MEDICAL INSURANCE
Medical insurance (also called health insurance) is a type of healthcare protection against the unforeseen future of ill health.
Sometimes, it may also cover medical losses, injuries, disabilities or dismemberments incurred by accidents. Basically, it’s a form of risk management used to windbreak against the probability of a conditional or uncertain medical loss. Insurance generally is postured to provide a guarantee to compensate the insured in the case of specific loss, damage, illness or death so far as the insured will commit to the payment of a specific, agreed premium. This then becomes an agreement between the insurer (the entity presenting the insurance policy as a product) and the insured (the customer who benefits from the product of the insurance company). This insurance simply narrows the focus – being an insurance policy that covers the whole or a part of the risk of a person incurring medical expenses. Medical insurance could be provided by a government agency, private business or a not-for-profit entity.
MEDICAL INSURANCE UNDER A GOVERNMENT AGENCY
Ghana’s National Health Insurance Scheme (NHIS) administered by the National Health Insurance Authority (NHIA) is an example of a health/medical insurance scheme provided by a government agency. Established under the National Health Insurance Act 2003, Act 650, as a body corporate, with perpetual succession, an Official Seal, that may sue and be sued in its own name, the flagship mandate of the Authority is to attain universal health insurance coverage in relation to persons resident in the country (Ghana), persons not resident in the country but who are on a visit to this country (Ghana) and to provide access to healthcare services to the persons covered by the scheme.
The Authority is spurred on by its mission statement to provide financial risk protection against the cost of quality healthcare for all residents of Ghana. They thus work to implement a national health insurance policy that ensures access to basic healthcare services to all residents. The Authority also registers and supervise private health insurance schemes.
Persons may join the medical insurance provided by this government agency as annual premium paying members (i.e. they pay premium and processing fee once every year for renewal; or as a member of the exempt group (a pregnant woman, a SSNIT contributor of good standing and a pensioner with a SSNIT card to prove same). These collected premiums become the National Health Insurance Fund that the Authority manages assiduously to ensure equity in healthcare coverage and access by the poor.
Benefit package promised to persons who have committed to this kind of medical insurance (as offered by a government agency) includes out-patient services (e.g. malaria, skin diseases, eye infections, respiratory tract infections, laboratory tests, xrays, medications, etc.); in-patient services (e.g. breast and cervical cancer treatment, surgical operations, accommodation in general ward and feeding, processing for blood products, etc.); oral and eye care services (e.g. tooth extraction and pain relief, fillings, dental restoration, refraction, visual fields, cataract removal, etc.); maternity care (i. e. antenatal care, deliveries – both normal and assisted, Caesarean section and post-natal care); emergencies (e. g. medical emergencies and surgical emergencies, paediatric emergencies, Obstetric and Gynaecological emergencies, etc.).
True, the NHIS may have been introduced to score political points – as some may view it – but its coverage and impact over the years has made it arguably, the biggest, most subscribed medical insurance this part of the globe.
FOR-PROFIT INSURANCE COMPANIES
Medical insurance products could also be found in regular insurance companies that will be in it for business purposes to make profit unlike the government engineered medical insurance that could also pass as a not-for-profit medical insurance entity.
Companies like Acacia Health Insurance, Premier Health Insurance, Phoenix Health Insurance Limited and Nationwide Medical Insurance are examples of companies that have medical insurance policies for interested members of the general public who may have registered for the government sponsored medical insurance scheme but may be able (and willing) to pay to hold a medical insurance policy from an insurance company advertising same. That’s also owing to the fact that, generally, people consider medical insurance schemes as offered by the government to be substandard or unreliable (perhaps both) because of the outrageously low premiums paid or because of unsavoury experiences they/their loved ones may have had with that scheme (perhaps both).
For-profit medical insurance companies may charge premiums that are likely to be more than the not-for-profit government medical insurance schemes. Remember, they are in it for the business/profit and so the freebees not-for-profit/government schemes may offer may not be the case here. However, for their higher premium for their policy, they are minded to give premium services that the general interested public who can afford will find too good to resist. Once a policy holder doesn’t default on payments and deals with the accredited network of health facilities preferred by the insurance company to deliver healthcare services and support, it becomes a win-win for both the insurer and the insured.
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