It’s not a simple choice. The offer is very wide, the terms are complex, the formulas get mixed up and, through ignorance, on several occasions you end up paying more. To better understand how to choose, we spoke with an expert advisor. These are their recommendations.
The first thing to keep in mind when reviewing the different isapre plans is that the main goal is to choose one that has enough skill to get the best possible coverage in any case. Then, it is essential to understand the basics. For example, if a free choice plan, preferred plan, or closed plan is more convenient.
The difference is simple: in the free choice plan, the coverage offered by isapre is the same in any medical center; in the preferential there are medical centers in which isapre covers with a higher percentage; and in the closed ones it is covered only in certain places, where the service is much cheaper.
Pablo Galdames, independent professional advisor in isapres and insurance, explains that “the fundamental coverages to take into account when subscribing to a health plan correspond to hospital, outpatient and emergency care. These must be functional with the service circuit that the contractor wishes to have”.
At this stage, it is also relevant to ask whether there is additional insurance, “so that it is well linked to the premium where one wishes to be treated”, specifies Galdames. This is essential, because if you have supplementary health insurance, the cost of the plan can be significantly reduced.
An issue that worries many people is that of the pre-existence of certain diseases, as this can sometimes cause the isapres to reject a request. “They have the power to accept, condition or reject a potential member who has a certain pre-existence,” explains Galdames, which is transparent in the health declaration that is made at the time of hiring. In this document, the prospective member stipulates any diagnosis, treatment or relevant health information before the date. “ISAPRE may refuse to cover any benefit if the information was deliberately omitted when drafting the health declaration. You can even terminate the contract.
Another common doubt concerns gender, since women’s projects historically had higher value than men’s. Today, after many efforts, the situation is different and plans for women ultimately have no cost difference or hedging compared to men.
When choosing a plan, one thing to consider is restricted benefits. Pablo Galdames comments: “These are those who exceptionally will not have the normal coverage of the plan. These are shown in a special box and usually only have 25% coverage”. Some of the restricted benefits are usually certain surgeries, such as bariatric or refractory, among others.
The impact of Explicit Health Guarantees (GHGs) should never be forgotten when choosing a health plan. The GES now includes 85 benefits, to which all members, whether an isapre or a Fonasa, are covered by right, regardless of their plan.
“Their access, their opportunity, their financial protection and their quality are guaranteed for these services”, specifies the expert. “These will be granted in medical centers, clinics or hospitals predefined by isapre or Fonasa,” he adds. That is why the list of these 85 benefits should be reviewed in detail. But there are members who prefer to be treated in a particular way in a provider different from the network already defined, “and it is then that the health plan must have sufficient skills so that they can be treated in another provider with the coverage granted by said plan,” says Galdames.
Insurance and accessories
Beyond the packages chosen, the isapres offer additional products that can be very useful. For this, it is good to have specialized advice. Although it can be very tempting to take out catastrophic insurance, agreements with pharmacies, dental coverage, unemployment insurance and more, the ideal is to evaluate it in detail beforehand, to understand if these are really needed. What on paper may seem very useful, in reality it may not really be used and only serve to increase the cost of the plan.
Galdames also highlights the dynamism of the isapres system, as options are constantly emerging to improve coverage or reduce costs. “It is important that when there is a change in the contract by the isapre or any change in relation to the contingency of the user (such as unemployment, incorporation of charges or others), it is valued at new and the best alternative is contracted only at that time can be obtained,” he concludes.
Source: Latercera
I’m Todderic Kirkman, a journalist and author for athletistic. I specialize in covering all news related to sports, ranging from basketball to football and everything in between. With over 10 years of experience in the industry, I have become an invaluable asset to my team. My ambition is to bring the most up-to-date information on sports topics around the world.
