Clínica
Health insurance:
a guide for anyone deciding
How health insurance works in Portugal, what plans usually cover (and do not cover), and how to compare quotes without getting lost in the technical terms.
Health insurance vs health plan
Many people use the two terms as synonyms, but they are different products.
| Health insurance | Health plan | |
|---|---|---|
| What it is | Insurance contract regulated by the ASF; the insurer assumes financial risk | A discount card in a network of providers; the company does not pay medical expenses |
| Example | Multicare, Médis, Allianz Saúde | Operator plans (Vodafone, MEO) |
| Inpatient care / surgery | Yes, typically | Usually not, or very limited |
| Price | Higher | Lower, or included in another service |
If you do not yet have insurance, or if the operator plan does not cover what you need now, you can book a one-off consultation — without an annual policy. The next article in the series, Is health insurance worth it?, compares the annual premium with the cost of paying consultation by consultation.
ASF
Health insurance contracts are regulated — a discount plan is not regulated in the same way.
Network
In the contracted network, the insurer pays the provider; only the co-payment remains.
Reimbursement
Outside the network, you pay first and then claim reimbursement up to the policy limit.
Without a policy
You can also book a one-off consultation, without taking out annual insurance.
How the two access modes work
Contracted network
You use providers with an agreement with the insurer. The insurer pays the provider directly — you only pay any co-payment set out in the policy.
Reimbursement
You use the provider you want, pay out of pocket, and then claim reimbursement from the insurer up to the contracted limit. Deadlines and the reimbursement percentage vary from plan to plan.
What is usually included in basic plans
- Hospital inpatient care — the insured capital varies, from about €25,000 to unlimited depending on the plan
- Consultations, tests and outpatient treatment — network access or a fixed annual limit
- Online medicine / telemedicine — increasingly common to include at no extra cost for the insured person
What is usually left out or limited
- Waiting periods — waiting time after you take out the policy before certain cover comes into force
- Pre-existing diseases or conditions — often excluded, except in specific plans (rare on the market)
- Childbirth — frequently an additional option, not included in the basic plan
- Mental health — increasingly covered, but not always on the entry-level plan
- Dentistry / dental care — usually requires specific optional cover
- Clinical assistance while travelling / abroad — not always included in the most basic plan
Factors that determine the premium
| Factor | Impact |
|---|---|
| Age | Greatest impact — the premium rises with age, because of the higher claims risk |
| Breadth of cover | More complete plans cost significantly more |
| Insured capital and deductibles | Higher deductibles reduce the monthly cost |
| Household | Discounts for including more people (up to 15% in some cases) |
| Clinical history | May raise the cost or limit cover |
Frequently asked questions
A medical consultation without an annual policy
If you do not yet have insurance, or if the insurance does not cover what you need now (for example, a travel consultation or a prompt second opinion), LON Clinic lets you access a medical consultation without taking out an annual policy. Consultations are by telemedicine, in Portuguese, English, Spanish, French and German, and the clinic has a component with a special focus on travel medicine.
Need a consultation
without waiting for insurance?
Book online, the same day, without taking out an annual policy.
See consultations →Telemedicine · no travel · prescription when clinically indicated
A compilation of public information on health insurance and health plans in Portugal. Products, cover and prices change — always confirm the General Conditions and the Product Information Document, and consult the ASF when necessary.
Revisto pela equipa médica da Lon Clinic ·