In Kaldus, there will be only 1 insurance option. This will be single payer which means the government pays into the health insurance system – therefore allowing the patient to get health care at cost, or maybe even free. All doctors authorized to work in the nation is in network. All pharmacy chains are in network. Any Class 1-3 drug approved by the FDA will be in network. Any Class 4-5 drug will be at the cost of the patient. Specialty visits are covered in the insurance plan.
Since there is no other insurance option, Health1 is the only insurance plan. There are no monthly premiums, but there might be copays. If the patient will see the doctor for the first time, the receptionist will be required to provide any copays that would be required. This could be found out at Health1’s website. If there are copays – they must be affordable for the citizen of the nation. There is no tiered system, and prevention of coverage for “pre-existing” conditions will be forbidden. All conditions, and treatments must be covered.
Health Insurance won’t cover everything. Elective surgeries such as breast adjustments, or face lifts will not be covered. Exceptions might be made. For example, someone with a cleft lip might be able to get surgery to repair the lip even though it won’t be medically necessary.
Insurance will also be required to cover for prosthetics, and prescription options. This will include dentures, eyeglasses, and specialized shoes. Obviously, everything one would assume to be a prosthetic will be included as well. If the patient can’t walk, then a wheelchair must be afforded to them, especially if the condition will be lifelong. In the case of a wheelchair, it must be motorized if the need is permanent.