Having a health plan is a wise decision for anyone seeking healthcare. However, choosing the best option isn't always easy. Whether you are protecting yourself or your family, it's important to learn a little more about each option, understanding its characteristics and recommendations.
In this article, we’ll provide information that will help you choose the options that fit your needs and budget!
Individual and Family Health Plan: Differences
Individual and family health plans differ in terms of coverage. While the individual model is ideal for single users who want coverage tailored to their own healthcare needs, the family health plan is designed to guarantee coverage for spouses and children and sometimes other dependents.
How does the individual plan work?
Individual health plans are designed for those who require exclusive medical care. They allow you to customise your benefits and sometimes include a co-pay feature, which lets you contribute a small portion of medical costs, while keeping your monthly premiums lower. However, because the plan covers only one person, total costs can be higher than those of a shared family plan.
How does the family plan work?
Family plans, unlike Individual plans, allow you to include your spouse/partner, children, and sometimes other dependents (relatives up to the third degree of blood). This option is often more economical on a per-person basis and provides a single, convenient cover for the entire household. It is especially useful for families with children and dependents, as it includes specific coverage for these age groups, such as vaccinations and pediatric appointments, as well as maternity care. 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.
1. Coverage
Check what services are included: outpatient visits, consultations, hospital stays (your preference for a room or ward), laboratory tests, emergencies, maternity care, prosthetics, and so on. Details like these also affect the cost.
2. Cost
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.
3. The waiting period and claims process
The waiting period is the time during which the beneficiary cannot use the plan. It is usually immediately after signing the contract. Insurance providers typically set a time limit for reserving funds and ensuring that the user's needs are met. Understand how long you must wait before certain services are available.
Understand how reimbursement works. Is the claims and reimbursement process straightforward and fairly priced?
4. Pre-existing conditions
Pre-existing conditions are those that you were already aware of before signing the contract. Licensed insurers cannot deny coverage based on pre-existing conditions, but waiting periods or adjusted premiums may apply, as guided by the Regulator.
Get the Best of Both Worlds with M-KOPA Health Cover
At M-KOPA, we are committed to helping Every Day Earners access essential services that improve their quality of life. Through our partnership with Turaco Insurance, a duly licensed and regulated insurance intermediary, customers can access affordable and reliable health insurance through our digital platform. This partnership ensures that our customers benefit from:
- Simple enrolment and claims support through digital channels
- Affordable premiums designed for low-income and informal earners
- Transparent and compliant terms
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.
M-KOPA Health Cover is distributed in partnership with Turaco Insurance, a duly licensed and regulated intermediary. All terms and conditions apply as per the Turaco policy documents.
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