Healthcare insurance benefits are often portrayed in the most eye-catching ways. Pictures of helicopters flying the injured to safety, world-class hospital operating theatres offering treatment fit for a president, a child lying in a hospital bed being comforted by the presence of its parents.

So, you've seen the picture, you're about to sign up for the benefit. You're all shored up? Well, no - not necessarily. Expats should make doubly sure that the benefits they believe they are entitled to are really theirs. In other words, they should take the time to study the small print which details the terms and conditions about which benefits they may actually receive. It’s a lot to plough through, but it will give you peace of mind and may also save you money in the long term.

Ceilings

If you do need to call on your insurance policy, then you will need to be able to quantify the amount you are covered for. Look carefully at the conditions on ceilings. There will be an overall ceiling per annum which is the total amount the policy will stump up each year. But for each individual benefit there will be a ceiling as well. In many cases, particularly for inpatient care, you should expect a full refund for your treatment. But don't take this for granted. A full refund will normally only be paid when this is clearly guaranteed under the terms of the individual benefit concerned.

Excesses

Once you have checked out the general level of cover available to you, it's time to think about 'excesses'. This refers to the amount of money you, the policyholder, undertake to pay for treatments before you are free to make any claim on your insurance policy. With some benefits there will be mandatory excesses, where you have to pay the first £50 or £100 worth of treatment. But there are other excesses which are optional. To weigh the true value of these it is worth reaching for the calculator. The more excesses you opt to undertake the more your overall annual premium should be discounted. Playing the excesses game can offer a sizeable reduction.

Exclusions

Healthcare insurance providers are getting better at flagging up what's not covered in their policies and lists of exclusions are now more prominently displayed on web sites. These upfront declarations make life a lot easier for the individual customer/researcher. But remember, if the list of exclusions is not there it does not mean there aren't any. Every insurance policy is likely to exclude certain conditions and treatments.

Typical exclusions include pre-existing conditions, experimental and unproved medicine, cosmetic surgery, certain conditions and treatments around pregnancies and child-birth, sex change operations, alcoholism and drug or substance abuse, suicide or attempted suicide, as well as elective treatment in the US on account of the costs being so high.

Remember that no two policies are the same and whereas there will always be common ground between insurance plans, what's excluded by one insurer may very well be a condition or treatment included by another.

Pre-existing conditions

The term “pre-existing conditions” will probably come under the list of general exclusions, but this is such a significant area it should be treated as a category in its own right.

You are likely to see a liberal sprinkling of the word 'moratorium' under this heading and it's as well to be clear about exactly what the word means. A moratorium is a time frame which links to a pre-existing condition. It will be a set period - say one year or two, maybe longer - and can be defined as either a term before which the policy's cover commences or after which the medical condition has established. Crucially during this period, listed conditions will not be covered by the policy - and this is likely to include medical attention or treatment of any description, as well as surgery. Remember it is your sole responsibility to declare any existing illness or injury or condition before taking on the policy.

This can be a grey area. Who hasn't fallen off a horse/bike/wall/ladder - and complained of back-ache from time to time over the course of their life? But if the two can be linked - that is the back pain is directly attributable to the fall, then that must be declared as a pre-existing condition and, as such, it is likely to trigger a moratorium preventing the policy holder from claiming for back treatment during the specified time-frame. Other typical pre-existing conditions include migraine, hay fever and other allergies.

Once the moratorium has expired, however, policy-holders should then be able to claim for treatment in the normal way if that becomes necessary. Some policies do not offer a moratorium and will exclude pre-existing conditions from cover permanently. In these cases the wording in such policies will be similar to, 'all conditions pre-existing before enrolment are excluded in perpetuity.'

Territorial restrictions

Territorial restrictions also exist on many healthcare plans because, around the world, the cost of the medical care varies considerably. Essentially, when it comes to healthcare policy planning the world divides into three areas - Europe, North America and the Caribbean and, thirdly, the rest of the world. What must be double-checked here is, wherever the geographical area for which you are buying cover, whether it includes the possibility of you wandering ‘off piste'.
For example, say you are based in Italy and your cover premium is based on the Europe zone. Remember to ask whether you are covered for a one-off visit to Hong Kong, or Dubai or New York. Many policies will cover travellers on an allowance of so many days per annum, but some will not. You must also check whether there are restricted territories within any allowance. If you are a frequent traveller to the United States, be sure you ask about terms and conditions specific to America and what the parameters of cover are for receiving medical assistance in this zone.