The health insurance policy is the set of documents that title the contract signed between the insurer and the policyholder, and which includes the respective General, Special and Particular Conditions, as well as the Additional Minutes to the contract.
The policyholder is responsible for the policy as well as for its payment. The insured person is the one who benefits from health insurance. The insured person and the policyholder can be the same individual. And the same health policy can cover several insured people (for example, your entire family).
The health insurance premium is the amount you will have to pay to access your coverage. This amount to be paid depends on the age, sex, lifestyle and medical history of the insured persons. The premium is always annual, but it can be paid, in addition to annually, on a monthly, quarterly or semi-annual basis.
The insured capital corresponds to the maximum amount that the insurer undertakes to pay for treatments, consultations and other medical acts.
How to use health insurance
Whenever you go to an appointment or undergo an examination or treatment within the agreed network, you will have to pay a stipulated amount in accordance with the conditions of the contract. It is called co-payment , the percentage of the cost of the medical procedure that will be your responsibility.
There are situations in which you will have to advance the cost of the consultation or treatment. If you are using the services outside the agreed network of providers, for example. To be reimbursed for this amount, you must send the medical bill to the insurer and it will reimburse you : the transfer of the amount that is borne by the health insurance.
Health insurance coverage
Ambulatory encompasses medical acts that do not imply hospitalisation: consultations, emergencies, analyses, exams and physiotherapy. Some insurances limit the number of appointments you can access per year. This is why choosing the right health insurance is so important.
All medical acts that require an inpatient stay are considered a hospital stay . Your health insurance will allow you to use the services of each hospital in the agreed network up to the limit imposed by the capital of your policy. However, this hospitalisation may also take place outside the agreed network, in which case you will have to bear part of the expenses (co-payment).