The health insurance is a form of insurance that provides
that the insurance company, upon payment of a premium,
reimburse the insured for costs incurred by these hospital admissions
or stays in hospital or clinic as a result of
Accident, disease or surgery.
In general, the health insurance cover then, Within the limits of
ceiling agreed, expenses that the insured must bear
in hospitals or nursing homes because of private or public
illness or injury, or expenses related to surgery
rendered necessary by illness or injury.
Generally, the guarantee of health insurance does not cover
check ups and preventive health examinations by the insured,
because there is a character of uncertainty underlying the
insurance contracts.
What are the guarantees provided?
Insurance for medical expenses
Covers expenses incurred for hospitalization, necessitated by illness or injury, or surgery.
For the latter do not require hospitalization, could be
in outpatient or day hospital, and are not even mentioned
the sickness or injury, but there are conditions
implicit.
In fact, surgery is not motivated by illness or
accident (is. correction of deformities, Cosmetic surgery) are
subject of explicit exclusions.
In other words, unless otherwise stated in the conditions
Contractual, the warranty is effective for diseases and injuries
that do not lead to hospitalization or surgery, although
expose the insured to major expenses such as, eg, diseases
for which is not always necessary to be admitted.
The events are considered the disease ("Any alteration in the state of
employee health is not an accident "), l’infortunio ("Every event should have
fortuitous because, violent and external, that these lesions objectively
constatabili”), childbirth, l’aborto. So under warranty
medical expenses, which is a type of insurance,
the event an accident - unlike the specific insurance
Accidents - not relevant in and of itself, but only as a result in
hospitalization or surgery, which shall secure the repayment of
costs. The hedged risk is generally made up, unless otherwise agreed
and in any event upon presentation of a prescription, by
expenditure on disease and not found the full cost for fear of
a disease or for prevention.
Thus diagnostic tests and specialist visits, to be reimbursed, would normally be associated with illness or injury and
have led to a hospitalization for a minimum period of time indicated
in the policy.
Insurance for permanent disability from disease
It covers the final and irremediable loss or diminution of earning capacity resulting from permanent disability, resulting in turn from a disease "which occurred" after the effective date of the contract and before the date of expiry.
Therefore must be distinguished when the manifestation of the disease
(which must occur during the term of the contract) since
the event of permanent disability resulting (that can
occur beyond the end of the contract).
Is a sum of which is fixed in the policy the amount
maximum (sum insured) and the amount, in case of accident, is
actually determined by a percentage
sum insured (percentage of compensation).
The latter is in turn related to the percentage of disability assessed
and correspondence is normally presented in a table
included in the policy.
As in determining the degree of disability, assumption
for the settlement of compensation, it should be at
late disease, intended as a stabilizing consequences. It is generally
provided for a minimum period before which it is not possible that stabilization
(is. six months from the complaint) and a maximum (is.
18 months after the complaint) within which it must still be done
l’accertamento.
Insurance daily allowance for admission to nursing home
provides for the payment of a predetermined amount insured
for each day of institutionalization of care necessitated by illness
or accident. The compensation is independent of the actual costs
incurred by the insured and aims to integrate the non-income
inability to conduct business.
Assicurazione Long Term Care (LTC)
It covers the expenses arising from the impossibility
to perform the functions of daily living independently,
not necessarily because of illness or injury but also because of senescence
and consequent impairment of self-.
Insurance against serious diseases (“Dread desease” o “Critical
Illness”)
Covers the needs arising from the occurrence of a serious
diseases referred to in the policy (is. infarction, cancer, blindness, stroke, failure
renal) through the payment of a fixed capital. The
guarantee is often provided in conjunction with life insurance that
provide coverage in case of death.
Who it is for a health insurance?
The individual itself and / or your family (individual policy
insured on one or more heads) or a contractor (company, Association,
cash assistance ...) on behalf of their dependent or associated
(collective policy).
What you need to take out health insurance?
The most relevant aspects of:
Explanations of the insured and medical questionnaire
The medical questionnaire before the conclusion of the contract is usually asked to fill;
represent questionnaires from which the insurer takes the information
necessary for the health risk assessment. You
important to fill out the questionnaire personally and carefully:
in the case of incorrect or incomplete information on the actual state of
health, the insurer may withhold payment of compensation
or proportionately reduce the amount.
This is not a mere formality, so much so that misrepresentations and reticent (See Articles. 1892 and 1893 Civil Code) can lead to total or partial loss of the right to, indeed, the questionnaire serves to draw attention to diseases and disabilities for which you
may not be able to appreciate the importance, with the risk of
do fall within these inadvertent omissions and consequences.
For example, where the request is related to previous surgery,
also be declared any cesarean.
Attention to the clauses relating to securities other than
In general consequences are excluded from the coverage of situations
pathological prior to the stipulation of the policy which have given
home-care, tests, diagnosis and are therefore assumed to be
"Known" by the contractor or the consequences of accidents, occurred in
previously silenced and with malice or gross negligence when the contract. The
diseases arising prior to the signing of the contract but "not
known "because they do not care to be highlighted, tests, diagnosis are generally covered, albeit with the imposition of a time of expectation.
Do not confuse the condition of exclusion from the guarantee of
a specific service on the condition involving the inassicurabilità
of certain categories of people such as alcoholics, drug, AIDS patients, people with mental illness.
For these guarantees simply do not work independently
the performance required. This means, unless otherwise agreed, that
if any of these conditions occur during the contract, the contractor
lost the requirement of insurability, the guarantee is no longer operational
Therefore, the insurer is not required to provide any.
Pensionable age
The companies generally provide a maximum
pensionable age: they may refuse to ensure that a person
I've already made a certain age (is. 70 years). However,
Once signed the bill, the company can not provide for the termination
Automatic coverage if the insured carries the maximum
pensionable age during the contract.
Waiting period of contract
The terms of insurance contracts usually provide for an initial period from the date of the contract ("Expectancy") during which any claim is not covered under warranty and will not be paid by. Then attention needs to be done if insurance is provided in a "period of expectation":
in this case, if the accident occurs during its course, you are not entitled
to any compensation.
Conversely, the injury is not usually subject to terms of expectation,
being by definition a violent and sudden event: expenditure
incurred for hospitalization or surgery it conseguentisono reimbursed even if the accident (and the related hospitalization or surgery)
have taken place immediately after the commencement of the policy.
Ceilings - limits of compensation
The ceiling is the sum
maximum that the insurer is willing to pay for all claims
covered by the policy occurred in the same policy year.
The higher this limit, the higher the premium.
The annual ceiling may concern, with reference to the same
policy, each insured (maximum per year per insured)the
all insured persons who constitute a family (ceilings
per year per household insurance), but there are also plans
several. There are also policies that provide an unlimited maximum,
which impacts significantly on the extent of the premium.
Conventions
Many policies provide for agreements with a network of clinics
or medical centers so that the benefits are paid directly
dall’assicuratore (“indennizzo diretto”). Rely on other suppliers
(the so-called "offline") may result in loss of eligibility
direct compensation and the burden of bringing forward expenditure and is also
penalized by the limits of compensation or discovered.
Alex Gaetani
Main Board: