How to get the most from your healthcare insurance policy


Whether you are on a self-payment (cash) insurance plan, or one where your insurer pays directly for your healthcare, it’s worth thinking about how to get the best value from your healthcare insurance. After all, especially if you are paying for health insurance yourself, it can be a considerable expense. There are a number of ways you can do this.

Are you covered?
Do your research if you want to get the most out of your healthcare insurance policy

1. Before you even start thinking about using your healthcare insurance, it’s important to choose the right plan for you

Healthcare insurance policies vary widely, even from the same insurer. It is therefore a good idea to think carefully about what you are likely to need, and buy a policy that provides that. For example, you may decide that you are comfortable paying for the first visit to a private healthcare practitioner, but want to be confident that any investigations and treatment are covered, or you may want the comfort of knowing that everything is covered. You might be happy to have a bigger excess for the sake of a smaller premium, or want to pay more upfront so that your out-of-pocket expenses will be low. The point is to consider these questions, and shop around for the right policy for you.

2. You need to understand your policy, and the benefits it provides

When you or one of your family are ill, you are not likely to be at your best. This is therefore not the ideal time to be trying to understand your healthcare insurance. Take the time when you take out your policy to understand how it works. Ask questions beforehand, so you understand your benefits. You need to know, for example:

  • The basis for payment, such as whether your doctor will send the bill to the insurer or to you
  • Whether you have to use practitioners and clinics or hospitals on your insurer’s list, or are free to go wherever you want – this is more likely to be the case with a ‘cash plan’
  • Any limit on your benefits as a whole, or on particular aspects, such as scans, or timeframes
  • What treatments and investigations are actually covered

Knowing the answer to these questions will help you and your GP choose a suitable practitioner.

3. Make sure that you see the right healthcare practitioner

There are a number of aspects to this issue, so it is worth taking time to disentangle them. First, you need to be sure that you are seeing the right type of specialist. For example, physiotherapists, chiropractors and osteopaths all treat similar types of issues and conditions, but in slightly different ways. Getting to the right one first time will save you money on consultations.

Second, even specialists with the same overall job title may have expertise in different areas, conditions or treatment types. For example, orthopaedic surgeons may specialise in particular parts of the body, such as hips or backs, or in particular conditions, or be an expert in a particular type of surgery. Doing your research thoroughly before booking will ensure that you see someone with the right expertise, who will be able to treat you, rather than refer you onwards to someone else. It is worth looking beyond your insurer’s directory, or even the hospital’s list, to find out more about individual practitioners, and make sure you are seeing the right person. Just because a specialist is on your insurer’s list, it doesn’t necessarily mean that they are the very best person for your problem.

4. Shop around for different prices, as you may be able to get more from your insurance by choosing a different clinic or location

Whether you want to maximise the amount of healthcare you get from a cash insurance plan, or your insurer simply has a maximum benefit level, and you are worried about breaching it, it can pay to shop around for lower prices. Some clinics, for example, are much more expensive than others. It may also be cheaper to go further afield, even when travel costs are taken into account. We would not suggest that you compromise on quality for the sake of price, but price could be a key difference between two practitioners with very similar skills and experience levels, especially if they are in different geographical areas. You may even find that the specialist you want to see has different fees depending on which clinic you see them at! So do try and find out if they work at more than one location.

5. Check whether your insurance policy offers other benefits—and use them

Some healthcare plans also offer other benefits, such as rewards for lifestyle changes, or reduced prices for activities designed to keep you healthy, like gym membership. It is worth investigating these, as they may save you money. Getting the most out of your healthcare insurance is not necessarily only about what happens when you are sick.

Some healthcare plans also offer benefits such as rewards for lifestyle changes