Medical cover: Where does my money go if I do not fall sick?


You might be wondering what happens to your health insurance premium if you don't get sick during the year. FILE PHOTO | SHUTTERSTOCK

Medical insurance provides financial protection against the high costs of medical treatment.

It is designed to help individuals and families pay for expenses that may arise due to illness or injury.

However, what happens to your money when you do not fall ill? This is a common question that many people ask when they purchase medical insurance.

You might be wondering what happens to your health insurance premium if you don't get sick during the year.

The short answer is that you must still pay your premium whether or not you used your insurance cover.

This is because health insurance isn't meant to reward people for not getting sick, but rather to provide financial security in the event that you do become ill or injured.

When you purchase medical insurance, you are essentially paying for the peace of mind that comes with knowing that you will be financially protected in case you fall ill.

You pay an annual premium to the insurance company, and in return, they promise to pay all your medical expenses in accordance with the agreed policy limits as per your policy document if you need to seek medical treatment.

There are a few reasons why your premium may not change if you remain healthy throughout the year.

Insurance operates as a pool and thus the reason why premium rates are lower for corporates and higher for individuals is because of the law of large numbers.

The majority of staff will pay for the few sick staff. For starters, insurance companies base their premiums on the likelihood of the insured becoming ill or injured.

They use a variety of factors, such as age, gender, and medical history, to determine the likelihood of a person requiring medical treatment.

If you are generally healthy and have a low risk of needing medical care, your premium may already be relatively low, even if you do end up using your insurance.

For example, an individual may pay a premium of Sh50,000 for benefits of up to Sh100,000 outpatient and Sh2,000,000 inpatients.

Therefore, the premiums members collectively pay from a resource pool that is used to cater to the medical expenses of those who fall ill.

In the event you fall ill in a consequent policy period, the concept of shared resources would then apply to you as well.

So, all is not lost since the value of paid premiums is far less than the cost of medical bills.

It is understandable for a client to feel like medical insurance is a waste of money if they do not fall ill during the duration of their policy.

However, it is important to remember that medical insurance is an investment in your future health and well-being.

Here are a few reasons why medical insurance is still valuable, even if you do not fall ill:

Financial protection: Medical treatment can be expensive, and without insurance, you may be responsible for paying all your medical bills out of pocket as we have seen and continue to see cases where people have to fundraise or sell off property to be able to meet these expenses putting them in precarious financial situations.

Medical insurance provides financial protection against the high costs of medical treatment, so you can rest easy knowing that you are covered in case you do fall ill.

Preventative care: Many medical insurance plans offer preventative care services such as annual check-ups, screenings, and vaccinations.

These services are designed to catch health issues early and prevent them from becoming more serious, which can ultimately save you money on medical bills in the long run.

Wellness programmes: Some insurance companies offer wellness programs such as health talks, webinars on hot topics in the health space, discounts on health-related products like self-monitoring devices, and incentives for healthy behaviour such as exercising regularly and eating a balanced diet like cash backs or even discounts in selected outlets the company may have partnerships with.

These programs are designed to help you maintain good health and prevent illness, even if you do not require medical treatment.

Peace of mind: Knowing that you are covered by medical insurance can provide peace of mind and reduce stress and anxiety. This can positively impact your overall health and well-being.

Lastly, there are some insurance companies that offer incentives in case your benefits go unclaimed such as discounts in the following year, an increase of some key benefits at no additional cost, and even cash back.

It is therefore important to view medical insurance as an investment in your future health knowing that if you fall ill you can rest easy as you have safeguarded your tomorrow.

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