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Health Insurance - Private Individuals

Health is a precious gift.

If you care about your well-being and want above all else to receive quality service when it comes to medical assistance, we provide a comprehensive health team which ensures an important range of services, from designing health plans to replacing the insurer in reimbursing costs, with significant improvements in speed of service.

Did you know there are two different types of Health Insurance?

Insurance by Reimbursement - where you pay your costs and the Company subsequently reimburses them.
Managed Care Insurance - where you make use of the services of agreed establishments and doctors, and only have to pay the corresponding contribution (e.g. Médis, Advance Care, Multicare, etc.)

FAQ - Health Insurance

Sickness insurance covers treatment for accidents and sickness in Portugal and, normally, abroad if they occur during a trip lasting up to 60 days, or with treatment prescribed by insured person’s doctor, with the previous consent of the clinical office of the insurer, in accordance with the cover expressly provided for in the contract conditions, within the limits established therein (excesses and insured amounts).

If the insured person receives any contribution towards costs from a social security system, the cover shall only apply to the amounts paid by the user. The cover can be provided by means of reimbursement of costs incurred with healthcare, direct payment to the health service providers or a combination of both systems.

•    Occupational illnesses and work-related accidents.

•    Nervous disorders and psychiatric illnesses.

•    Check-ups and general health examinations.

•    Disturbances caused by alcoholic intoxication or illegal use of drugs and narcotics.

•    Accidents or illnesses resulting from participation in sports competitions involving vehicles; sports at a professional level and respective training, or at an amateur level in official championships; underwater hunting, boxing, martial arts, parachuting, bullfighting and others.

•    Treatment or surgery for purposes of obesity correction, weight-loss or similar, artificial fertilisation, organ or bone marrow transplants, and the consequences thereof.

•    Aesthetic, plastic or reconstructive treatment and/or surgery and the consequences thereof, unless due to sickness or accident covered by the insurance

•    Costs relating to internment in psychiatric establishments, spas, nursing homes, old people’s homes, rehabilitation centres for alcoholics or drug users.

•    Illnesses and handicaps which pre-date the insurance contract.

•    Consultations, treatment and surgery of a stomatological nature

•    Costs related to pregnancy, childbirth and abortions

The policyholder and insured person have the duty to tell the truth about the circumstances and consequences of any accident or sickness, follow the instructions of the assisting doctor, submit if necessary to medical examinations specified by the insurer, notify the insurer of any hospital admission or surgical intervention, provide supporting documents for the costs incurred with healthcare and inform the insurer of the claim event within a maximum of 8 days of its occurrence or of becoming aware of it.

The insurance contract is only valid after payment of the premium, without which cover ceases. The premium must be paid:

•    Initial premium or first instalment thereof - on the date of signing of the contract

•    Subsequent instalments of the initial premium, the premium for subsequent yearly periods and subsequent instalments thereof - on the dates set out in the contract

•    Variable premium determined by adjustments to the value or alterations to the contract - on the dates specified in the respective notifications.
The insurance contract may be terminated specifically as a result of:

•    - Expiration - automatically with the occurrence of a contractual condition (term and cessation of the risk, for example);

•    - Withdrawal - The insurance will terminate at any time by agreement between the policyholder and the insurer, with the consent of the insured if different from the policyholder

•    - Resignation - by unilateral decision of one of the parties, which must notify the other party with a minimum of 30 days’ notice in relation to the renewal date (maturity);

•    - Dissolution - because one of the parties invokes at any time a cause for termination (a claim event under certain circumstances, for example) or because the policyholder, if an individual, does so of their own volition in certain cases following receipt of the policy. Except for life insurance, capital redemption operations and long-term health insurance, in the event of termination before the contract term, a refund of the premium proportional to the time remaining shall be due.

•    Providing false or inaccurate facts or circumstances to the Insurer or omitting them when known will result in the contract being invalid (void).

•    It is advisable for communications and notifications between the parties to be made by registered letter or other means resulting in a written record, to the last address of the policyholder or insured as provided in the contract and to the registered offices of the insurer.

•    Unless otherwise agreed, the premium is yearly, payable in advance and in full, without prejudice to any division into instalments for payment purposes, and coverage of the risk by the insurer only begins after payment of the premium or first instalment thereof. The parties may agree that cover shall become effective 30 days before the due date of the premium or first instalment thereof - however, the validity of the cover shall always depend on the payment of the premium or instalment.

•    The inclusion or removal of insured persons listed in the contract affects the amount of the premium due. Inclusion or removal from the 1st to the 15th day of the month shall generally be considered to become effective on the 1st of that month, while from the 16th to the end of the month they shall, for the purposes of the premium, be considered to become effective on the 1st of the following month.

•    The policyholder and insured person must inform the insurer of any other insurance policies providing the same cover as listed in the contract entered into or to be entered into.

•    The increased risk regime no longer applies to health insurance policies, following entry into force of the new Law on Insurance Contracts (Decree-Law no. 72/2008 of 16 April).