Private Medical Insurance Coverage

Private Medical Insurance: Everything You Need to Know

Private medical insurance can cover a lot of things. It is important to know what your plan covers so you don’t end up paying for something that isn’t covered by the policy. There are many different options out there, but we’ll discuss some of the most common ones in this article.
The Ultimate Guide for Older Adults on How to Get Health Insurance

What’s Covered by Private Health Insurance?

You may not know this but,

By law, every private health insurance policy must provide extensive cover for hospitalization, surgery, and physician services.

In addition to these comprehensive covers, most policies also cover some diagnostic procedures as well as mental health care. There are many different ways a plan can be tailored to suit your needs so it is important you know what the differences are between the various policies.

Here’s a quick list of the main benefits offered by private health insurance:

Let’s have a look,

  • Inpatient services ( private hospital)
  • Outpatient treatments, where you don’t stay overnight in the hospital but are seen outside of it
  • Visits to your physician for various ailments such as low back pain or bronchitis
  • Prescription drugs
  • Mental health treatment
  • Durable medical equipment, such as wheelchairs and walkers or specially designed clothes for burns victims.

Acute Conditions Covered by Private Health Insurance

There are many different conditions that can be covered by a private health insurance plan.

  • Heart disease
  • Stroke
  • Cancer treatments, such as breast cancer or prostate cancer
  • Coronary artery disease (also called CAD1), which is often the result of high blood pressure and other risk factors like smoking. Risk factors for CAD include being overweight, drinking too much alcohol, and not exercising
  • Pancreatitis
  • Kidney disease. Your kidneys filter your blood to remove waste products and fluid from your body but if you have kidney disease, they can’t do this job well anymore. Kidneys also help regulate other bodily functions like blood pressure or the balance of salts.
  • Asthma, if it is severe and has restricted your quality of life in the past
  • Acute myocardial infarction (AMI), which occurs when a blood vessel supplying oxygen to heart muscles becomes blocked by plaque or clots

What’s Not Covered by Private Health Insurance?

There are some things that private health insurance won’t cover.

  • Referrals to a psychiatrist or psychologist
  • Counseling for grief, anxiety, or depression due to the death of someone close to you
  • Dental treatment and routine eye exams

Chronic Conditions Often Not Covered

There are some chronic or pre-existing conditions that private health insurance won’t cover.

  • High cholesterol
  • Asthma, if it is mild and doesn’t restrict your quality of life

I know the feeling,

This can be a lot to take in but understanding what’s covered is really important so you don’t end up paying for something that isn’t covered by your policy.

Are Therapies Covered?

Many private health insurance policies have specific limits on therapy coverage.

  • Mental health care will be covered for depression, anxiety, trauma, and mood disorders but it is not always covered for other mental illnesses like schizophrenia2 or bipolar disorder
  • Counseling Services – Counseling services are often limited to a certain number of visits per year
  • Psychiatrists – Psychiatric care is often limited to a set number of visits and may not cover the entire cost of treatment that are available, such as prescription drugs.

Many policies also have limits on coverage for therapy services provided by psychologists or social workers. Some plans will only offer coverage if you have been diagnosed with certain conditions and only if you are in a specific geographic location.

Which Services Does PMI Cover?

Private health insurance can cover many different services. The following items are typically covered:

Let me show you,

  • Doctor’s visits, tests, and procedures – Diagnostic tests, x-rays or MRIs with no co-pay for your doctor’s office visit to order the test or procedure (some plans allow a small co-pay)
  • Prescription drugs from retail pharmacies when prescribed by doctors and filled at those pharmacies (most prescriptions have an initial deductible that might apply before coverage kicks in)
  • Hospitalization as well as emergency room expenses incurred outside of hospitals when referred by physicians who don’t work at hospital ERs. These costs may include ambulance transport charges, surgical supplies, and operating room fees not included in physician charges which will be billed separately
  • Doctor’s visits, tests, and procedures – Diagnostic tests, x-rays or MRIs with no co-pay for your doctor’s office visit to order the test or procedure (some plans allow a small co-pay)
  • Prescription drugs from retail pharmacies when prescribed by doctors and filled at those pharmacies (most prescriptions have an initial deductible that might apply before coverage kicks in)
  • Hospital treatment costs as well as emergency room expenses incurred outside of hospitals when referred by physicians who don’t work at hospital ERs. These costs may include ambulance transport charges, surgical supplies, and operating room fees not included in physician charges which will be billed separately.

Can I Get Private Cover for Psychiatric Treatment?

Private health insurance may cover mental healthcare, but it is not always covered for certain disorders.

Are Prescriptions Covered?

Most private health insurance plans will cover prescription drugs depending on what medications you take, your plan, and other factors.

Common Questions

What Does Private Health Insurance Cover?

Why Do I Need Private Medical Insurance Policy?

What Is Not Covered by Private Health Insurance?

How Much Does Private Health Insurance Cost?

In conclusion

Go and take the next step.

Private health insurance can cover a lot of services. Private health insurance providers usually have different limits and restrictions on what they will offer coverage for, so it is important to know what your company covers before you sign up.

Private health insurance can help provide quick access to care that might otherwise not be affordable. It provides peace of mind in knowing if something happens to your health, you have a backup plan to help pay for the expenses.

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