Frequently Asked Questions

Health insurance covers medical expenses while you're alive: hospitalizations, consultations, medications, surgeries, emergencies, and treatments. It protects you against the costs of getting sick or injured.

Life insurance pays a benefit to your beneficiaries when you pass away. Its purpose is to financially protect your family if you're no longer there to provide.

Many people have both types of insurance because they serve completely different purposes.

A pre-existing condition is any medical condition you had before purchasing insurance: diabetes, hypertension, asthma, prior cancer, previous surgeries, etc.

Insurers handle pre-existing conditions in three ways:

• Permanent exclusion: They never cover that condition
• Waiting period: They cover it after a certain time (12-24 months)
• Additional premium: They cover it but charge more

It's the time that must pass from when you purchase insurance until you can use certain coverages.

Why does it exist? To prevent someone from purchasing insurance only when they already know they'll need to use it.

The deductible is the amount you pay out of pocket before insurance begins to pay.

Deductibles can be:

• Per event: Applied to each hospitalization or claim
• Annual cumulative: Once you meet it, you don't pay more deductible that year

Tip: A higher deductible means a lower premium, but you must be able to pay it if needed.

Coinsurance is the percentage of the expense you share with the insurer after the deductible.

Typical coinsurance is 80/20 or 90/10 in-network, and may be lower out-of-network (70/30 or 60/40).

In-network:

• Providers with agreements with your insurer
• Generally direct payment (you don't advance money)
• Better coinsurance percentage (80-90%)
• Lower negotiated rates

Out-of-network:

• Providers without agreements
• Generally you pay and then request reimbursement
• Lower coverage percentage (60-70%)
• Rates may be higher

Usual coverages:

• Hospitalization (room, services, physician fees)
• Surgeries
• Medical consultations
• Medications (outpatient and inpatient)
• Diagnostic studies (labs, imaging)
• Emergencies and urgent care
• Maternity (with waiting period)
• Therapies (physical, respiratory, etc.)

Additional coverages (may have extra cost):

• Dental
• Vision
• Mental health
• Alternative medicine

Common exclusions:

• Cosmetic surgery (except post-accident reconstruction)
• Experimental treatments
• Intentionally self-inflicted injuries
• Injuries from participation in crimes
• Infertility treatments (in many plans)
• Undisclosed pre-existing conditions
• Services not medically necessary
• Non-prescribed medications

Maternity generally includes:

• Waiting period: 10-12 months before you can use it
• Specific limit: Maximum amount for delivery and related care
• Includes: Prenatal care, delivery (natural or cesarean), complications, newborn hospitalization

You need life insurance if:

• You have financial dependents (children, spouse, parents)
• You have debts others would inherit (mortgage, loans)
• You want to leave a legacy or inheritance
• You're a business partner (to protect the partners)

If no one depends on you financially and you don't have significant debts, life insurance may not be a priority.

Your broker:

• Advises you on the right plan for you
• Compares options in the market
• Explains coverages and exclusions
• Helps you with the enrollment process
• Assists you when you need to use the insurance
• Manages complex claims
• Negotiates on your behalf at renewal

There are several reasons why a medication may be declined at the pharmacy. These are the most common causes:

1. Annual limit exhausted — Your policy has a maximum annual medication coverage cap and it has been used up. Check your account statement to verify your available balance.
2. Medication not covered — The medication is not included in your plan's formulary (list of covered medications). Your doctor can suggest a covered alternative.
3. Brand-name medication not covered — Your plan covers the generic version but not the brand name. Ask the pharmacist for the generic equivalent, which has the same active ingredient.
4. Mismatch between specialty and medication — The prescribing doctor's specialty does not correspond with the type of medication prescribed. You will need a prescription from the appropriate specialist.
5. Incomplete prescription document — The medical prescription does not meet requirements: it may be missing the stamp, date, diagnosis, or doctor's signature. Request a complete prescription.
6. Policy suspended due to non-payment — Your policy is temporarily inactive because there is an outstanding balance. Contact your broker to regularize payment.
7. Card does not match active insured — The card presented does not match an active insured in the system. Verify that you are using the correct current card.
8. Inadequate verification by the establishment — Sometimes, pharmacy staff do not correctly complete the electronic verification process. Ask them to try again or visit another pharmacy in the network.
9. Cash billing by the establishment — Some establishments may prefer to charge in cash rather than process through insurance. Insist that it be processed through your policy — it is your right as an insured.

It's a health insurance plan that covers you in multiple countries, including access to world-class medical care. It generally includes:

• Coverage at any hospital worldwide (or contracted region)
• Emergency medical evacuation
• Treatment at international centers of excellence
• Option for care in the U.S. (generally with additional premium)

• People who travel frequently
• Those who want access to treatments not available locally
• International executives and entrepreneurs
• Families who want the best possible protection
• People with conditions that may require specialized treatment
• Expatriates and their families

Medical evacuation is an emergency transfer to an appropriate medical center when adequate treatment is not available locally.

Includes:

• Air ambulance if necessary
• Medical accompaniment during transfer
• Complete logistical coordination
• Transfer to the hospital of your choice

They are hospitals recognized worldwide for their specialization:

• Mayo Clinic, Cleveland Clinic, Johns Hopkins (U.S.)
• MD Anderson, Memorial Sloan Kettering (oncology)
• Hospitals in Europe and Asia

Many international insurance plans facilitate preferential access to these centers.

Liability covers damage you cause to third parties: bodily injuries, damage to other vehicles, property damage.

It is mandatory by law because it protects victims of accidents you may cause.

• Total theft: The vehicle doesn't appear. You're paid the insured value minus the deductible.
• Partial theft: Parts are stolen. Limited coverage with deductible.

Requirements: Immediate police report, waiting period (30-60 days), surrender keys and documents.

At the scene:

1. Make sure everyone is okay
2. Call emergency services if needed
3. Take photos of everything
4. Exchange information with the other driver
5. DO NOT admit fault
6. Call your broker before making any statements

Afterwards:

1. File the claim with your insurer
2. Follow your broker's instructions
3. Obtain repair estimates
4. Cooperate with the adjuster

Commercial use is generally NOT covered by standard personal policies.

You need: A commercial policy or specific endorsement. Consult with your broker.

• Tow service (up to certain km)
• Roadside mechanical assistance
• Flat tire change
• Jump start
• Emergency fuel supply
• Vehicle locksmith

Structure (building): Walls, roof, floors, fixed installations, improvements

Contents: Furniture, appliances, clothing, electronics, valuables

Covered risks: Fire, explosion, water damage, theft, natural disasters (with extension), home liability

Yes, but different:

• The landlord insures the structure
• You as a renter should insure your contents and liability

Generally NOT automatically included. They are extensions you need to add:

It covers damage that you or your property cause to third parties:

• A visitor gets injured at your home
• Your plumbing damages a neighbor's apartment
• Your pet bites someone
• An object falls from your balcony

In-network:

1. Verify that the doctor is in the network
2. Present your insurance card
3. Pay only the copay
4. The doctor bills the insurer

Out-of-network:

1. Pay the full consultation fee
2. Request an invoice with NCF
3. Fill out the reimbursement form
4. Submit documents
5. Receive reimbursement

• Completed claim form
• Original invoice with NCF
• Medical prescription (if for medications)
• Medical report (if for a procedure)
• Copy of your ID

Typically 60-90 days from the date of service. After that, the insurer may reject the claim.

It's the insurer's prior approval before certain services.

Pre-authorization is required for:

• Scheduled hospitalizations
• Elective surgeries
• High-cost studies
• Specialized treatments

1. Request the reason in writing
2. Contact your broker
3. Gather additional documentation
4. File a formal appeal

In the moment: Seek immediate care. Emergencies don't wait for authorizations.

Afterwards (24-48 hours): Notify your insurer and broker. Keep all documents.

First:

1. Protect the people
2. Prevent additional damage
3. Call emergency services if needed

Then:

1. Document everything with photos and video
2. Don't touch or move anything
3. Contact your broker before making any statements
4. Notify your insurer

Your broker:

• Knows the correct process
• Knows what information to provide
• Protects your interests from the start
• Prevents you from saying something that could harm your claim

The adjuster evaluates your loss:

• Inspects the damage
• Verifies the cause
• Estimates the repair cost
• Determines if you're covered
• Calculates the indemnity

It depends on your policy:

• Designated shops: You must go to network shops
• Free choice: You can choose any shop

Yes, but:

• Only repairs necessary to prevent further damage
• Document BEFORE repairing
• Keep receipts
• Preserve damaged parts

These emergency repairs are generally reimbursable.

A contract that covers a group of employees under a single policy:

• The company is the "policyholder"
• The employees are the "insured"
• Terms negotiated for the entire group
• Volume discounts
• More flexible medical underwriting

Loss Ratio = (Claims / Premium) x 100

1. Employee completes the form
2. HR verifies eligibility
3. Submission to insurer/broker (within 30 days)
4. Insurer confirms enrollment
5. Employee receives certificate and card

Business risks can:

• Destroy assets
• Paralyze operations
• Generate lawsuits
• Hold executives liable
• Lead to bankruptcy

Insurance transfers these risks, protecting corporate assets.

It covers financial losses while your business cannot operate:

• Lost gross profit
• Continuing fixed expenses
• Extraordinary expenses

Key elements:

• Waiting period: Initial 48-72 hours not covered
• Indemnity period: Maximum time (6-24 months)

First party: Incident response, data recovery, extortion, cyber interruption

Third party: Liability for data breach, privacy violation, regulatory fines

It covers multiple vehicles under a single policy. Generally applies with 5+ vehicles for business use.

Prevention: Training, driver policy, background checks, preventive maintenance

Technology: GPS, dash cams, telematics, speed alerts

Management: Periodic analysis, consequences for negligence, incentives for good behavior