Health care insurance


Health care insurance is insurance that covers various medical services, such as consultations and tests. Its scope is stipulated in a contract and requires the payment of a premium by the insured.

That is, this type of policy covers the expenses of medical consultations, tests, treatments, medicines, emergency services and others. This, in exchange for a single or periodic payment to be made by the beneficiary.

To access coverage, the applicant must fill out a form. In this way, the insurer will know the level of risk of the insured and the probability of a loss occurring.

Characteristics of health care insurance

Among the characteristics of health care insurance are:

  • The insurer can directly bear the insured's expenses or reimburse him for the services he has consumed. In the latter case, the beneficiary is treated at the center of his or her preference and then presents the invoice or receipt to the insurance company.
  • Some policies require a co-payment, that is, the insured must pay a part of the services received.
  • It may be that, for its use in certain specialties, it must have a grace period, that is, a period during which the coverage is not active, even if it has been contracted. This means that the individual signs the insurance contract, but must wait, for example, eight months to be able to use it for that specific service. In this way, the company ensures that its client is not purchasing the insurance to take advantage, knowing that he has a disease or health condition.

Exclusions from health care insurance

Healthcare insurance exclusions vary, depending on the contract, but are usually:

  • Pre-existing care, that is, injuries or illnesses suffered by the insured before signing the contract. These must be communicated to the insurer. Otherwise, if a lie is discovered, the policy can be canceled.
  • Suicide attempts or self-harm.
  • Drug addiction alcoholism treatments.
  • Illnesses or injuries caused by work activity.
  • Diseases or injuries generated by the practice of risk sports.
  • Aesthetic treatments and cosmetic surgeries.

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