Last week I spent half a day at the doctor’s office (Hospital) for a check-up after two weeks of suffering from cluster headaches.
Having gone through all the medical check-up procedures it was down to the main issue of bill settlement. The total bill to some extent was more than I had anticipated for such a medical check-up. Luckily for me I had to settle the bill using a medical scheme (medical insurance) as provided by my corporate employer. The experience brought to my attention the lack of medical services access by most citizenry due to among other factors the high costs associated with medical services.
This brings about the importance of medical insurance – the type of insurance that covers the risk of a person incurring medical expenses. Just like motor insurance for example protects the owner of the vehicle against any financial loss arising out of damage or theft of vehicle, medical insurance covers medical expenses for the insured. The insured person(s) accesses medical facilities at the prescribed medical centres and
the insurance company settles the outstanding balance.
The common two types of health insurance covers are the following:
I. Managed medical scheme. The scheme administrators have contracts with health care providers and medical facilities to provide care for members. The scheme administrators enter into contracts with various institutions e.g. companies and societies.
The members of such institutions have access to various medical health providers under the scheme arrangement within set limits.
A membership card is issued to the member. Premiums to this scheme are usually remitted by the institution to which the member belongs to. Sancare by Sanlam is a good example.
II. Standalone Hospital Cash Plan Insurance (commonly known as HCP e.g. Zanaco Hospital Cash Plan, Barclays Hospital Cash Plan and FNB Hospital Cash Plan). This insurance policy pays a fixed amount of money for each day you are hospitalised. The main objective is to cover the insured against loss of income during periods of hospitalisation. This policy does not pay for medical expenses e.g. bills and medication. The individual sign up with the insurance company and has an option to cover him or herself and immediate family members (spouse, children and extended family members). Premiums are calculated based on the cover plan one chooses and the number of lives covered (insured). Premiums are as low as K17 per month on the Zambian market.
Example 1 illustrates a Standalone Hospital Cash Plan while Example 2 illustrates a managed medical scheme.
Example 1
Mr. X is a customer of Barclays Bank and decides to sign up for the Hospital cash plan with daily benefit pay out of K1000. Months later Mr. X is admitted in the Hospital as a result of an illness and is hospitalised for 7 days. Mr. X personally settles the medical bill incurred upon discharge. Mr. X thereafter submits an
insurance claim with Barclays Bank with regards to the Hospital cash plan he had signed up with them. Barclays Bank then pays Mr. X a total of ZMW 7000 (ZMW 1000 daily benefit he signed up for * 7 days hospitalised).
Example 2
Mr. X falls sick and decides to have a medical check-up at ABC memorial clinic. After been attended to (consultation, tests and drugs), Mr. X produces an insurance card courtesy of Sancare for example. The bill is not settled by Mr. X in his personal
capacity but Sancare (the health insurance provider) settles the bill with ABC memorial clinic. Such schemes are mostly provided for by employers who enter into partnership with health insurance providers.
Last year, the republican president signed into law the National Health Insurance Bill. The main objective was for the
introduction of the National Health Insurance Scheme that will enable Universal Health Coverage for all Zambians regardless of status ( employed or non-employed).
With the introduction of the National Health Insurance, Example 2 illustrates the purpose of the bill. For now we await the modalities the Government will put into place on how the scheme will be administered.
Remember a healthy person is a highly productive individual. Let us invest in our health through various medical insurance schemes and policies offered by our insurance companies.