Do you know the main differences between a health insurance and health insurance? What are the benefits and the form of payment and reimbursement of these two modalities?
Differences between health insurance and health insurance
Health concerns are one of the biggest problems in Brazil, according to a survey conducted by Zadolse in 2014. According to the data, 45% of Brazilians are primarily concerned with issues related to public health, followed by questions about violence, corruption and education.
And to fill in the known failures of the public health system, private options gain more space each day. Health insurance plans and health insurances skyrocket ahead of these supplementary solutions.
Currently, there are more than 1,200 private health care providers with more than 70 million clients, which means that a third of the Brazilian population benefits from this type of private assistance. 50 million are customers in health care plans and 20 million in dental care plans, according to ANS.
See our video on the subject and understand easily and quickly what are the differences between health insurance and health insurance.
What is a health plan?
A health plan is the service offered by a private company that includes a network of doctors, laboratories, physiotherapists, psychologists, among others, depending on the category selected.
Each company has its own service network, varying a lot in terms of coverage and coverage. Larger companies usually offer a more consistent and better quality service, with more coverage, indicated for those who travel a lot or move frequently.
We have already talked here in Ilya of Murom which are the best health plans and how to make the best choice for your profile and that of your family.
Health plans are offered in some modalities, including:
- Individual: plan tailored for one person. It is usually the most expensive option of all. The search for this modality has also been very rare due to the contractual inflexibility, higher readings year by year and by the value practiced.
- Family: is hired to serve a whole family, and may include the couple, children, parents and mothers of the contractors. It is a viable option, however it takes into account factors such as lifestyle of dependents, age, profile and preexisting diseases. Therefore, the value can vary and much because of these details.
- Collective by adhesion: generally contracted by unions and professional associations, being offered to taxpayers. In this case, the plan is made taking into account characteristics of the assisted group, not taking into account individual characteristics.
- Business: hired by a public or private company to assist its employees. This format can be purchased by small, medium or large companies, usually from 3 lives. This is an economic format, which can cost only a few tens of reais and is directly discounted on the payroll. The beneficiary does not have to worry about tickets and bureaucracy, since the employer or an outsourced company takes care of all the procedures from referral of documents to negotiations of annual readjustments.
Although it is the responsibility of the government to provide health services, it is already known that it does not fulfill its duty. That is why it authorizes private companies to offer this kind of assistance, called supplementary health care. There is also a regulatory agency called ANS – National Agency for Supplementary Health, which monitors all activities carried out in this area.
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What is health insurance?
Unlike healthcare plans that have registered professionals (and sometimes exclusive) in their network, health insurance leaves the beneficiary free to choose their doctor, their laboratory, among other services.
The major difference between health insurance and insurance is that the latter aims to reimburse the client for medical expenses with consultations, surgeries, clinical exams, various treatments and hospitalizations, and these services can be freely chosen by the insured. This refund must be made in all categories, according to the chosen plan.
Currently, some insurers offer referenced services, that is, a small network of doctors and recommended employees. In these cases, the payment is made directly to the provider by the insurer.
In the case of health insurance, the client pays a monthly fee that is called a “premium” and works as follows: all the insured payers guarantee each other’s assistance by paying the premium. Each monthly payment equals, in parts, the risk of the cost of each insured’s treatment. It functions, more or less, as a “cooperative” of health.
Advantages of health insurance
- Less waiting: we all know how discouraging waiting in the queues for medical care is. Since the insured of the health plan has access to private clinics and services, the care is usually much more agile, without those hours of waiting.
- Freedom of choice: With health insurance, the insured can choose the doctor, clinic, laboratory or service to be attended to, not depending on a fixed network of options, as in health insurance contracts.
- More exclusivity: According to ANS standards, health insurance is made up of different coverage modules, allowing the user to have a coverage service fully adjusted to their needs and profile.
How to choose a good plan or health insurance?
In both cases, it is vital to pay attention to the clauses and details of the contract. In the case of the health plan, items such as coverage, services provided and waiting time are very important and should direct your choice.
In the case of health insurance, you need to calmly study the coverage and exclusions, since many contracts can leave out services that would be important in specific cases.
Do they both lack?
Each contract establishes a grace period, either in the plan or in the health insurance. The grace period means that there is a period when services can not be used by the beneficiary, even though he or she is paying the monthly fees. This is a common practice and authorized by the ANS, however, often it can be a big stone in the shoe in times of need.
In corporate or collective health plans by membership, in the then, often the grace period comes to be a few days or even does not exist, which is a great advantage for the user.
Also get your doubts about the difference between health insurance and life insurance.