Learn how to choose health insurance (if you have or have had a medical condition)

Health is priceless. There’s no point in having financial security if you or your family have health problems that prevent you from enjoying life to the fullest.

As the past two years of the pandemic have shown, the unexpected happens, and the best way to prepare for it is to have a Health Insurance that ensures quick and convenient access to medical care. According to data from the Basef Seguros study, conducted by the market research firm Marktest, About 3 million Portuguese have or benefit from health insurance, a figure that corresponds to 34.3% of the population consisting of residents of Portugal aged 15 and older.

Having grown steadily for 16 years, this indicator rose sharply with the onset of the pandemic, rising from 30.7% to 34.3% between 2019 and 2021, a rise never before seen in such a short period of time since Basef Seguros began publishing its data.

Although the number of Portuguese people seeking health insurance is on the rise, some questions remain regarding the scope and extent of this type of coverage, especially among those who have or have had a medical condition.

If you want to learn how to choose the health insurance plan that best suits your needs, then this article is for you.

If you have or have had a medical condition and are considering purchasing health insurance, here are the factors you should keep in mind:

Coverage, exclusions, pre-existing conditions, and age limits

Health insurance may not cover all treatments or medical specialties, which means that some risks may be covered while others are not. Uncovered risks are called exclusions and may include, for example, cosmetic surgery, checkups, or addiction treatment.

In addition to paying attention to the coverage and exclusions of the health insurance policy you intend to purchase, it is very important—if you have or have had a medical condition—to understand the insurer’s rules regarding pre-existing conditions and age limits, since conditions that are known and disclosed at the time the policy is issued are not necessarily covered by the policy.

Grace Period

Regarding this waiting period, the law (Legal Framework for Insurance Contracts) states that the contract may provide for “a waiting period of no more than one year for coverage of pre-existing conditions.” In most health insurance plans, this period ranges from 60 to 90 days for outpatient care (consultations, tests, and treatments), dental care, and hospitalization, and 365 days for childbirth and serious illnesses.

That's why it's important to clarify this point, especially if you have a medical condition that may require additional medical care.

Prompt access to health care

When your health fails, prompt care is essential. Pay special attention to the network of health care services and specialties offered by the insurance plan you intend to purchase, as well as their proximity to you—thereby avoiding long wait times—and to the home care services the plan provides.

Type of insurance

Health insurance comes in different forms: those that refund or of affiliated network, and the mixed (a combination of the two types of payments).

Under the reimbursement plan, policyholders may choose which doctor or medical service they wish to use, and are responsible for paying the full cost of the service. After paying for the healthcare service, the insured person submits proof of payment to the insurer, which will reimburse a predetermined portion of the amount.

If the Insured Person receives care within the Network of Participating Providers, they pay a minimum amount, as agreed in the policy, using a card that grants them access to a network of thousands of healthcare providers offering various types of medical care, where, among other services, they can receive general and specialty medical consultations, clinical exams, and diagnostic tests, paying only the portion of the cost not covered by the insurance.

If the service provider or doctor is not part of the network of providers, you will have to pay the full cost of the service directly and will be reimbursed later upon submission of the necessary documentation.

What is the best health insurance for people who have or have had a medical condition?

As we mentioned, the terms regarding pre-existing conditions are one of the most important factors to consider when purchasing health insurance if you have or have had a medical condition.

This is one of the strengths of the health insurance plans offered by EXS Seguros’ partner insurers. In total, EXS has established partnerships with the country’s leading insurers (26 in all), thereby ensuring the solution best suited to each policyholder’s needs.

It is among this wide range of options that you’ll find the only health insurance plan on the Portuguese market that guarantees coverage for any illness the insured may have (even those diagnosed before enrollment), has no age limits for enrollment or policy tenure, and does not require medical questionnaires.

In addition, health insurance arranged through EXS gives you access to the private healthcare system and its various specialties at a competitive price, thereby helping you avoid long wait times, offering you greater choice, and providing benefits in terms of home care.

Easy to sign up for, taking out health insurance through EXS provides access to a network of more than 16,000 healthcare providers and 90 hospitals spread across nearly three hundred municipalities nationwide, guarantees round-the-clock care 24 hours a day, 7 days a week, and EXS covers a wide range of expenses regardless of the insured person’s age or pre-existing conditions:

• Expenses for general and specialty medical visits at hospitals, doctors' offices, or at home;
• Expenses for treatments and additional diagnostic tests;
• Expenses Related to Serious Illnesses.

If you'd like to learn more, come with us and discover a handful of reasons to choose one Health Insurance with EXS Seguros so you don't have to pay for unnecessary coverage.

The process is simple—just ask for one simulation using the online form that EXS offers you—please wait for us to contact you, and you’ll receive a comparative analysis of the best offers from 25 insurance companies, with no obligation and at no additional cost, and always with close, personalized support.