Insurance, Plan, or Health Card: What are the Differences?

Do you already know the differences between the products and are just looking to hire health insurance? Get straight to the point: use the services of Poupança no Minuto mediators. If you want to first understand which product is most suitable for you, continue reading the article below.

What is health insurance?

Health insurance is a policy that covers costs for the provision of health services, according to the coverage options chosen.

By hiring health insurance, you have access to coverage for certain medical expenses, not having to bear them or only partially bear them, through the payment of a premium (usually monthly).

Not sure about healthcare, it may include some coverage options, but not others (exclusions), such as accidents at work, occupational diseases, or pre-existing conditions.

How does health insurance work?

A health insurance has two operating systems when it comes to reimbursing healthcare expenses.  

It can be through a refund system, where the policyholder pays expenses directly and the reimbursed amount is later refunded, or a direct payment system by the insurer to the service provider included in the conventional network. There may also be insurance policies that combine the two systems.

Regarding the amount that is refunded in the refund system, you should know that it will be detailed in the policy: 

• Maximum participation percentages;  
• The value available in each coverage;  
• If exists, the value of the initial deductible for each coverage.
• The maximum deadline to request the refund of expenses, starting from the date they were incurred.
• The maximum deadline for the insurance company to reimburse the policyholder.

But in the direct payment system, just knowing that, when paying for expenses after healthcare, you only pay the part not covered by insurance if the service provider is included in the network. This is because the portion covered by the insurer is paid at that moment directly to the service provider.

What is the difference compared to health insurance?  

Health insurance also operates according to a network of providers, where the included entities provide access to healthcare at a lower cost than non-adherent users. However, the network of providers is more limited than in an insurance or health card, and payment is always made through a reimbursement system, with the customer paying first.

Health insurance is also a more targeted option for personal needs of a client, with more specific coverage.

Unlike health insurance, health plans do not have waiting periods, age limits to hire and maintain, deductibles or maximum ceilings.  

In addition, the amount you pay does not increase as you get older, unlike health insurance premiums.  

And in this case, there are also no exclusions for pre-existing conditions, as no exams or medical questions are conducted prior to hiring.

What differentiates insurance and a plan from a health card?

The health card is a more simplified option, with fewer health services coverage. It provides access to discounts on some medical services, such as specialty consultations, nursing, and exams, but generally does not cover hospitalization.

Just like health insurance, the health card differs from health insurance in that the network of providers is smaller, it has no waiting period, age limit, does not exclude pre-existing conditions, and the cost is lower.  

In this case, the discount is applied at the time of payment after the clinical act, and not by reimbursement.  

Despite the health cards issuing entity not being an insurer, it is the same ones that issue and sell this product.

To clarify any doubts regarding health products, the insurance mediators Poupança ao Minuto can assist you. And to contract health insurance, they are also the ones you should turn to: they offer a free and effective service, so you can subscribe to your insurance without any complications.