MEDICAL insurance, just like any other form of insurance, is a risk?transfer mechanism whereby the insured transfers risk to the insurer?and the insurer accepts the risk in consideration of a fair and?equitable premium.
The insured refers to any one of us faced with the risk of illness,?sickness or injury requiring medical treatment or specialist’s?consultancy.
The emphasis for today is not whether medical insurance is necessary?or not but why one should consider Medical Insurance contrary to?engaging themselves only to certain hospital (s) in a certain area?(s).
However, it is vital to stress that everyone is susceptible to the?risk of illness or sickness irrespective of their gender, nationality,?religion, educational status or age.
This, therefore, justifies the inevitability of medical insurance, as?we never know when and how we will fall sick notwithstanding if?finances will be readily available at this critical moment.
Insurance, therefore, protects us during these moments of uncertainty.
When one joins a Medical Insurance scheme they are given a membership?card inscribed with names of all beneficiaries with their contact?details which in the unfortunate event of illness, sickness or an?accident they will produce at the hospital and access medical?attention.
On the other hand direct hospital arrangement is a system whereby?individuals, families or companies make arrangements with specific?hospitals to provide medical attention to specified members in return?for payment of monthly/quarterly or annual subscription fees.
The medical bills will be sent to the respective individuals or?companies for settlement at an agreed interval often monthly.
It is vital to note that in most instances individuals and companies?alike tie themselves to the reputable and competent private and?Government clinics and hospitals.
This often gives relief that in the event of a critical medical?condition requiring specialist treatment capacity will be available?and priceless life will be saved.
The two forms of providing medical cover explained above seemingly?appear similar and equally appropriate but it is important to spot the?differences to enable the public to make informed choices.
Medical insurance companies have lists of approved medical providers?nationwide which members can access.
This is contrary to having access?to medical attention only from specific hospitals or clinics in?specific towns or areas.
It is paramount to note that sickness may befall us when we least?expect and may be in a town or village far away from the hospital we?made arrangements with.
Alternatively, have you ever thought of an accident in a town far away?from where you stay?
It is my fervent opinion that nationwide access to medical facilities?is important contrary to restricting oneself to one town or hospital.
On the other hand, although experience has proven that certain?hospitals generally have incomparable capacity to handle critical?medical conditions than others, it also remains an indisputable fact?that the other hospitals maybe far better in treating certain medical?conditions.
In short no matter how capable one hospital maybe it will always have?its own shortfalls especially on certain specialist medical cases.
A good example is when I (George) relocated to the Copperbelt and my?daughter fell sick; colleagues advised that I should not take her?anywhere else but to one paediatric specialist at one seemingly small?clinic.
The services rendered were beyond my expectations.
In short one hospital can never be excellent in treating all medical?conditions, maternity,   kidney, heart, malaria, cancer, HIV/AIDS?etc but with Medical Insurance you are given a wider choice depending?on the condition.
Further, medical insurance assists in cash flow management as once?premiums are paid one does not need to pay anything at the hospital.
The patient will be required to complete a one page form and sign it?up after receiving consultation or treatment.
The bills will be sent to the Medical Insurance company which will in?turn pay the respective hospital.
It is also vital to note that medical insurance would provide an array?of benefits that maybe excluded under direct hospital arrangements;?examples are optical, dental, evacuation and death benefits.
However, there are different medical options some of which may offer?cross border treatment be it at a higher premium.
On a concluding note with about 10 people on board and through the?human resource department you can request for a quotation via a?broker/agent or directly from any insurer that provides medical?insurance and compare the premium with total annual medical bills.
With insurance riding on the law of large numbers chances are that the?insurance route would be cheaper and more advantageous.
Many thanks to George Marekera from Marsh Zambia who based on a myriad?real life experiences contributed to this article.
Comments:webster@pic
co.zm or webster_tj@hotmail.comor on face book?search for Insurance Talk-Zambia page or call/text 0977 857 055
(The author is a chartered insurer with 10 years industry experience)