What is a Family Medical Expense Insurance?


What is a Family Medical Expense Insurance?

A family health insurance provides greater security against any medical unforeseen since this type of policy can pay for a large part of medical treatments or interventions. When choosing medical insurance, you can choose an individual or family insurance, in the latter the members of a household will be covered.

So inside of the same policy can include the spouse, parents of the insured holder and children under 25 years of ageIn addition, the insured sums can reach up to $ 50,000,000 pesos depending on the coverage.

Basic coverage of Family Health Insurance

Some insurance institutions cover three aspects:

  • Medical expenses: Hospital expenses, medical fees, consultations, medications, required studies that are needed due to an accident or illness covered by the policy.
  • Medical services: the company pays expenses for ground ambulance or oxygen equipment, in addition to serum, transfusions of blood, plasma or other blood derivatives. It can also cover part of the equipment for recovery from illnesses or surgery and even the payments of the nursing service for a limited time.
  • Plastic surgery: or any other aesthetic treatment whenever necessary and as a result of an accident or illness covered by the policy.

Additional coverage in the Family Medical Expense Insurance

In some cases, companies provide a broad coverage abroad, which covers illnesses and accidents that occur while the insured and his family are traveling. In general, the companies have a network of hospitals around the world, but the vast majority operate under reimbursement, in which the insured will have to pay the expenses of their treatment in the other country and the insurer would be paying them back.

Another coverage that is of great help to the family is the one that covers maternity expenses Because when hired, it covers normal delivery or cesarean section, in addition to costs that entail recovery. It should be noted that there is a specific sum insured for this plan, and that there is also a waiting period of about 10 months from when this coverage is contracted.

AND medical care for sports activities, in the event that a family member practices extreme sports as long as said activity is not professional, because if so, there are special plans for athletes.

What does a Family Medical Expense Insurance not cover?

General and coverage exclusions can be found in the terms and conditions of each contract. Some of these are as follows:

  • Plastic surgery that is not the result of an illness or accident covered by the policy.
  • Weight loss, except those operations that are needed due to illness.
  • Accidents as a result of alcohol or drug use.
  • Fertility treatments and sexual dysfunction.
  • Human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS)
  • Psychiatric or psychological disorders. In some companies it is covered when due to an illness or accident, even assault, the person requires these specialists.
  • Pre-existing diseases, for example, someone with diabetes will be unlikely to be able to purchase this insurance.
  • Congenital diseases.
  • Injuries as a result of the insured, whether from being part of a popular uproar, riots, by extreme activities, as a passenger in a high-speed vehicle, by fights, suicide or self-inflicted injuries.
  • Internment in places not recognized as hospitals.
  • Hospital expenses generated by the companion of the insured.

Considerations in family health insurance

  1. As usual, the age of acceptance is from 18 to 64 years, although there are insurers with plans for people over 70.
  2. You can choose the coverage, deductible, coinsurance and additional plans, as well as the hospital in which you want to attend.
  3. The deductible is an amount that the insured will have to pay if they need to make use of some coverages, for example, maternity coverage.
  4. Coinsurance is the percentage of total to be paid for all covered expenses after the deductible.
  5. There are diseases with a waiting period such as cancer, diabetes, fractures, etc.
  6. In case of being treated in a hospital outside the insurance network, the holder will have to pay 100% and, through invoices, the company will study to make the reimbursement, this will depend on the vouchers.
  7. In the event of a claim, it is recommended to call the company as soon as possible and keep invoices, laboratory tests, medical report, accident notice, identifications, etc.
  8. Many companies recognize the age of the other insurance, that is, if the insured was with another medical expense company. For this, it will be necessary to deliver proof of payments.
  9. The insurance payment medical expenses is tax deductible, although it depends on the regime and fiscal situation.

How to find insurance for major medical expenses?

These companies usually offer different forms of payment and various terms, for example, it can be installment and / or annual. In Mexico, 73.1% of adults do not have any insurance because they believe that it is expensive, according to the 2015 National Survey of Financial Inclusion. However, there are companies with basic coverage that are inexpensive, and you can also take advantage of promotions like the Good End in which insurers grant up to 20% on health policies.

Also by listing with several insurers you can save on hiring them. As in Mexico there are different companies that have this product, and finding them or comparing what they offer can be a bit slow and tedious, there are online insurance quotes that help you find everything in one place.

One of them is the Major Medical Expenses simulator of the National Commission for the Protection and Defense of Users of Financial Services (Condusef). This simulator compares insurance offers on the market, it is only necessary to capture the data of the holder and family members, as well as the deductible and coinsurance.


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