Choosing a health plan: What consumers should know?

August 14, 2020

Health Insurance is a product that covers a consumer’s medical expenses. Like auto insurance covers vehicles for when accidents occur, health insurance covers individuals who get sick or injured.  While no one plans to get sick or hurt, most people need medical care at some point. Having health insurance protects individuals and families from unexpected costs.

 Fiji’s Health Insurance products

 Health insurance is a is a critical component of the Fijian health care system that can take pressure away from the public health system. For this to happen, it is vital that consumers have the confidence that the insurance policies they purchase will provide them with real value when the need arises.

 Health Insurance products in Fiji however, is not without its issues. Most of the complaints received at the Council in relation to health insurance reveals that some insurance companies use pre-existing medical conditions as a reason to decline insurance claims. Additionally, the emergence of ‘exclusionary products’ and ‘restricted products’ is of no help when the premiums keep increasing every year. In such cases, the insured is unable to realise the benefits of the premium payments made while having to pay for the medical costs from their own pockets in times of emergencies. It has also been identified that the option to choose a medical facility where treatment can be done is restricted. Apart from restriction of choice, concerns also have come to light of the poor operative and post-operative care provided by the designated medical facilities.

 What can consumers do?

 Determine what health insurance options are available – some individuals get health insurance with their employers; others will be required look for affordable health care plans on their own. Getting health insurance in Fiji is not mandatory so for most consumers, purchases are made through private exchange or directly from an insurer. It’s important therefore to get a listing of all the health insurance products available.

Compare the health insurance products – when comparing products, look for a summary of benefits and see what works for you. Many insurance plans in Fiji have limitations so it is important that comparisons are made to identify the best plans for you and your family. It is also important to identify your family’s needs. Sometimes making decisions such as whether or not you would like to see a specific physician or visit a particular hospital can help you determine which plans best suit your needs.

Compare premium costs – Some health benefits require hefty premiums. It is important to determine what is affordable for you. Before putting pen to paper decide whether for the long term, the premiums you pay along will not leave you strapped for cash.

Compare out of pocket costs – these are expenses for medical care that are not covered or reimbursed by the insurance. Insurance companies may only cover certain aspects of medical care and require that consumers bear the costs for all expenses outside the cover. When comparing insurance policies or products determine if the out of pocket costs are more or there are sufficient aspects of medical care covered under the policy. You goal ideally will be to narrow down choices based on out of pocket costs. A plan that pays a higher portion of your medical costs, but has higher monthly premiums may be better if:

  • You see a primary physician or a specialist frequently
  • You frequently need emergency care
  • You take expensive medication on a regular basis
  • You are expecting a baby, plan to have a baby or have small children
  • You have a planned surgery coming up
  • You’ve been diagnosed with a chronic condition such as diabetes or cancer

A plan with higher out-of-pocket costs and lower monthly premiums might be a better choice if

  • You can’t afford higher monthly premiums
  • You are in good health and rarely need to see the doctor

Insurance checklist

In summary when shopping for an insurance plan, consumers must consider the following:

  • Go to your marketplace and view your plan options side by side.
  • Decide which type of plan is best for you and your family.
  • Eliminate plans that exclude your doctor or any local doctors in the insurance policy.
  • Determine whether you want more health coverage and higher premiums, or lower premiums and higher-out-of-pocket costs.
  • Make sure any plan you choose will pay for your regular and necessary care, like prescriptions and specialists.

For any concerns, consumers are urged to contact the Council on toll free number 155 or lodge a complaint via the mobile app.