Would you like to know what a catastrophic insurance and how it works? In this article we offer you the information you need to enjoy this type of insurance, which is so important for people's peace of mind.
Catastrophic Insurance
The World Health Organization (WHO) defines health as follows:
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Considering that health is an essential legal asset protected by the Chilean State, when situations occur that compromise health or endanger it, collaterally causing an economic imbalance, services are implemented to counteract this action, such as the so-called catastrophic health insurance. If you are interested in life insurance, read the following article Why is Hiring Life Insurance Important?
What is catastrophic insurance?
El Safety catastrophic It is a type of health plan that offers coverage in times of emergency, but also offers preventive care. These catastrophic health plans have low cost monthly premiums, but high deductibles.
The user of the policy must pay for any medical emergency received up to the amount of the deductible and most preventive care is covered at 100%.
Regarding catastrophic health coverage, it is available to people under the age of 30 who are looking for minimum coverage and low monthly premiums, and for those of any age who are eligible due to economic hardship, or to request a hardship exemption.
This waiver request means the inability to pay for health care insurance due to unforeseeable circumstances such as loss of home or filing for bankruptcy or other criteria to consider.
In this sense, having a catastrophic insurance constitutes an important protection mechanism, preventing quality medical care and minimizing the expenses that lead to curative care for any unforeseen event of a health nature. Before continuing with the development of this article, it is convenient to know the type of insurance, how it works and the criteria to consider when choosing one.
Health-related services in Chile are very expensive, so it is convenient to have a complementary health insurance policy that works as financial support to meet the expenses derived from consultations and medical attention.
However, when it comes to policies, whose purpose is preventive in relation to cushioning the economic impact, originating from a serious health problem, it is the occasion where catastrophic insurance comes into action, Chilean citizens in many cases are not so clear its benefits.
In the Chilean market, there are two types of this type of catastrophic insurance:
- It consists of contributing to complementary health insurance and the health plan, whether from the National Health Fund (Fonasa) or Isapre.
- Covers specific catastrophic health events.
The offer of this type of insurance in the Republic of Chile is promoted by the National Health Fund (Fonasa) and isapre and all private insurance companies; it is illustrative to expose some of its particularities.
Catastrophic insurance modalities
There are various types of catastrophic insurance, which we will explain below:
-
Catastrophic Insurance of the National Health Fund
The characteristics, as well as the benefits of this fund, according to the Superintendence of Health, the Fonasa catastrophic bonus with 100% of the expenses but only if you attend establishments designated by the Fund.
It is necessary to understand that your coverage is guaranteed in the medical establishments affiliated with the fund. In addition, this Fonasa insurance only applies to the following diseases, according to the Med Guide portal:
- Hemodialysis and Peritoneodialysis
- Cardiosurgical Benefits
- Neurosurgical Benefits
- Scoliosis
- Kidney transplant
- liver transplant
- Comprehensive Care for the Fissured Patient
- Emergency Care for the Burned Patient
- Benefits of the Chemotherapy Group
- Benefits of the Radiotherapy Group
- Pharmacological treatment of HIV
- Emergency Care for Patients with Complex Trauma
-
Isapre Catastrophic Insurance
- The Additional Coverage for Catastrophic Illnesses (CAEC) constitutes an additional benefit that some ISAPRE offer, informs the Health Superintendence. Its usefulness consists in mitigating high-cost situations, regardless of whether they are related to a specific illness, although there are some benefits that are not covered.
- Fulfilling certain stipulated requirements, the CAECs cover 100% of the member's expenses that exceed the deductible, or the amount that corresponds to cover the insured.
- It is important to highlight that this option is available in almost all isapre, few people activate this coverage. The reasons why few affiliates take advantage of the CAECs are the lack of information and the belief that they generate more expenses.
3.-Catastrophic Insurance offered by insurance companies
If the Qué Plan health plan comparison platform is taken as a reference, the promotion of these products illustrate the coverage selection criteria, that is, if it is partial or total of the costs generated by catastrophic episodes related to health; This condition is not reflected in the policies offered by Fonasa and Isapre.
However, it is important to know that the catastrophic insurance works or operates as a reimbursement, once the coverage of Fonasa and isapre is exceeded, but the CAECs contemplate in their policies the option of a payment for the deductible.
Within the characteristics of this type of policy offered by insurance companies, they generally contemplate the enjoyment of this benefit for people within a range between 18 and 80 years of age, precisely ruling out the exclusion of coverage for people with pre-existing diseases, aesthetic or psychological treatments.
How does catastrophic insurance work?
At the time that the user decides to contract this type of catastrophic health insurance, he must know the characteristics of the policy before signing the contract, questions must be asked such as: the existence or not of the deductible and its amount, what are the claims contemplated and the conditions for their recognition.
Fonasa's catastrophic insurance is activated automatically, without the presence of a contract to access this claim, only the quality of affiliate is enough; It is a fundamental condition in this policy to go to a public health facility.
If the user decides to take out catastrophic insurance sponsored by ISAPRE, the coverage must be activated before the loss occurs or when a medical diagnosis could turn into a catastrophic illness based on the cost of the claims it generates. If this is the case, the user must go to their institution and fill out the form “Request for incorporation into the closed network of the CAEC and GES-CAEC.
More catastrophic insurance
Next, we will answer the most frequently asked questions that you may ask yourself as a beneficiary of catastrophic insurance or if you are interested in contracting this type of insurance.
What type of medical care does catastrophic health insurance cover?
Once your plan deductible is paid, catastrophic coverage should pay for accidents, unforeseen injuries, sudden emergency illnesses. These plans may have 100% coverage for some preventive care services, flu shots, some routine checkups, or annual checkups. Most of these plans cover at least three visits to the primary care doctor.
How to choose the most suitable catastrophic insurance?
Now that you know what catastrophic insurance is, what it is for and how to use it, we allow ourselves to suggest some useful recommendations when choosing the best option to enjoy the benefits of your policy
- Think about territorial coverage. The acceptance of health centers located throughout the national territory.
- Look at the reimbursement and what your coverage distribution is (which includes hospital, doctor, outpatient and pharmaceutical expenses).
- Always read the fine print and do not sign anything until you are sure you understand all the implications of the policy.
- Require the policy number and keep it in a safe place with the idea of using it in an unforeseen catastrophic event and be known by your relatives.
- It is important to understand what features are and are not covered by the plan of your choice.
Remember that the World Health Organization reflects health as an integral complex, the result of which is a harmonic balance of the well-being projection person within the human conglomerate where he interacts.
In the same way, it considers health as a human right and it is included in Chilean legislation, consequently the Chilean State has the obligation to ensure that this right is fully complied with. It is a social duty with the population of all strata that make up society.
Here is some very important audiovisual material for you to continue learning about catastrophic insurance.