Do you know what types of supplementary insurance coverage are? And in each of these coverages, to what extent is it possible to have the financial support of the insurance company? Considering that different companies provide supplementary insurance services and each of them has different plans to cover medical expenses, it is easy to conclude that choosing the best insurance company and knowing all the coverages that There is no easy task in each of the supplementary plans. For this reason, Iris has tried to fully review health insurance coverage in this text and familiarize you with the limits of insurance companies' obligations.
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Supplementary medical insurance will act as a supplement to the basic insurance, so if you plan to fully benefit from medical insurance coverage, it is better to continue with Iris. It should be noted that more tips on how to buy this insurance are mentioned in the supplementary medical insurance guide article .
Types of supplementary insurance coverage
Additional insurance coverage in the field of medical services can be divided into several important categories. Some of these coverages are available in most of the plans provided by insurance companies, and some expenses (such as the cost of cosmetic surgery, the cost of herbal and enhancement drugs) are not supported in any of these plans.
Supplementary insurance coverage in the field of treatment services is divided into three categories
From this point of view, all therapeutic, laboratory, medical, diagnostic, clinical and paraclinical services can be classified into the following groups:
Services that are part of the main supplementary insurance coverage.
Services that are included in the additional coverage of supplementary insurance.
Medical services that are not covered by supplementary health insurance.
You may know that there are three main types of supplementary insurance: individual, family and group. Before you want to get more information about the supplementary insurance coverage that you can use, you should first see which type of supplementary insurance you intend to use.
Types of supplementary insurance
Supplementary insurance services are provided to people in the form of various plans by insurance companies. The types of supplementary insurance are:
Individual supplementary insurance
Supplementary family insurance
Group supplementary insurance or corporate supplementary insurance
An important point that you should never forget is that some insurance companies only offer group supplementary insurance or corporate supplementary insurance.
These companies have their own coverages, which are different from the coverages, waiting period, and limits of the company's obligations in individual insurance or supplementary family insurance . The best insurance companies that are providers of supplementary group or company insurance services in the country are listed below for you:
Group supplementary insurance of Iran
Dana health insurance
Alborz supplementary insurance
Asia group medical insurance
Health insurance of the nation
Entrepreneur's supplementary insurance
Asmari supplementary insurance
Saman medical insurance
Therefore, you should choose plans that have a more appropriate insurance premium by comparing supplementary insurances. In the following, we will compare the types of supplementary insurances that provide individual and family insurance services. However, if you intend to purchase supplementary insurance as a group or company as an organization, you should pay special attention to the difference in insurance coverage provided by each of the companies listed above.
Individual and family supplementary insurance coverage
If you are not covered by additional insurance services as a group or under the supervision of a specific company or organization, there are two ways to use additional treatment services:
Buying individual insurance
Buying additional family insurance
In the first stage, it is recommended that you, as the head of the family, try to get all the family members to benefit from the services of insurance companies by purchasing additional insurance.
But in many cases, people need to be individually covered by these services.
Unlike group or company insurance where several insurance companies provide services to different organizations, companies and groups in society, individual or supplementary family insurance services are provided by a few companies.
The most well-known individual and family insurance service providers are:
Saman Insurance Company
Cooperative Insurance Company
SOS individual supplementary insurance
Asmari Insurance Company is also one of the providers of supplementary family insurance services.
Now that you are familiar with the types of supplementary insurance and the important companies that provide these services individually, in groups and in the family, we will further examine the supplementary insurance coverage.
The main supplementary health insurance coverages
In this section, the most important services provided by insurance companies to the insured and insurers are listed. It should be noted that insurance companies provide Iranian citizens with compensation services in various areas up to a certain limit, and the higher the amount paid to purchase supplementary insurance, the higher the limit of the insurance company's obligations and the variety of medical coverage.
The ceiling of the insurance company's obligations and the variety of higher medical coverages require paying more.
Supplementary insurance coverage for hospitalization expenses
Paying the hospitalization fee of patients is one of the services that you will be able to enjoy by having supplementary insurance.
Different insurances in individual, family and group plans cover the cost of hospitalization up to a certain limit.
To know the limit of the insurance company's obligations in covering the cost of hospitalization, you can review and compare the plans provided by them. Below are some important points regarding the payment of hospitalization fees by two companies, Cooperative Insurance and Saman Insurance:
The cost of general hospitalization paid by cooperative insurance (according to the selected plan) is between 15 million and 50 million tomans.
The cost of general hospitalization paid by Saman insurance (in its cheapest and most expensive plans) is 15 million and 37.5 million tomans, respectively.
General hospitalization fee payment services include many items that we suggest you read the text of the insurance contract for more detailed information. For example, Cooperative Insurance considers the following items among general hospitalization services in supplementary medical insurance coverage:
Reimbursement of hospitalization expenses after surgery
Cardiac angiography cost
The cost of the game knife
Types of spine surgery
Types of stone crushers in medical centers
Surgical centers limited
day care centers
In Saman Insurance, the supplementary insurance coverage list for hospitalization and surgery services is also mentioned.
Supplementary insurance coverage for specialized hospitalization and surgery
Another main coverage of supplementary insurance is related to surgeries related to types of cancer. Organ transplantation is one of these cases.
In general, the following items can be included in the supplementary health insurance coverage in most insurance companies:
The cost of surgeries related to types of cancer (stomach cancer, colon cancer, lung cancer, bone marrow cancer, etc.)
The cost of neurosurgery
The cost of spinal surgery
Heart surgery
Lung and liver transplant cost
Kidney transplant cost
bone marrow transplant
The limit of the obligations of surgical or specialized hospitalization services
If you intend to buy additional individual insurance, the limits of the insurance company's obligations (specifically Saman Insurance and Cooperative Insurance) are different in different plans, and you will be able to enjoy the services of the insurance company up to a higher limit by paying more insurance premiums.
The maximum amount that Cooperative Insurance Company pays for specialized surgical services (surgery related to cancer, heart surgery, kidney transplant, etc.) in its cheapest and most expensive plan is between 30 million and 100 million tomans (these figures are related to The year is 1400).
Saman Insurance Company has the option of paying 30 to 75 million Tomans to insurers for specialized surgery services in its various plans.
Ambulance fee
The cost of an ambulance is usually much lower than the cost of hospitalization or specialized surgery, and therefore it is less considered. However, remember that the payment of the ambulance fee is also covered by the health insurance (of course, if the transfer of the patient by ambulance was done with the doctor's opinion).
Saman Insurance Company will pay the ambulance fee or the medical emergency fee if the person is hospitalized.
Note that except for hospitalization and surgery or ambulance costs that are present in almost all individual, group and family supplementary plans, there are a number of services that can only be used as the main supplementary insurance coverage in certain plans.
Other services covered by supplementary insurance
If you look at the list of supplemental insurance coverage, you will find that many individual, supplemental, and family supplemental plans cover at least one or more of the following services.
Laboratory services covered by supplementary insurance
Paying for laboratory services is one of the services covered by supplementary insurance in cooperative insurance companies and Saman Insurance and many supplementary group insurances. These services can include payment in the following cases:
Pathology
Radiography
ECG
Physiotherapy
The cost of laboratory services is covered by individual and family supplementary insurance.
Certainly, your knowledge of other insurance companies' coverage in other plans can help in choosing the best individual and family supplementary insurance or even group insurance.
Paraclinical services covered by supplementary insurance
Paraclinical services are very diverse, and some of them are related to taking brain tapes, nerve tapes, and similar services, and others are related to fracture treatment or related services, such as plastering, etc.
Insurance companies cover the cost of paraclinical services up to a lower limit (compared to the costs of surgery or hospitalization).
The following is the list of additional insurance coverage for paraclinical services (in plans that have a higher premium):
Reimbursement of the cost of exercise testing
Cost of breath test
The cost of allergy testing
The cost of getting muscle tape
The cost of getting a nerve strip
The cost of the brain scan
Taking a bladder tape
Audiometry test
Optometric test
The cost of heart monitoring
Paying for eye angiography
The supplementary insurance coverage of paraclinical services is very diverse.
Other cases covered by supplementary insurance that are related to another group of paraclinic services include:
The cost of bone dislocations and fractures
Casting of a broken limb
The cost of circumcision
The cost of stitches in cuts
What is the cost of evacuation?
Cost of biopsy
Cryotherapy
Other items covered by supplementary insurance (which are covered in many plans of insurance companies) are:
Paying for ultrasound and mammography
Paying for all types of scans and endoscopy
This service can help a lot in the diagnosis and treatment of many diseases. Also, bone density measurement and MRI and services such as echocardiography and stress echo are among the services covered by individual and family plans in companies such as Cooperative Insurance or Saman Insurance.
In the end, it is hoped that getting to know supplementary insurance coverage will be useful for you. You will certainly be able to compare the coverage of supplementary insurance plans by choosing the best family or group health insurance, and have the possibility of having health insurance coverage and paying hospitalization, surgery and diagnostic, clinical and paraclinical costs.