It’s an altogether too-familiar scenario for many young people trying to navigate the convoluted world of health insurance. It’s easy to assume that your primary insurance plan will have your back in any number of scenarios — but coverage is often less cut and dry than you might think.

This query may pertain to incidents such as ambulance rides, certain types of accidents, unexpected diagnoses. While every insurance plan varies, there are a few services that standard major medical health insurance policies generally don’t cover

Dental bills are just one costly expense generally not covered by primary health insurance plans. According to BenefitsPRO, 81% of health plan benefits exclude adult dental care, which means a toothache can be painful in more ways than one — physically and financially.

It’s crucial to read your insurance plan meticulously to ensure you’ll be covered in the event of a serious illness or injury. It’s also important to consider that your level of coverage may be contingent upon your lifestyle.

There’s no easy formula for calculating the blanket costs of “average” out-of-pocket expenses when it comes to health insurance, especially with such a wide range of plans in the market.

These situations are particularly crippling for young adults, sixty-two percent of whom typically have less than $1,000 in savings on hand to pay for out-of-pocket medical expenses.

With premiums rising by almost 50 per cent since 2009, the question becomes more pressing each year.

And to counter this problem Consumer advocacy group Choice has launched an online calculator to help people decide whether to pay for health insurance.

The calculator works by entering personal details like income, state of residence and age, and the website gives you either a yes, a no, or a maybe, as to whether or not private health insurance is worth it.

Choice spokesman Matt Levy said young people especially are vulnerable to being sold policies they do not need.

Applying for supplemental insurance is one of the best safety nets for mitigating unexpected health expenses. These voluntary policies can help fill common holes in major medical or employer-sponsored health plans — such as critical illness or accident coverage.

On the other hand Actuaries Institute is putting pressure on the government to stop dragging its heels on the rationalisation of obsolete life insurance products and help boost confidence in the under-fire sector by addressing problems such as outdated medical definitions.

And the other body working in the interest of general customer is the corporate watchdog- ASIC.

ASIC recently put the industry on notice that it was watching advisers with poor lapse and switching rates, companies with high claims denials, insurers with low levels of goodwill payments and call centres selling unneeded and inappropriate policies.

While ASIC chairman Greg Medcraft has long pushed for tougher penalties for corporate criminals, the threat of further investigation is another headache for life insurers dealing with tumbling profitability and tougher prudential regulation.

After ASIC produced a scathing report into the sector in October, which outlined sky-high rates of claims denials at a number of the nation’s largest life insurers, including rejection rates of 24, 25 and 37 per cent of all claims, the corporate watchdog is now pleading with Canberra for more power.

The corporate watchdog also put the industry on notice for further possible fallout, flagging the next stage of its claims-handling investigation will probably uncover unfair practices in the sale and design of policies, problems in the use of outbound call centres selling life insurance, and issues raised by the lack of standard definitions in trauma and disability insurance policies. While ASIC’s life insurance report in October found one company to be rejecting 37 per cent of claims, the regulator said better quality and more consistent data was necessary to properly compare companies.