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You and your health

By Finbar Garcia LUTCF, FSS, MFA

When last did you look at the cost of health care at private hospitals? While we are privileged to have free health care at the public hospitals, many persons will opt to visit the private hospitals or doctors. However, the cost of private care is what you need to be prepared for and having the right health plan plus something extra is all part of your financial planning process.


Health plans, Group/Individual

There are many health plans available from the different insurance companies, but you may not get everything you want from any one insurer. The key to this is making sure you get ‘value for your money’.

Most of these plans, if not all, will carry the basic Medical, Dental, Vision, Prescription Drugs and Preventative Care, along with a list of other benefits, but the amount covered with each benefit is where you need to look deeper into.

While you may not know when you will need to seek medical attention, having some coverage is better than none. These plans are structured, in most cases as a reimbursement plan, with a predetermined percentage reimbursed with every claim, after all terms and conditions are met. Understanding the following is of utmost importance.

Deductible: This is a set figure that you must first satisfy at the beginning of every calendar year, from the first set of claims submitted. Once this is done, you will be reimbursed based on the percentages and limits offered on each benefit/claim. Most plans carry three deductibles, one each for medical, dental, and vision. The same procedure applies with your claims.

Waiting Period: This is something that is set in place to avoid moral implications and unethical methods to claim benefits from the insurer. It safeguards against individuals who may take out a health plan and not disclose any pre-existing conditions, and immediately seek treatment for the condition in question. These waiting periods will vary between three to six months. Pregnancy will carry a longer waiting period.

Benefit Limits: It is not impossible to get larger or every benefit in a health plan, but it would not be cost effective to the insured and may cause some plans to be out of reach for the average person. When plans are designed, they take into consideration an expected loss ratio. If these loss ratios exceed the annual premiums received over a certain percentage, then the premiums will be increased every policy anniversary, again taking it beyond the reach of individuals. The greatest effect is felt on an individual health plan rather than a group plan. Group plans spread the risk across a wider cross section of people, which balances the expected loss ratio, as not every employee will claim every time.

Coordination of Benefits (CoB): This is a feature in all health plans that allows the insured to recover expenses from two plans. In most cases, the main plan is a Group plan then an Individual plan or another Group plan from a spouse. Claims are coordinated between the two insurers and the difference is paid by the secondary plan.

Having understood the basics of a health plan, let’s move to another plan that covers not just medical, but reimburses you almost 100 per cent of expenses, even if you decided to seek medical attention at a public hospital.

Now, I don’t usually quote products, however, there is a plan called ADmed. This plan covers you for five major benefits: Accident and Emergency, Hospital Diagnostic, Surgical, Life Insurance and Critical Illness Coverage.

There are different levels of this plan that allow you to choose based on terms and conditions. Not everyone may qualify for this plan, and it does not cover all the benefits of a normal health plan.

This plan can augment a health plan, as you can claim from both. ADmed provides you with easy, convenient, and hassle-free admittance at all the ADmed accredited private hospitals. You can call me for more details.

Critical illness plans: These are a must-have plan. While the individual or group health plan may detect/diagnose you with a critical illness and will even take care of surgical, prescription and other services needed during that period, a critical illness policy will pay to you a lump sum coverage benefit, that can be as much as seven million dollars. This can be used to extend your treatment if the health plan benefits were exhausted, as there may be certain maximums per lifetime or policy period.

So, where are you now? When last did you have a review of your health benefits?

As they say, “Your health is your wealth”.

“If you are serious about changing your life, you will find a way. If not, you will find an excuse” – Jen Sincero.


Call me for more information on planning your financial future.

Send your questions to or call 620-1185.