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know what it is and how it works

Do you know what a health plan is? What are the advantages and disadvantages of this option? Clear all doubts.

If you are thinking of subscribing to a health plan It is important to know the main features of this option. Even because, often, there is some confusion between plans and health insurance. And, as we will see, they are different products.

The purpose of joining a health plan is to be able to access medical care from private providers, but paying less than what you would pay if you did not subscribe to this product. Health plans, as they do not have grace periods or age limits, also end up being, in some cases, an alternative to health insurance.

What is a health plan?

A health plan works like a discount card. By subscribing to this product, you will benefit from a discount at providers (eg clinics and private hospitals). That is, you will pay a price below the table whenever you use these providers.

This option allows, upon payment of a monthly fee, access to consultations in different specialties, treatments, surgeries and exams in the private sector. Teleconsultations and home consultations are other common services in this product.

Choosing a health plan can be a complement or an alternative to the National Health Service, especially in situations where waiting periods are long. It was, therefore, a highly sought after option during the most complicated phase of the pandemic.

Is a health plan health insurance?

Not. And, therefore, it is not subject to the same legal rules as an insurance contract. Health plans are also not under the supervision of the Insurance and Pension Funds Supervisory Authority (ASF), which is the insurance regulatory body in Portugal.

This fact can be advantageous, but it also requires some additional care before subscribing.

What are the benefits of a health plan?

A health plan, therefore, allows access to health care more quickly than in the public sector, paying less than if using the private sector without having a plan.

However, the main advantages of these products relate to the fact that they do not have some of the limitations of health insurance. For example, do not impose grace periods. That is, you will not have to wait to start enjoying the product.

Also do not establish ceilings annual. That is, there is generally no cap on the amount of medical care you can benefit from. So, you can do the treatments you need and have the number of appointments you want.

Health insurance generally excludes older people, but health plans do not. This means that you can subscribe to a plan even if you are over 65 or 70 years old.

The same applies to pre-existing diseases that are often penalizing for those who want to take out health insurance. Health plans do not, as a matter of principle, exclude diseaseswhich makes them more accessible to those with a condition that may require more care.

The fact that they do not require the completion of a clinical questionnaire in order to adhere is another advantage of this system.

If your plan includes more members of your family, you may have additional benefits, including lower monthly fees.

Evaluate before deciding

However, keep in mind that each health plan has its own rules. Therefore, there may be cases in which some usage limits are imposed or in which, by subscribing, you commit to remain in the plan for a minimum period.

So, before making a decision, it is important to know the conditions they offer and compare them with other similar products.

What are the disadvantages?

As mentioned, there may be an obligation to remain on that plan for a certain period of time. Or you may have to communicate, with some time in advance, that you do not want to renew your subscription. Once again, the advice is that, before choosing, check all the conditions of access and stay.

Another disadvantage of health plans is that, if you use a provider outside the agreed network, you will not be entitled to a discount or reimbursement of part of the expenses.

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