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【醫保知多啲】購買醫療網絡保險4大注意事項

市面上的醫療保險五花八門,近年就有不少以醫療網絡掛帥的醫保計劃,主打靈活方便,讓大家可以在毋須擔心找數問題的情況下,於指定醫療網絡內放心求診。這類計劃雖然在索償時程序相對較簡單直接,但大家投保時,仍有不少需要注意的地方,阿睥今次就為大家歸納出以下四點: 

1.    注意醫療網絡覆蓋程度

此類醫保計劃多數都會以龐大的醫療網絡作賣點,但各個醫療網絡的覆蓋從註冊/專科醫生,到診所/醫療中心,以至合作的醫院,其實也不儘相同。如想在免找數的情況下到心儀的診所或醫院求診,大家就記緊要光顧醫療網絡內的醫生。

因此,大家如習慣找指定醫生求診又或對入住醫院有要求的話,就記得先了解清楚計劃內的醫療網絡名單是否合用。

2.    清楚索償程序和條件

如上文所言,這類醫保計劃在索償程序上都較簡單,但為免事後口同鼻拗,大家在投保前都應先了解清楚索償程序和條件,切勿掉以輕心,例如:

  • 找專科醫生前是否先要獲普通科醫生轉介?
  • 進行手術前是否先要獲得預先批核?
  • 光顧非醫療網絡內的醫生在事先申請下能否獲得理賠?

3.    留意賠償上限

這類醫保計劃的另一好處,就是受保人在求診期間無需為醫療費用操心,大家只要憑著手上有效的醫療卡,前往醫療網絡名單內的診所和醫院,即可「無慮」求診或做手術。所謂「無慮」,亦即無需先付住院按金,出院時無需找數,亦無需事後索償。不過大家就記得注意自己投保計劃的保障上限及病房級別,如最後醫藥費超過每年之保障限額;又或計劃本只保障住普通房,自己卻住了私家房,就需要額外自掏腰包了。

4.    細項是否設索償上限

除了賠償上限外,大家亦應留意計劃會否針對各醫療細項收費或每次疾病索償設定上限,以癌症為例,由事前檢查到住院期間的化療和標靶治療,至出院後的門診護理,一個疾病當中便已涉及多個醫療細項,如計劃沒有設細項索償上限,就能提供更全面的保障,讓大家可以更放心對抗頑疾。

以上內容由持牌保險經紀公司GoBear Insurance Broker (HK) Limited 帶給您。我們網站上提供的信息不構成任何建議或推薦,並沒有就您的狀況作考慮。我們網站上的信息提供對產品主要特點的概述,您應與涵蓋更多產品資訊的其他資料一併閱讀。

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