Guide on private medical insurance

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Waiting lists to see a specialist have never been very agile in public health and are constantly increasing. If you have suffered this situation, you will know the frustration generated by being sick and having to wait for months to see a specialist doctor and then wait again for the tests they send you and again to see the doctor again.

Private health insurance is positioned increasingly harder, as an affordable option for many people. They guarantee medical, hospital and surgical assistance without long waiting lists and it is precisely the speed and agility of their medical and hospital services is the main reason for hiring them. In Spain, private healthcare has gained a lot of ground in recent years despite being optional and voluntary.

Have you started investigating which one suits you best? In Rastreator.com we have created this Guide on private medical insurance so you know how they differ from each other and what you should keep in mind when choosing your health insurance.

Health insurance and private health

Private medical insurance is a contract signed between a citizen and an insurance company. In exchange for a series of payments or premiums, the insured receives the type of health care that he has chosen in the policy when hiring it.

One of the reasons for its existence is the need to offer better health care that fills the gap that the public sometimes leaves. Therefore, insurers usually offer services that either cannot be found in public health or that have deficiencies in it.

Normally, to ensure the best care, Health insurance companies have their clinics, laboratories, and care centers. The insured avoid long queues and receive the results of their analysis or tests much faster. However, unlike in public health, the patient can only go to health institutions that have an agreement with the company that insures them.

Advantages of private health insurance

20% of the emergencies and 30% of the surgical activity are carried out in private institutions. This helps reduce the waiting lists of the national health system and represents a clear advantage for the insured as well. Other advantages of private health insurance compared to public health are:

  • To be able to access specialists, it is not necessary to go to the GP first.
  • It is possible to choose the hospital we want to attend and the doctor who will attend us.
  • Access to alternative treatments and new techniques is usually associated with private medicine.
  • Greater benefits for companions, in case of hospital admission.

Types of Health Insurance

There are many types of Health insurance, depending on the coverage included and the method of payment of the premium. In general, they can be divided into medical boxes without copayments, medical charts with copayments, a medical chart with reimbursement, a medical product with hospitalization and dental insurance.

Medical box without copayments

They are that insurance for which you pay a single premium and with which you can go to the medical consultation as many times as you want without additional payments per visit. With the medical team without co-payments, you can choose between all the medical and hospital centers that have agreements with the insurer, that is, that is part of your medical team.

Medical chart with copayments

These policies allow the insured to go to the centers that are part of their insurer’s medical staff, but in addition to the annual premium, a price is paid for each visit or consultation. These amounts vary depending on the product and are billed in the following Health insurance copper.

The advantage of insurance with co-payments is that your premium is usually reduced and that the amount contributed by each consultation is not equivalent to its actual price, if not a minimum part of it.

Medical box + Refund

With this type of Health insurance, the user has a choice of doctors and clinics, regardless of whether they have agreements or not with a specific insurer. However, the services that are not in the medical chart are paid in advance, then the expenses are presented to the company and it is responsible for making the reimbursement to the insured between 70 and 100% of the costs, as established in the contracted Health policy.

This type of insurance has a higher premium than the rest. It is an interesting model for all those who want to opt for private health insurance but want to see doctors who are not in the care of the company with which they want to hire it.

Medical product without hospitalization

This type of health insurance does not include the possibility of hospitalization.

Dental

It exclusively includes dental treatments and services. This coverage is usually included in more complete health insurance. This product offers greater coverage than public health coverage and is priced lower than the consultations of private dentists.

Some insurers offer special promotions on their products if more people are included in the policy. Others, instead of applying a discount, have unique products for families and groups with special prices. In this way, the hedges acquire an even lower price.

Private health insurance coverage

Among the coverages that include health insurance are:

  • General Medicine The insured chooses his family doctor from among those listed in the list of doctors of his company. The assistance will be provided in the consultation, but in many cases, if the circumstances require it, it will be done at the user’s address.
  • Pediatrics It is one of the services best valued by citizens. These are specialized medical assistance for minors, which, like general medicine, will be provided in the office or at home.
  • Puericultura. Newborns are entitled to medical assistance, in consultation or domicile, in charge of the mother’s policy. This warranty is covered for a few days, depending on the policy, but not all offer it.
  • Nursing. The nursing service is provided in the office or even sometimes at home after the prescription of the attending physician who is treating the patient.
  • Hospitalization. Guarantees free stay in a private hospital of the patient for at least 24 hours. It is a coverage highly valued for the conditions of these hospitals as well as the comforts of obtaining a single room, in most cases.
  • Day Hospital. It allows the patient to remain in the hospital units called “by day” after receiving a specific treatment or having been under anesthesia. It is usually for less than 24 hours.
  • Emergency Service. The policyholder has a 24-hour emergency service for home care and hospitalization. The Optional Lists include telephone numbers and addresses where to go in case of an emergency.
  • Special treatment techniques. Some insurances include among their coverages:
    • aerosols and ventilation therapy
    • the surgical laser
    • extracorporeal lithotripsy
    • oncology
    • rehabilitation
    • Pain treatment
    • Other specialized services.
  • Family planning. Medical policies may include consultations, IUD implantation, vasectomy, and tubal ligation, as well as the diagnosis of the causes of infertility or infertility.
  • Preventive Medicine. As the prevention cardiologist, gynecological, urological, digestive system and children’s health.
  • Other services included, depending on the insurer and the product purchased are:
    • possibility of second medical opinion
    • rehabilitation and physiotherapy
    • transplants
    • prosthesis
    • acupuncture
    • homeopathy
    • chiropody
    • umbilical cord cryopreservation
  • The dental coverage can include clinics, emergency departments, diagnostic tests, oral cleanings and fillings, root canals, orthodontics, and implants.

What is excluded from insurance coverage?

The coverage of private medical insurance usually excludes attention to pathologies before contracting the policy and not declared when hiring them. Also the pathologies produced in professional or sports activities of high danger. The plastic surgery for cosmetic reasons, sex change, those related to morbid obesity and robotized are also out of their guarantees.

Its centers do not perform experimental diagnostic or treatment techniques or not recognized by medical science. They usually do not facilitate the medication, except in case of hospitalization or if it is chemotherapeutic.

Health care abroad

Most private medical insurances have international health coverage for travel abroad. Normally, insurers offer a specific telephone number to contact them in the case of medical insurances if a medical emergency occurs to the insured when they are temporarily outside their country. If possible, they take charge in their centers or through agreements with other insurers, and in other cases, the patient will pay the assistance abroad and his insurer will reimburse him when he returns. They generally cover temporary trips, less than 3 months long.

To take into account with health insurance

Lacks

Some health products include deficiencies. The lack indicates the time that must elapse between the discharge in medical insurance and the possibility of using a certain health care service. Until this period has elapsed, the insured must bear the expenses related to the interventions he needs.

Thus, normally if the insured becomes pregnant after contracting the policy, the follow-up of the pregnancy is covered. However, childbirth and epidural anesthesia will only be covered after a period of lack that will be fixed in the contracting. This period will not be required if there is a danger to the mother or the future child. In the case of Dental insurance, for example, the period of lack is usually about 30 days.

There are other exceptions to the shortcomings, such as when changing companies.

Preexistence

The pathologies that the client has before the date of contracting must be communicated to the insurer by the policyholder before its formalization. In this way, the company can assess the risk to be covered with specific insurance.

Indisputability

Through this clause, the insurer is responsible for the coverage of a pre-existing illness if the insured did not know it or did not intentionally omit it when completing the questionnaire before the acquisition of the insurance product.

Choose Private Medical Insurance

Health insurance provides the user with a wide range of family doctors and specialists. Its prices and coverage make it an accessible, affordable and highly recommended product. Among the services best valued by the insured are oral care, gynecology service for women and cardiology for men. With medical insurance, the health of the whole family will be well protected.

Choose the type of medical insurance you choose, whether with a co-payment or without it, with reimbursement, without hospitalization, or only Dental insurance, the speed and ability to choose when accessing specialists or the attending physician are indisputable. The efficiency of the medical staff of the insurers, in addition to the personal choice of the hospital and access to the most modern medical techniques, among other issues, make Health insurance the best option when it comes to protecting your health and health. your family. If you also want to get the best coverage at the best price, go to the Health policy comparator of Rastreator.com and in a couple of minutes, you can access them.

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