The intricacies and fine print can be overwhelming, and not very helpful in many cases. Recent political and economic upheaval has only served to add fuel to the healthcare crisis, further complicating processes and leaving many individuals in the dark regarding their rights and personal responsibilities. One of the simplest ways to combat this confusing condition is to become educated regarding the ideals and basis upon which the insurance industry is built. This can be particularly important if an individual is utilizing a private medical insurance provider as opposed to an employer-provided policy.
Given the apparent complexity of any healthcare insurance policy, it is best to begin with an overview of the principles behind the private medical insurance industry. Anytime that a company takes on an individual client, there are basic legal requirements that must be met. Here is a brief list of several of the more commonly recognized legalities:
-Insurable interest – This refers to the concept that in order for the insurance company to honor policy benefits, the insured must typically have suffered directly from the claimed loss. It is generally assumed that the insured individual must have some specific interest in the claim being made. In the case of medical insurance, this means that the healthcare provided must be provided directly to the policyholder, or an individual named as a recipient of benefits under the policy.
-Utmost good faith – The principle of utmost good faith operates on the belief that the individual being insured and the insurance company are bound in a mutual agreement to be honest, fair and forthright. This is supported by the accepted practice that material proof of claim and benefits be provided.
-Indemnity – The purpose of the any insurance company, even private medical insurance, is that the insurance company compensates the insured individual in the event of a loss. This indemnification is conditional upon the limits of the insured’s interest in the policy.
-Subrogation – Subrogation refers the right of the insurance company to pursue monetary recoveries on the part of the insured individual. For instance, an insurance company may sue the driver responsible for the injuries to their client during an automotive accident.
-Contribution – This is the principle that insurers that have an obligation similar to that of the insured contribute to the indemnification, based on conditions outlined in each policy.
-Loss minimization – This is the principle that the insured must make every reasonable effort to avoid the loss, behaving as if he were not insured and were personally responsible with any incurred costs or damages brought about by the loss.
-Proximate Cause (causa proxima) – Proximate cause is based on the concept that the cause of the loss is covered under the insurance policy agreement. This principle goes further to include that the dominant, or ultimate cause, of the loss or peril must not be excluded.
More Expat Resources
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
PGRpdiBjbGFzcz0iaXRlbSBibG9jX2ltYWdlIiBzdHlsZT0iYmFja2dyb3VuZDp1cmwoaHR0cDovL2hvbWUuZXhwYXRmaW5kZXIuY29tL2RhdGEvaW1ncy9jbXMvcnViOV8xMzIyMjEzNjc2MjE0NTk3MDAuZ2lmKSBuby1yZXBlYXQgI0YyRjJGMjtiYWNrZ3JvdW5kLXBvc2l0aW9uOjMwcHggMjBweDsiPg0KCTxoMz5Eb3dubG9hZCBvdXIgRlJFRSBHdWlkZXMgbm93ITwvaDM+DQoJPGRpdiBjbGFzcz0iZGVzY3JpcHRpb24iPkRvd25sb2FkIHlvdXIgY291bnRyeSBndWlkZSBmcmVlIG9mIGNoYXJnZSEgQ29zdCBvZiBsaXZpbmcgZ3VpZGVzIGFuZCBtb3JlLi4uIFRoZSBQREYgY29uc2lzdHMgb2YgMTAtMTUgcGFnZXMgZnVsbHkgcGFja2VkIHdpdGggdXNlZnVsIGluZm9ybWF0aW9uIGFib3V0IHlvdXIgbmV3IGNvdW50cnkuPC9kaXY+DQoJPGRpdiBjbGFzcz0iY2xpY2tib3V0b24iPg0KCQk8YSBjbGFzcz0iYnV0dG9uIGJjc19iMTQwXzQ1IGYxNCIgIGhyZWY9Imh0dHA6Ly93d3cuZXhwYXRmaW5kZXIuY29tL2ZyZWUtZG93bmxvYWQiPjxzcGFuPkRvd25sb2FkIG5vdyE8L3NwYW4+PC9hPg0KCTwvZGl2Pg0KCTxkaXYgY2xhc3M9InNlcGFyYXRpb24iPiZuYnNwOzwvZGl2Pg0KPC9kaXY+DQoNCg==
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
