Having a health plan is a wise decision for anyone seeking healthcare. However, choosing the best option isn't always easy. Before deciding, it's important to learn a little more about each option, understanding their characteristics and recommendations.
In this article, we’ll provide information that will help you choose between an individual and a family health plan!
Individual and Family Health Plan: Differences
Individual and family health plans differ in terms of coverage. While the individual model is ideal for people without dependents or spouses, the family health plan is designed to guarantee coverage for spouses and children.
How does the individual plan work?
Individual health plans are designed for those who require exclusive medical care, ideal for those without dependents to include in their coverage. It is a beneficial option for single individuals or those who don't have the option of a group health plan.
One of the main advantages of an individual plan is its customizable structure. It offers greater autonomy in controlling aspects of the health plan and allows costs to be tailored to individual needs.
In some cases, this type of plan may offer a co-pay option. This feature allows the plan holder to contribute a fraction of the cost of medical services, making the individual health plan more affordable.
However, it is important to note that, when compared to other types of health plans, the individual plan may have higher costs.
How does the family plan work?
When purchasing the family plan and becoming a member, the person can include dependents, including relatives up to the third degree of blood, partners, or spouses.
Some of the main advantages of this type of plan include the savings generated by family members. In other words, when compared to an individual plan, the cost per person is significantly lower with the family plan.
This type of plan also offers the benefit of convenience by allowing all family members to be covered by a single health plan.
For families with children and dependents, this type of health plan is beneficial, as it includes specific coverage for these age groups, such as vaccinations and pediatric appointments. Therefore, it provides integrated and consistent care for the entire family.
Choosing a Plan
Choosing between an individual and a family health plan will depend on your needs. To help you make this decision, we've compiled some details to consider before deciding on a plan model.
Identify which plan is right for you
The first tip is to understand the differences between individual and family plans and understand which model best suits your needs, especially considering that the financial commitment of both plans also differs.
To decide, you should understand the options for outpatient, inpatient, or even obstetric care. Additionally, determine whether you would prefer a room or a ward when you visit the hospital, because details like these also affect the cost.
Check whether the coverage includes services such as consultations, exams, treatments, hospitals, laboratories, prosthetics, and so on.
Pay attention to the monthly fee
The monthly amount to be paid by an individual or family health plan provider is determined by the beneficiary's age. Therefore, it's important to pay attention to these details. It's common for providers to charge a predetermined amount based on age, regardless of usage.
However, it's important to understand the terms and conditions of co-pay plans. After all, with the individual paying fees for consultations, exams, and procedures, the monthly cost of this model is lower.
Check the refund and grace period
Before purchasing a health plan, understand the reimbursement process and the waiting period. Check whether the reimbursement process is straightforward and whether the amount is consistent with fair prices.
The waiting period is the period during which the beneficiary cannot use the plan immediately after signing the contract. Insurance providers typically set a time limit for reserving funds and ensuring that the user's needs are met.
Check for any pre-existing conditions
Pre-existing conditions are those that the user was already aware of before signing the contract. The law does not allow an insurer to refuse to hire an individual.
However, the operator is allowed to not authorize the contracting party to carry out procedures related to the disease for a certain period, or to add a monthly amount to the plan, as long as it is proportional to the health problem.
Get the Best of Both Worlds with M-KOPA Health Cover
At M-KOPA, we aim to connect Every Day Earners in Africa to the digital world. Our health insurance, in partnership with Turaco Insurance, allows customers to access coverage in an affordable and accessible way.
Now you know the differences between individual and family health plans. If you're still unsure about which model to choose, contact us to learn more about our health cover.
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