health insurance

What is medical insurance

Medical insurance is insurance against health risks that the individual may be exposed to and supports him in facing them by covering the examination, diagnosis and treatment of diseases that occur to the insured individual. With so many people that the people who have the insurance share in covering the costs of treating any of them who get sick.

The principle of insurance is based on the individual obtaining insurance coverage in exchange for an annual subscription paid to the insurance company, which in turn collects contributions from large sectors of individuals and provides coverage for the treatment of sick cases to which any of the insured is exposed, and if the individual bears the cost himself and without Insurance that may lead to him having to spend from his savings, which are likely to be redeemed or greatly reduced in the event of exposure to diseases whose treatment is costly, God forbid.

Advantages

The biggest advantages of insurance is the peace of mind that the insured acquires when he obtains coverage from a reputable company, and that one will be reassured about himself and his family in case of need for various treatment services, because if God forbid a need occurs, the person will be able to obtain appropriate medical care and He saves himself the costs of treatment without worrying too much about his inability to bear the costs of treatment, which may be more expensive than his capabilities or lead to the consumption of a large part of his savings.

Coverage

Health insurance coverage varies according to the insurance program, and insurance companies usually offer various levels of coverage and benefits that suit different needs and budgets, and there is a ceiling for annual consumption specified for each policy, and it may range from 10,000 pounds per year per person to one million pounds or more and of course The higher the maximum coverage in the policy, the more the insurance price will be, and the usual coverage includes:

Examinations, x-rays, tests and medicines

Treatment and stay in hospitals

Various surgeries

Pregnancy and childbirth coverage, but with specific waiting times

Dental and optics coverage can also be added at an additional cost

However, insurance coverage in general does not include cosmetic or slimming operations. To understand the conditions of coverage, the following points must be clarified

endurance ratio

It is the percentage that the client bears from the cost of the medical service, for example, if you buy a drug and the deductible is 20%, this means that you pay 20% of the value of the medicine and the insurance company pays the rest, which is 80%. In most cases, the company bears 100% of the percentage of inpatient treatment and one-day surgeries in the hospitals contracted with within the network, but in other services, the percentage varies according to the type of service and the level of coverage in the document.

Pre-contracting diseases

They are the diseases that the insured complains of before subscribing to insurance and are completely excluded from the insurance coverage or in some cases (in the insurance of corporate employees only) they are covered with a specified maximum limit of the total maximum limit of the policy

Types of medical insurance

Domestic insurance, international insurance

the local international

Provides coverage through a network of medical service providers within the borders of the subscription country

The value of the subscription is calculated in the local currency

Provides coverage through a network of medical service providers that extends around the world and allows the subscriber to obtain all services in any country of his choice

The value of the subscription is calculated in a foreign currency

In some international medical insurance companies, there is no maximum age for participation.

Medical insurance for individuals and families, medical insurance for companies

people companies 

Covers individuals and families

The annual coverage ceiling is higher, up to one million pounds per person

It does not cover previous illnesses from contracting 

Covers the employees in the company and the company bears all or part of the insurance cost

The annual coverage ceiling is lower than the individual insurance

Insurance for companies covers pre-contracting illnesses with a specific annual limit for each employee

The difference between insurance companies and health care companies

One of the terms that we need to know well, what is the difference between the medical insurance program and the health care program, and this makes us ask about the company presenting the program, since only insurance companies are allowed to offer health insurance programs

Insurance companies

They are companies registered with the Financial Supervisory Authority (the authority competent to supervise insurance). This registration requires a large amount of capital. The details of the various programs and subscriptions are constantly reviewed by the Financial Supervisory Authority, and the Authority guarantees to insurance subscribers that their rights reach them in full, and a complaint can be submitted to it in the event of non-compliance. Fulfillment of the insurance company's promises to the insured.

Healthcare companies

They are companies whose main role is to contract with hospitals, centers and pharmacies to form a medical network and present it to insurance company clients while managing the clients’ medical file according to the terms of the documents. Sometimes these companies provide medical care service to clients directly without an insurance company, and this is considered a medical file management only and not insurance.

Calculating the value of the annual subscription for health insurance

The annual subscription price is calculated based on 3 main factors

The age of the insured person, so that the older the person is, he enters a higher price bracket because the general health level of individuals in the community is related to advancing age and the older one is more likely to use health insurance

The level of coverage and the maximum annual coverage, so that the higher the level of coverage and the annual maximum, the higher the annual subscription price

Additional benefits that are optional, such as dental and optics coverage, for example, affect the increase in the price of the policy if added.

And through the Aman Lake website, you can instantly know the prices of medical insurance and calculate the actual cost of the annual subscription to various programs from the best insurance companies in Egypt for the individual, the family, and also for companies. You can see all the details and compare between them in order to choose the most suitable for you with ease and trust.

How to participate and terms and conditions

Individual medical insurance can be subscribed as a policy holder from 16 to 64 years old, and some companies offer coverage up to the age of 75, provided that subscription is before 65, with the value of the policy and its exceptions reviewed annually in the period from 65 to 75 years. As for families, children can be insured, but in the form of their father or mother, from birth to 21 years of age, but the insurance is not valid for a single child under 16 years of age without the participation of at least one of his parents.

Obtaining insurance does not require a medical examination before subscribing, but it is sufficient for the contributor to answer a set of questions in a questionnaire regarding his medical condition and his health history, and to clarify any chronic diseases he suffers from. Of course, the contributor must answer transparently and honestly to avoid discovering any false information during the coverage period.

And when you decide on the appropriate insurance offer for you from the Aman Lake website, you will contact one of our representatives to confirm and review the details of the program and start the procedures for extracting the insurance

Steps to get insurance

Fill out the application for obtaining insurance and the health status questionnaire

Pay the annual subscription fee

Extract and send subscription cards, user manual and network to you.

The benefits of subscribing through Aman Lake include obtaining additional customer service to assist in using insurance throughout the subscription period.

These programs include some of the following coverages:

Comprehensive coverage for hospital admissions from surgeries, emergencies or daily cases, including accommodation, surgeon’s fees, anesthesia, medications and intensive care

ambulance.

Diagnostic procedures (radiography, MRI, CT scan, ultrasound, etc.)

Physiotherapy, chemotherapy and radiation.

Treatment in outpatient clinics and private clinics with professors and consultants in different specialties.

Laboratory tests, x-rays, and medical assistance examinations.

teeth medicine

Pre and postpartum care from the start of pregnancy to childbirth

pharmaceutical

Daily financial benefits for a parent accompanying a covered child under 10 years old.

Medical supplies (slices and screws - proline mesh - intraocular lenses).

Chronic and critical cases and previous diseases.

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