A simple guide to help you use your medical cover with confidence
Health insurance plays a vital role in protecting both your health and your finances. However, taking up a policy is only the first step. To fully benefit from your cover, it’s important to understand how it works in real-life situations—especially waiting periods and how claims are processed.
These two areas are among the most common causes of confusion for policyholders. This guide explains them clearly, helping you access medical care smoothly and avoid unexpected challenges.
A waiting period is the time that must pass after your policy starts before certain benefits become available. Waiting periods help insurers manage risk fairly and keep health insurance affordable for all members.
Common waiting periods include:
⏱️ Waiting periods vary by insurer and policy type, so reviewing your policy document is always essential.
Corporate (employer-sponsored) health insurance policies often offer more favourable terms. Because risk is shared across a group, insurers may reduce or waive certain waiting periods.
Many group policies:
This makes corporate health plans particularly attractive for employers and consequently their employees.
Understanding the Claims Process
Knowing how to make a claim correctly helps you receive treatment without unnecessary delays.
How to Use Your Medical Card
Always present your medical card (physical or digital) when visiting a healthcare provider. Confirm that the facility is within your insurer’s approved network, as non-network visits may affect claim settlement.
Pre-Authorization: Some treatments require approval before they are done. These include:
The care team (qualified personnel at your insurer) reviews documents forwarded by the healthcare provider, including a doctor’s request for treatment, clinical notes, lab reports, and cost estimates. After review, the care team confirms coverage and provides approval or guidance on next steps.
Cashless Treatment vs. Reimbursement
Co-Pay
A co-pay is the portion of medical costs that you, the insured, contribute at the point of service alongside your insurer. This amount is paid directly to the healthcare provider at the time of treatment and is typically required for outpatient services, medications, and some treatments.
Co-pays help prevent unnecessary doctor visits or tests.
They encourage insured members to use healthcare services wisely.
Sharing a small portion of costs ensures the insurer can maintain coverage for everyone without raising premiums excessively.
Understanding Policy Exclusions
All health insurance policies have exclusions—services not covered under the plan.
Common exclusions include:
Understanding exclusions helps manage expectations and plan your healthcare decisions wisely.
Final Thoughts
Health insurance works best when you understand how it functions. Being aware of your waiting periods and claims process allows you to access care smoothly, avoid delays, and make informed decisions about your health.
At Surefront Insurance, we guide our clients through every step of their health insurance journey—ensuring clarity, confidence, and peace of mind when it matters most.
Get in touch with us:
📞 Mobile & WhatsApp: 0724 964 071
📧 Email: info@surefrontinsurance.com
🌐 Website: www.surefrontinsurance.com