I04E - Health Insurance

This bulletin provides information on the types of medical insurance available in Portugal and outside for Portuguese residents.  The immigration authorities require foreigners wishing to take out a resident’s permit to have health insurance protection. For EU citizens the National Health Service protection from their country of origin is normally adequate. For non-EU citizens however, private medical insurance is mandatory. Even for EU citizens additional protection may be considered desirable and many such as residents take out private health insurance policies.

This Bulletin discusses some of the factors to consider when choosing a policy.  In all cases afpop recommends that members take professional advice before making a final decision. 

Types of medical insurance and schemes available
Medical treatment can be expensive and so medical insurance is also expensive. Some schemes for instance do not cover the long-term treatment of chronic illnesses, such as cancer, or for specialist treatments such as organ transplants.  Insurance schemes therefore provide various levels of cover to meet their clients’ needs.

Basic Policies normally covers the cost of unexpected Hospital internment and Surgery, as well as medical expenses, consultations, exams, and treatments up to the level of the policy amount. Some companies apply an excess which the insured person must pay first either per event or per policy term. In some schemes additional cover can be arranged to include a salary subsidy during hospital internment.  The level of the premiums will relate to the maximum level of payments payable per year and to the amount of excess payable by the policy holder.

The need for medical treatment increases with age.  Many schemes therefore also have premiums that increase with age.  Most schemes also have a maximum age for taking out a new insurance policy (often 55-65 years), a limit to stay insured (70-75) and few policies are for Lifetime. Few medical insurance schemes cover existing conditions, and routine dental treatment and pregnancy are often excluded.  Some schemes still exclude AIDS related symptoms and treatment for persons with HIV infection, mental disorders, congenital problems, alternative medicines. 

A policy may include coverage for medical expenses during periods of travel outside of Portugal and repatriation back to Portugal in case of sudden illness or personal accident.  However, this coverage is usually limited to short periods of one to two months.

Portuguese or foreign insurance company?
Most medical insurance schemes offered by Portuguese insurers are aimed at Portuguese citizens and long-term residents.  They are therefore designed for the level of medical costs in Portugal, assume that participants will also have recourse to the National Health Service, and usually do not cover treatment in other countries except when travelling on holiday.  As a result, premiums tend to be considerably cheaper than for schemes provided by international insurers for expatriates.  A Portuguese scheme may therefore be the most appropriate for those who intend to stay in Portugal permanently or who are of an age that will permit them to take out coverage with another company when they leave Portugal.

Schemes provided for expatriates by the larger insurance companies or specialist medical insurance companies are usually flexible and permit the policyholder to move from one country to another.  They may not cover the policyholder in their country of nationality and, given the higher cost of medical treatment in the USA, may apply higher premiums for cover in North America or exclude cover all together.

Tax deductions
Medical expenses, including medical insurance premiums, are allowable expenses for deduction against income tax in Portugal.  There are limitations to this, and members should confirm whether a particular policy is tax deductible before taking out the policy.

Selecting a policy provider
Companies like MEDAL offer afpop members special group terms and details of these arrangements can be obtained directly from their local agents, whose names and contact details are available from the afpop office. Policies offered by these companies diverge in many terms and also vary considerably in price. When considering taking out a new policy, members are advised to carefully examine some issues:

• Capitals for Hospital Internment/ Surgeries and Outpatient Expenses

• Excesses

• Coverage for Pre-existing Conditons 

• Cancelation of the waiting period 

• Coverage for treatments considered as long-term care, palliative care or convalescent care

• Confirm if you are buying a health insurance or a Discount card, which only give you discount in the network providers and not cover you in case of illness or accident

• Payments on Doctors/Clinics/Hospitals that belongs to insurance company network

• Percentage of refund when you use providers that does not belongs to insurance company network

• Age limit to join and stay insured

• If there are any sub-limit capitals inside the main covers for some particular treatments (Cancer, robotic devices, Prostheses, Physiotherapy…)

• The rate at which premiums have risen over recent years should also be questioned.

Members who already belong to a medical insurance scheme may have obtained substantial rights in that scheme.  They should therefore think very carefully before deciding to move from one scheme to another and satisfy themselves that the terms of the alternate scheme compensate for the loss of those rights. If you are insured by another health insurance policy, you must confirm that new policy will accept your clinic history since the starting date of your actual policy and if they will cancel the waiting period.

While afpop can give general guidance on health insurance, the decision to join a particular scheme must be the member’s and the member’s alone. afpop cannot accept responsibility for any dispute between a member and the insurer or dissatisfaction with any service provided by the insurer such as the refusal to meet certain claims.