Insurance | The terms of health insurance are full of pitfalls, and for many it is impossible to get insurance

Shocking swamp. It comes to mind when wading through the terms and prices of health insurance from different insurance companies.

“You probably noticed that a comprehensive comparison is almost impossible. That quickly ends the excel table”, says the leading expert Helena Tuorila From the Finnish Competition and Consumer Authority (KKV).

In 2019, Tuorila compared the conditions of voluntary health insurance with KKV in the report. As a result, the complexity of the offer has not decreased at least.

Let’s try still. I compared the prices and contents of health insurance offered by insurance companies using a simple method. I looked at what kind of medical insurance the companies would offer me, a 53-year-old woman living in Kerava, in their online service.

All insurances have in common that you can only get the insurance if you have a Finnish Kela card. The reason is obvious. Really serious ailments are usually treated on the public side.

If many cancers, heart diseases and demanding surgeries were treated with insurance, and the state did not pay most of the expensive drugs, the insurance prices would be much more expensive.

Insurances differ immediately in terms of the age limit. OP Group’s insurance in Pohjola is valid until the age of 99. Fenia has no age limit at all. With If and Lähi-Tapiola, the insurance ends after 80 years, which is when the insurance would probably be most needed.

According to If’s expert, the insurance ends for this very reason. “The price of the insurance would become so expensive.”

It is an attractive idea that private insurance could secure high-quality care in the old days. However, you can spend a lot of money on it.

The OP says that the insurance premium for a 75-year-old taking out a similar medical expense insurance would be around 1,600 euros, and for an 85-year-old around 2,000 euros per year, when the deductible is 250 euros per year.

Common for all offers is that medical insurance is only granted after a medical examination. For example, if you have had allergies in the past, the insurance will probably not cover allergy treatment in any way. If coronary artery disease has been diagnosed, the insurance does not cover heart problems.

“If you have had any kind of cancer, you usually don’t get insurance at all. Mental health problems may also prevent you from getting insurance, which seems pretty cruel,” Tuorila says based on his report.

According to the companies, the line is not quite so strict and categorical. The consideration is influenced, for example, by how long it has been since the illness.

But then to those actual conditions. In principle, the insurance covers all treatment of the disease, which is not excluded. There are quite a lot of exclusions, and there are huge differences between the companies.

As a 53-year-old woman, I am particularly interested in the risks typical of women of this age, such as the treatment of breast cancer and menopause symptoms. Cancer treatments are reimbursed by all companies.

But reconstructive mastectomy, which is sometimes necessary after breast cancer surgery, is usually not covered. It is considered cosmetic surgery.

The exception is made by Pohjola of the OP group, which includes this in the package it offers. However, the price limit is 10,000 euros. Breast reconstruction is also part of the breast cancer treatment path in public healthcare.

Compensation Manager Hanna Väyrynen according to OP’s insurance would also cover breast reduction surgery performed for medical reasons.

On the other hand, it is pointless to imagine that the insurance would cover all the latest possibly experimental medical treatments for cancer, which are not yet in use in the public sector.

Insurances usually only cover treatments that are in accordance with general treatment practice, i.e., for example, valid treatment recommendations. What it means in practice can be open to interpretation.

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Obesity treatments are not reimbursed by any company, even if you are morbidly obese.

Menopausal symptoms often required hormone replacement therapy is not covered by all insurance companies, even though the symptoms can be very troublesome. In Ifi’s terms, hormone replacement therapy is equated with erectile dysfunction drugs and baldness treatment.

OP is an exception here too. According to Väyrynen, health insurance would also replace hormone replacement therapy.

Obesity treatments are not reimbursed by any company, even if you are morbidly obese. In other words, recently popular obesity drugs have to be paid out of your own pocket. Dental treatment is also not reimbursed, nor is any preventive treatment, such as vaccinations or health checks.

Luomen depreciation is often excluded from the scope of the insurance. With If, the removal is replaced if the mole is so suspicious that a tissue sample is taken from it to be examined.

For OP, it is enough that the mole grows, itches or has changed color.

PhysiotherapyN compensability varies. With If, you can only get it after surgery or cast treatment.

The package offered by OP and Fennia would replace physiotherapy also other than after surgery, up to 10 times a year.

The companies have their own specialties anyway. There is usually no substitute for psychotherapy. Except for Lähi-Tapiola five times and Fenia 25 times.

To everyone In addition to medical expenses insurance, health insurance also includes mandatory accident insurance, although many people already have one through, for example, trade union membership. You cannot take out insurance without accident insurance.

“There may be some overlap. In the insurances of the associations, however, the compensation amounts are often quite low, and not necessarily enough for, for example, all surgical treatment”, says the product manager Mirva Vahvelainen from If.

On the other hand, the associations’ insurances do not always have a deductible, which means that ordinary fall injuries and casts can be treated for free.

Insurance conditions the comparison is all in all incredibly complicated. The conditions are often packaged in a broader package of conditions for, for example, all personal insurances, from which you need to know which conditions apply to your own insurance.

Some of the offers received by HS already included various add-ons. Getting an overview of the whole, let alone a comprehensive comparison of the contents, is very challenging.

Not all interpretations and details can be found even in the insurance terms, but HS asked them separately from the companies.

OP’s package seemed significantly more comprehensive than other offers for the same price due to the additional parts it contained. But even that is impossible to say with absolute certainty, for example because the deductible could not be adjusted to the same amount as other companies.

How about tariff. Even the prices are difficult to compare completely uniformly, at least based on the offers available in online services. The price is also influenced by the place of residence.

According to Ifi Vahvelainen, insurance is a quarter cheaper in Inari than in Helsinki. At OP, the price difference would be more than 40 percent. Even in Kerava, the price is a bit cheaper than in Helsinki.

There are few, if any, private health services available in Inari. Private medical centers in the Helsinki region, on the other hand, offer many types of emergency room, surgery and hospital, which are also used.

The deductible and the maximum compensation amount also have a great influence on the price of the insurance.

In online services, it is not possible to set the deductible uniformly for all companies. Nor is there a maximum compensation amount.

With everyone the companies have selected a price for the comparison table that includes the insurance centralization discount. It can be up to 25 percent.

The deductible is charged again every year. It means that in practice the policyholder pays for the first doctor’s visit every year himself. The price of the insurance increases considerably if taken without the deductible.

The maximum compensation amount applies to the total treatment costs accumulated during the entire insurance period. With OP and If, the default value of the compensation amount is 200,000 euros for the entire insurance period, with Fenia, the highest compensation amount that can be selected is 120,000 euros.

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Medical expense insurance is a season ticket for the medical center.

According to If’s Vahvelainen, most often customers take a lower amount of 50,000 or 100,000 euros. However, the online service only offers the supplier an option of 200,000 euros.

That may seem like a huge amount. If the ulterior motive of taking out the insurance is that, if necessary, you can quickly access, for example, cancer treatments, the amount is not excessive.

According to the price list of the cancer hospital Docrates, the treatment of ordinary breast cancer can accumulate a bill of almost 50,000 euros. If the treatments are prolonged, the amount will increase even more than this. The same is true of prostate cancer.

Even larger surgeries quickly accumulate compensation amounts.

of KKV Tuorila thinks that with medical expenses insurance, you usually want to ensure quick access to a doctor. Although specialized medical care is increasingly available privately, the most serious illnesses are usually treated in the public sector.

“People seem to be generally quite satisfied with the demanding specialized medical care. On the other hand, in primary health care, it can be difficult to even get in touch with a nurse. With the insurance, we want to ensure that you can get to the doctor quickly,” he says.

One insurance company boss states in the background discussion that medical expense insurance is not really insurance at all, but a season ticket for a private doctor’s office.

To be like that it seems quite expensive. For someone my age, the insurance would cost almost 900 euros a year with a reasonable deductible of 150 euros. With this amount, you can go to the doctor’s office quite a few times without insurance.

On the other hand, if you happen to be related to cancer, you might want to double-check that you get fast treatment in all situations. You can perhaps get peace of mind for the price.

In recent years, the prices of health insurance have risen rapidly. This is partly influenced by the fact that when there is insurance, it is usually also used. Along with the popularity of insurances, the supply of private medical services has also grown and diversified.

After the corona, the use of health insurance has clearly increased for one reason or another. It only means one more thing: prices will rise even more.