Private medical insurance can be confusing and a bit of a minefield as no two policies are alike. So here are some useful tips and questions to ask yourself before deciding on a suitable policy:
Do I need a policy for cover just in Portugal, the rest of Europe or Worldwide?
By restricting your cover to treatment just in Portugal you will certainly reduce the premium and this could be combined with a travel insurance to cover trips outside of your country of residence.
What are the benefit limits on the policy?
This is the maximum the insurer will pay in a policy year and again the lower the limits the less the premium will be. The limits should be realistic at both the lower and top ends – a €15,000 limit may not quite cover a hip replacement and at the other end of the scale you are unlikely to use at €2 million limit.
Do I need a policy for hospital only treatment or do I want one that covers outpatient (doctor consultations, tests or scans) as well?
Although a policy that just covers hospital admission will be less expensive, outpatient treatment can get costly so think carefully before taking out this type of policy.
Do I need cover for dentists, medicines, check-ups, pregnancy, complementary medicine such as chiropractic, osteopathy and Chinese medicine?
If these, often optional, risks are included then the premium will be more expensive so again think carefully if you are going to need them because they will be costed in to the policy.
What is the excess (deductible) and can I increase it?
The excess is the amount that you pay out of your own pocket before the insurer will reimburse you. It is usually on an annual basis but some policies apply the excess to each medical condition. If you are generally healthy and don’t habitually go to the doctor then taking a voluntary higher excess is a good way of reducing the premium as most insurers give generous discounts for this.
Will I be able to use any doctor or hospital or will I have to use a network?
A number of the Portuguese health insurers use a network of doctors and hospitals that you will need to use to maximise the benefits of the policy, which is one of the reasons why the premiums are lower than the International policies. The network is usually widespread so this type of policy can provide real value for money. You can still go outside of their network but be aware that the reimbursement may be lower with usually a monetary cap on doctor consultations.
Will there be a waiting period before I can claim?
Check the policy conditions carefully as there could be a waiting period of up to 3 months and even 12 to 18 months for certain medical conditions. The International policies tend not to have this waiting period and if you are moving from one health insurer to another, without a break, then often the waiting period is waived.
Will my pre-existing conditions be covered?
I have left this very important question to last. Generally, if you have an on-going chronic medical condition, requiring check-ups and medication, it will be excluded from the policy. You are usually asked to complete a medical questionnaire and the underwriters will either:
• include any previous/on-going condition
• exclude the condition for a certain period of time
• exclude the condition completely.
With some insurers you do not need to complete a questionnaire and they will underwrite the policy on a moratorium basis, which means that any medical condition that you have had (usually) in the previous 5 years would be excluded for 2 years. It would only be accepted after the 2 year period if you have not taken medication, consulted with a doctor or experienced symptoms.
As I said at the beginning of this article, Private Medical Insurance can be a minefield …. Ibex Insurance Services has a range of policies and we would be more than happy to make a comparison, and help you choose the right policy at the right premium.
For more information please contact Angela Barden, Medical Insurance Sales Manager at Ibex Insurance on angela.barden@ibexinsure.com.
