Health Insurance

Protect your family's health

In a context of increasing pressure on the National Health Service (SNS), coupled with economic uncertainty and the search for faster and more personalized medical care, health insurance plans have become an essential tool for well-being and security for many Portuguese families. These plans guarantee quick and easy access to healthcare, offering users greater comfort, speed, and freedom of choice.

How Health Insurance Works

Health insurance is a contract in which the insured pays a periodic premium to the insurance company, and in return, the company guarantees the payment of medical and hospital expenses, according to the coverages, capital limits, and deductibles stipulated in the policy.

Access Options

• Accredited Network: The insured uses doctors, clinics, and hospitals that have an agreement with the insurance company. The user pays only a deductible (or co-payment) for each medical procedure, with the remainder paid directly by the insurance company. This is the most commonly used and advantageous method.

• Reimbursement: The insured can choose any provider outside the accredited network. You pay for the entire service and subsequently send the invoice to the insurance company, which reimburses a percentage of the value (usually between 70% and 90%), up to the limit of the insured amount.

Crucial Concepts

When contracting health insurance, the user should be aware of three key concepts:

A. Waiting Period

This is the time that must elapse between the start date of the contract and the date on which coverage becomes effective.

• Short waiting periods (30 to 90 days): Consultations and examinations.

• Medium waiting periods (6 months): Surgeries and hospitalization.

• Long waiting periods (12 to 24 months): Childbirth and serious illnesses.

B. Deductible / Co-payment

This is the fixed or percentage amount that the insured pays to the service provider for each use, even within the accredited network. For example, if the consultation costs €100 and the co-payment is €15, the insurer pays €85 and the user pays €15.

C. Exclusions

These are situations that are not covered by the policies:

• Illnesses or injuries resulting from work accidents or extreme sports.

• Cosmetic or experimental treatments.

• Pre-existing illnesses or medical conditions (known and diagnosed before taking out the insurance).

Typical Coverages

Health insurance policies generally include:

Outpatient Care

This coverage is for care that does not require hospitalization.

• What it includes: Routine and specialist consultations (e.g., cardiology, dermatology), diagnostic tests (e.g., clinical analyses, X-rays, MRIs, CT scans), and simple treatments.

• Capital Limit: Generally, it has a lower annual capital, fixed between € 1.000 and € 5.000.

Hospitalization

Considered the most important coverage, it is intended for serious medical situations that require hospitalization.

• What it includes: Scheduled or emergency surgeries, hospitalization expenses (including use of a private room), fees for medical and surgical teams, medications, and hospital supplies used during hospitalization.

• Capital Limit: Has the highest annual capital limit, ranging from € 50,000 to € 1,000,000, depending on the policy.

Dental Care

This coverage may be optional in many insurance policies.

• What it includes: Routine consultations, cleanings, simple restorations (fillings), and sometimes extractions.

• Capital Limit: Typically limited and low, often separate from Ambulatory coverage.

Childbirth

This coverage is specific to expenses related to pregnancy and childbirth.

• What it includes: Hospitalization expenses and medical fees related to childbirth.

• Crucial Condition: Requires a long waiting period (typically between 12 and 24 months) to be activated.

Preventive Medicine

Focused on prevention and early diagnosis.

• What it includes: An annual check-up (set of routine exams) or family planning consultations.

• Crucial Condition: Many insurance policies offer this coverage with a reduced fixed copayment or even at no additional cost.

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