Choosing The Right Medical Cover

Posted on December 9, 2016 in Health

Health insurance has become a modern necessity as it helps people offset the potential high medical bills.

Without a suitable medical cover, people have no choice but to rely on the public healthcare facilities which provide limited services or fund the costs of private medical treatment out of their own pocket.


Anyone at any reasonable age should have a medical cover because at any moment, anyone can require a medical intervention to recover. Undergoing a major surgery in a clinic without sufficient medical insurance can leave you financially ruined.


When choosing a medical cover, you need to do your due diligence to find one that will best provide you with the proper financial support against a range of unexpected medical events.


You should research on the different medical products which are being offered on the market and know your options. Then you will have to weigh out the pros and cons of each medical product and choose the one that best meets your needs on a long-term basis.


For a start, you should compare the monthly premium of each medical product. The premium is the amount which you have to pay every month for health insurance, regardless of whether you have used up the medical benefits during that month. You should make sure that this amount will fit in your monthly budget.


Moreover, you should not only enquire about the sub-limits under the Outpatient option which are allocated to optical benefits or dental benefits but also the limits allocated to other options such as Chronic Conditions, Preventive Care, In-patient Cover for clinical admissions or the Catastrophe Cover.


As an example, Xperience CarePlus also covers its members up to a certain amount for Chronic Conditions, Preventive Care (annual health check-ups and medical tests without a prescription) and also Lifestyle Benefits (Refund for Gym membership and Allen Carr Stop Smoking Programme sessions), among others. Moreover, the minimum overall annual limit allocated to the Inpatient Cover for Xperience CarePlus is Rs 50, 000 per illness.


The applicable deductibles and excess amount applicable on the various cover options of a medical product should also be considered. For Xperience CarePlus, the excess which is applicable on Outpatient claims is 20%. For clinical admissions which require a surgery, no excess is applicable.


Knowing the limits, sub-limits and deductibles beforehand will prevent you from being caught off guard when the payment is due. This will also ensure that you manage your medical benefits more wisely. For Xperience CarePlus, you can verify information about your medical cover in real-time such as your used and remaining limits from the Xperience Touch mobile app or on the Online Member Portal. This ensures more transparency for members.


When choosing a medical cover, it is also very important to ask about the additional benefits of each medical product. For instance, Xperience CarePlus is packaged with many added services such as:

  • Prise en Charge Helpdesks – On-site representatives are based at Fortis Clinique Darné and Apollo Bramwell Hospital to ensure a smooth admission and discharge process for members
  • Xperience Loyalty & Rewards – A loyalty programme which enable members to benefit from exclusive health related and lifestyle offers at various local partners
  • Instant Claim Settlement where outpatient claims are refunded within 15 to 30 minutes at the counter of Medscheme (Mtius) Ltd
  • Xperience Touch – its mobile application where members can check details of their medical cover in real-time.
  • Online member Portal – a web based platform which allows members to access their account online.
  • HR Portal – a web based platform especially designed for HR Officers to access and manage the membership details of employees.

These services add value to the medical product and give it a competitive edge.


You should also be aware of the time taken for claims to be refunded for the various medical products. Members of Xperience CarePlus are usually reimbursed within 10 days if their outpatient claims are submitted by mail and within 15 to 30 minutes if they come in person at the Medscheme counter with all their documents.


In certain circumstances, waiting periods and exclusions are applicable on certain health covers. In the case of a pregnancy, a waiting period of 12 months is usually applicable for Xperience CarePlus, which is reasonable compared to other medical products on the market.


Last but not least, you should consider the credibility and reputation of the insurance company. Xperience CarePlus which has been on the market for over 5 years, is administered by Medscheme (Mtius) Ltd, the leading health administrator with over 30 years of presence in Mauritius and it is underwritten by SWAN General Ltd, one of the leading local insurers.



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