, you should review your policy carefully to see if it meets your needs. if you decide not to keep it, write to the insurance company to notify them of the cancellation.

      Written notice must be given to the insurer within 14 days (21 days for ips) from the date you received your policy. The company will reimburse you for all of your premiums, less any medical and other expenses you’ve already incurred.

      switch between policies

      Health insurance policies generally do not cover pre-existing conditions when you purchase them. Before you switch to another health insurance policy, assess whether your health has changed since you purchased your current policy and whether you now have any new health conditions.

      If you have developed any health problems, the new policy you switch to may not provide the same coverage as your current policy. the new policy may also require you to pay more premiums to provide you with specific benefits. be careful with this.

      note: if you have existing medical conditions that are covered by your old ip, you may lose coverage if you switch to a new ip. so even though medishield life covers pre-existing conditions, if you switch from one ip to another, you will only be covered for pre-existing conditions up to the medishield life benefits.


      Health care costs differ greatly between public and private hospitals, and between ward classes. Before going to the hospital for treatment, ask about:

      • room charges and cost of medical treatment recommended by your doctor
      • conservatee class rights under your health insurance plan
      • how much your health insurance policy may cover
      • what options are available to you
      • if you selected the treatment or room you can pay for
      • You should also check with your insurer if they can issue you a letter of guarantee (registration). the record tells the hospital how much the insurer will cover. ask the hospital for an estimate of the bill.

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