Health Insurance Coverages: Purchasing health insurance for the first time can raise some questions. The offer on the market is vast and there are different types of coverage in each insurance.
Firstly, you should understand what types of coverage exist, which ones are included in the insurance you want and whether it is worth adding or removing some health insurance coverage.
The most common health insurance coverages
Table of Contents
1 – Hospitalisation
Hospitalisation health insurance coverage covers expenses associated with a hospital or clinic stay for more than 24 hours. This includes the payment of the hospital fee, room rental, fees for health professionals and auxiliary diagnostic elements . In addition, treatments during hospitalisation are covered, as well as surgical intervention. This coverage excludes expenses of a private nature, such as telephone or television, private nursing and home assistance. Expenses for companions are also not included, except in the case of hospitalisation of children up to 12 years old.
2 – Daily allowance in case of hospitalisation
This health insurance coverage is associated with hospitalisation and is optional in most insurances. When contracted, it pays a fixed amount for each day the insured person is hospitalised to cover expenses not covered by hospitalisation coverage . Daily prices can vary between 20 and 75 euros. Some insurers may set a maximum limit of two to take advantage of this guarantee or a maximum annual compensation. It is also possible to define a minimum number of days of hospitalisation after which subsidy coverage is activated.
3 – Ambulatory
Outpatient care is one of the most sought-after types of coverage by consumers and pays for general or specialist consultations, auxiliary diagnostic tests and outpatient treatments. In addition, it guarantees outpatient hospital assistance , such as expenses with minor surgeries without hospitalisation, fees for the professionals involved, material, operating room and some policies include transport by ambulance.
Excluded from this coverage are, as a rule, psychiatric and psychological consultations and treatment , routine examinations, physiotherapy (when this is not linked to an accident covered by the insurance), examinations and treatments for infertility or artificial insemination, hemodialysis, obesity treatments, spas , alternative medicines, professional illnesses and private expenses. In some policies, there may be payment for a specific number of consultations that are on the list of exclusions referred to here per year.
4 – Childbirth
In many insurances, childbirth is integrated into hospitalisation health insurance coverage, with an equity limit. However, if the insurance you want does not have the delivery included in the hospitalisation, you can add this coverage. Childbirth covers expenses related to pregnancy and childbirth, and cesarean section and spontaneous termination of pregnancy are covered. The insurance will pay the mother’s and newborn’s hospital fee, as well as the professionals’ fees, the operating room and the medications that are administered.
5 – Stomatology
Stomatology is a very sought-after coverage by the Portuguese when it comes to taking out health insurance. This pays the expenses for consultations and dental treatments. In many mixed insurances, expenses in this type of coverage are only guaranteed when carried out in the insurer’s network of providers . It is important to see capital for dental braces and dentures as they may have an imposed limit. Stomatology coverage excludes the application of precious metals.
6 – Medicines
This coverage pays for medication expenses. In this case, it is important to check the list of excluded articles that most insurance companies have available. Examples of articles regularly excluded from this coverage: hygiene and cosmetic products, contraceptives, over-the-counter drugs and vaccines.
7 – Prostheses and orthoses
This pays the costs of acquiring or renting devices that replace a limb or an organ, prostheses, and auxiliary functions, orthoses, when prescribed by a doctor. Examples of these are: wheelchairs, prescription eyeglasses and contact lenses, hearing aids, crutches and orthopedic prostheses and articulated beds . Excluded from this coverage are, for example, sunglasses, orthopedic footwear, elastic tights or stockings, braces and orthopedic mattresses.
8 – Second medical opinion
In this coverage if there is a serious illness (examples: cancer, stroke, cardiovascular disease or organ transplantation) the insurer will collect a second medical opinion on the diagnosis or treatment that the patient should follow from a specialist worldwide.
In these cases, the insurer is responsible for sending the entire clinical file, selecting doctors and hospitals, making appointments and reserving transport and accommodation abroad for the person and their family members. As a rule, insurers already have agreements published by their partners for this coverage, which can always be analyzed before taking out this coverage. The second opinion excludes services not approved by the insurer or in Portugal.
9 – International medical coverage in case of serious illness
This coverage is for people covered by the insurance who have a serious illness and choose to be treated abroad. When choosing this coverage, hospital care expenses will be paid, such as hospitalization, surgical intervention, exams and treatments, surgical prostheses and medications. In most cases, a limit will be determined to cover the cost of travel for the insured person and his/her companion, as well as accommodation abroad. This international coverage excludes illnesses not considered serious, and expenses in Portugal or outside the network of international providers covered by the insurance.
How to add and remove coverage from your insurance?
Before taking out health insurance, you should always first assess your needs and the offers that exist to get the most advantageous option for you. You can read our article “5 Tips For Choosing The Best Health Insurance ” if you have any doubts.
At the time of joining:
Any customer has the right to add or remove coverage from a health insurance policy . Before joining, you can choose the most advantageous coverage for you, both financially and in terms of health care.
To get the right insurance for your needs, you can speak directly with the insurers and try to reach an agreement that is beneficial to your needs. If you have any difficulties, you can always ask for help from specialized professionals in the area to get the coverage you need, at the best market price.
After purchasing health insurance:
If you already have insurance, it is normal that over time it no longer fully fits what you want. So you can always add or remove coverage from your insurance.
Procedures may vary from insurer to insurer, however it is always recommended to call the customer support line and explain your situation . Some insurers have forms for this type of request in the customer area of their website, others may ask you to make the request in writing to the indicated address. Remember that by adding more coverage the value of your insurance will increase, however you can eliminate some type of coverage that is not so advantageous for you.
Remember that your needs change at different stages of life, so you should review coverage whenever necessary.