How does health insurance work?

There are those who confuse health insurance with medical insurance, but the truth is that they are different services. Know more details!

Ever heard of health insurance? It is very common for people to confuse this type of insurance and health plan. And while they have similarities, they are different services.

In this way, we will explain in this article all the details about health insurance. So that you can solve your doubts and, if you want to hire the product, know exactly what it is about.

Health insurance is an alternative to health insurance. Especially for those who do not want to depend exclusively on the Unified Health System or cannot assume a high amount of debt .

What is health insurance?

The insured is free to seek the doctor they want without being stuck in the accredited network.

Therefore, when needing medical services, users can consult and, depending on their policy , request full or partial reimbursement of the amount paid.

The policy is contracted based on the risk questionnaire and takes into account all your needs and preferences. Thus, the monthly fee ends up being lower than a health plan.

How does health insurance work

Health insurance guarantees and coverage

When hiring this service, you need to be sure about the warranty and coverage. After all, when choosing it and not the plan, you need to be sure that your medical needs will be met.

Each insurance company works in a different way. With different coverage that, in general, are services in outpatient clinics, hospitals and obstetric clinics. Therefore, before hitting the hammer, you need to study your options well.

Find out if your insurer offers:

  • Hospitalization (operations and hospitalizations);
  • Outpatient care (consultations, exams and analyses);
  • Stomatology (dental consultations and treatments);
  • Childbirths (natural deliveries and cesarean section).

However, ensuring the provision of these services is not your only concern when choosing an insurance company. There are a few things that you should check before signing a contract. We’ll talk about them later.

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Considerations when choosing health insurance

It is like any other service, and when choosing the insurance company that will take care of your medical needs, it is important to pay attention to a few points.

Research the complaint numbers. Companies that accumulate excessive numbers of complaints are sure to pose future headaches.

As we said a few paragraphs above, the coverage offered may vary from one insurer to another, but there are some basic services that need to be provided in any case.

The grace period is the period of time between the contracting of health insurance and the date that the client can, in fact, use the service. This time must be clear in the contract and you need to be aware of it.

The last point to be considered is cost-effectiveness , that is, the service provided must meet the needs at a fair price.


Policy is the document issued by the insurer, which contains the insured’s data and all the conditions of the contract being insured.

In this case, you must pay attention and ensure that this document contains all the services you have contracted. Neither more nor less than what was agreed.

Read the contract carefully before signing and clear all your doubts with the insurance company. If you’re not 100% confident with the deal, don’t sign.

How much does health insurance cost?

The price of health insurance can vary depending on the insurer, the plans offered and many other variables.
However, the average should be around R$ 600.00. Payment can be in cash or in installments, depending on the agreement with the chosen insurer.

How is it redeemed?

The redemption of health insurance is the “return” of a part of the amount that was paid during the current contract period.

The situations in which this redemption is possible differ according to the clauses of your policy. However, there is a list of situations in which it is possible to request the redemption according to the Superintendence of Private Insurance:

  • Natural Death;
  • Death by Accident;
  • Total/Partial Permanent Disability due to Accident (IPA);
  • Total Permanent Functional Disability Due to Illness (IFPD);
  • Total Permanent Labor Disability Due to Illness (ILPD);
  • Medical, Hospital and Dental Expenses (DMHO);
  • Temporary Disability Days (DIT);
  • Daily Hospitalization Rates (DIH);
  • Serious Illnesses (DG)

To request the redemption, the insured must contact the insurance company and obtain the necessary documents. However, the required documents change from company to company. Consult your insurer.

Is it worth having health insurance?

After reading the article, you may still be wondering if health insurance is really worth it. The answer to this question will depend on your financial budget and the expectations you have.

However, in general terms, this is a cheaper alternative that offers a service similar to those provided by health insurance.

So, analyze the alternatives well, make a financial plan and decide consciously, that way you won’t end up in debt.


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