Health insurance provides the insured party with healthcare coverage, medical care and sometimes economic support in the event that they suffer an illness or disease.
1. Medical Care
The insured person receives medical/surgical care from a team of medical professionals and health centers agreed with the insurance company.
The main coverage consists of the provision of healthcare services. The payment of cash compensation as an alternative to the healthcare service provision is not permitted. The basic healthcare service can be complemented by certain economic provisions or other additional coverage.
For example, coverage for personal accident, payment of a temporary income, storage of stem cells from the umbilical cord, etc.
2. Reimbursement of Medical Expenses
In the case of illness or accident, the insured person can visit any doctor or health center they like, anywhere in the world, to get the medical attention they need. The insured person pays for the medical expenses incurred and later sends to the invoice and medical report to the insurance company for it to reimburse the amount corresponding to the conditions agreed to previously in the insurance policy. The usual practice is to agree to a percentage reimbursement of the total expense, which can vary depending on the medical care received, and sometimes maximum reimbursement amounts are also agreed to in the policy.
This type of insurance can also work in conjunction with the Healthcare Insurance whereby the insured person, without losing their freedom of choice, can receive medical treatment from professionals in the on the insurance company’s medical team. If the insured person uses the insurance company’s team they will not have to make any payments, as the insurance company pays the doctor’s or hospital costs directly and usually covers 100% of the expenses incurred (at all times within the limits established in the policy).
The policyholder receives a fixed economic amount established in the policy in the event of certain situations relating to his or her state of health (hospitalization, sick leave, etc.). The main coverage of this type of insurance is usually as follows:
- Compensation for temporary disability (or “sick leave”): This provides the insured person with a daily cash amount while they are unable to do their usual professional activity.
- Compensation for hospitalization for any reason: The insurance company pays the insured person a daily amount if they are admitted to hospital, regardless of the circumstances that have caused the hospitalization.
- Compensation for surgical intervention: The insurance company pays the insured person a single payment (established in accordance with a scale) if they have to undergo surgery.
4. Compensation for serious illness
A capital amount is paid out if the insured person is diagnosed with, or suffers from, a particularly significant disease (e.g. heart failure, ischemic stroke, cancer, cerebrovascular accident, chronic kidney disease, etc.). This insurance may include a complementary contingency to cover transplants.