What distinguishes health insurance, health plan, and health card?

What distinguishes health insurance, health plan, and health card?

In the end, what is the difference between insurance, health plan, and health card? These three products that can protect our health differ in some factors. Let's see what they are.

22 Aug 20234 min

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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 the mediators Poupança no Minuto. 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 chosen.

By hiring health insurance, you have access to coverage for certain medical expenses, without having to bear them or partially bear them, through the payment of a premium (usually monthly).

Not having health insurance may include some coverage options, but others may not (exclusions), such as work accidents, occupational diseases, or pre-existing conditions.

How does health insurance work?

A health insurance has two operation systems when it comes to reimbursing health care expenses.

It can be done through a reimbursement system, where the insured pays the expenses directly and the reimbursed amount is refunded to them later, or through direct payment by the insurance company to the service provider included in the conventional network. There may also be insurance policies with a combination of both systems.

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

  • The maximum contribution percentages;
  • The value available in each coverage;
  • If exists, the value of the initial franchise for each coverage;
  • The deadline to request reimbursement for expenses is calculated from the date they were incurred;
  • The maximum deadline for the insurance company to reimburse the policyholder.

But in the direct payment system, you just need to know that when paying expenses after healthcare, you only pay the portion not covered by insurance if the service provider is in the conventional network. This is because the portion covered by the insurer is paid directly to the service provider at the time.

What is the difference from the health plan?

Also, the health plan is governed by a contracted network, in which the included service providers give access to healthcare for a lower price than non-subscribing 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 an option more directed towards personal needs of a client, with more specific coverages.

Unlike health insurance, health plans do not have waiting periods, age limits for contracting and maintaining, deductibles, or maximum "plafonds".

In addition, the amount you pay does not increase as you get older, just like health insurance premium.

And, in this case, there are also no exclusions for pre-existing conditions, as no examinations or medical questions are done prior to contracting.

What distinguishes insurance and plan from health card?

The health card is a more simplified option, with fewer health services covered. It grants access to discounts on some medical procedures, such as specialty consultations, nursing, and exams, but overall, it does not include hospitalization coverage.

Just like health insurance, the health card differs from health insurance in that the network of providers is smaller, there is 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 through reimbursement.

Despite the issuer of health cards not being an insurance company, they are the ones who issue and sell this product.

To clarify any doubt regarding health products, the insurance mediators at Poupança ao Minuto can help you. And to get health insurance, they are also the ones to turn to: they provide a free and efficient service, so you can easily subscribe to your insurance policy.

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