Health Insurance and Health Insurance – What are the differences?

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

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?

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.

With Ilya of Murom, you can make an online quote of the best health plans in Brazil, such as SulAmérica, Bradesco Saúde, Amil and much more. Check out.

What is health insurance?

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?

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.

Find out how to have health insurance that is cheaper and tailored for you

Quality service and a good accredited network are essential. However, they are not the only attributes that most health care consumers want to get. Having access to economic plans is also at stake for those who do not want to compromise the pocket. So let us show you some ways to know how to have health insurance cheaper.

If you want to know how to have health insurance cheaper, stay tuned in the balance between “quality plan” X “cheap plan”. It is necessary to take into account all the pros and cons and to be attentive to some essential requirements.

How To Have Cheaper Health Insurance

How To Have Cheaper Health Insurance

Check out some tips that should be put into practice when quoting a health plan. Here’s how to have health insurance that is cheaper and that also fulfills the primary function – take care of you.

Evaluate the various options for marketplans

Evaluate the various options for marketplans

Yes, you may have more work, but it is essential to quote the various health plans offered by different operators. Only then will you know each one of them.

Do not even think about hiring the first option! This is essential so do not go wrong in planning how to have health insurance cheapest. Only with the information collected will it be possible to make comparisons. So you will find the best price for your pocket.

Be very aware of the coverage that is best for you.

Be very aware of the coverage that is best for you.

There are plans with various types of coverage. Identifying the one that will best suit you is a vital part of the process to know how to have health insurance cheaper.

For example, if you travel a lot, it is important to take this information into account. In this case, the chosen plan must have scope necessary to be used in all locations – or at least in locations close to them.

Imagine if your health plan only meets in a certain group of municipalities? If you are out of this area and need a doctor you will have to pay for a private consultation. Therefore, it may be worth investing more and having the security of care wherever you are.

Remember to quote the plans with and without coparticipation

Remember to quote the plans with and without coparticipation

Consumers should take into account their profile of use of medical services to assess what may be most appropriate.

The plan with co-participation, for example, is indicated for those who rarely use services. This is because the beneficiary pays a value for each procedure performed.

In many cases, coparticipation plans may be the right choice for anyone who wants to save on the plan, without losing quality.

On the other hand, the consumer who goes to the doctor often tends to choose the plan without coparticipation, even with a slightly higher monthly payment.

There is no way, the most appropriate way of checking which of them compensates is taking into account the number of trips to the doctor to then do the math.

It is worth taking into account accommodation for hospitalization cases

It is worth taking into account accommodation for hospitalization cases

A health plan beneficiary who does not use the hospitalization much should consider a plan whose accommodation is in the ward. This is an alternative that is shared and therefore has lower cost.

In general, many plans have wards to care for only two patients. But it is good to evaluate that privacy is compromised in relation to an apartment.

Another point about the issue of hospitalization is that we never really know whether we will use it frequently or not. That is, you can not predict. But you can tell if sharing accommodation for you is a problem or not. This can help you make a decision and thereby cheapen your plan.

Business or collective plan?

Business or collective plan?

This is a big issue for the pocket and for those who want to know how to have health insurance cheaper. Hiring an individual plan or family plan comes out much more expensive.

Whenever your company or union makes a health plan available, evaluate it. The costs are usually much lower.

This is due to the number of people who adhere to the plan, allowing operators to work at a more affordable value.

According to experts, collective plans are attracting the attention of consumers. This type of plan is already the most contracted in the market: of the 47.3 million plans in Brazil, 38 million are collective.

The main advantage is even the most affordable cost. But they warn that there is no limit to the price increase, even taking a check made by the National Supplemental Health Agency (ANS).

Already the collective business plans attract, therefore, depending on the size of the company, the margin of negotiation is much greater. This makes it possible to use good discounts or even minor adjustments.

But it is valid to know that who defines value is the administrator and the health care provider.

As with membership plans, the advantages and disadvantages are the same: prices are lower at first, but there are no limits to readjustments.

How are readjustments made in the plans?

How are readjustments made in the plans?

If you want to know how to have health insurance cheapest, this is a key point and it has financial impact over time.

Individual or family plans, for example, have two types of readjustment :

  • Annual adjustment, which is regulated by ANS;
  • Readjustment by age group.

Collective health plans have three types of readjustments:

  • Annual readjustment;
  • Readjustment by age group;
  • Adjustment of claims, which takes into account the frequency of use of the services provided.

Therefore, it is important to be informed about the indexes used in recent years to evaluate them in an up-to-date fashion.

Doing Health Insurance in Australia

As a foreign student in Australia, you need insurance that is called Overseas Student Health Cover (OSHC) and covers you for the duration of your studies in Australia. However, there are other types of insurance that could be useful to you.

Overseas Student Health Cover

Overseas Student Health Cover

Foreign students who undertake a formal course of study in Australia, as well as their relatives (spouses and children under the age of eighteen), must obtain an OSHC. This type of insurance includes coverage for medical examinations, ambulances and some basic pharmaceutical products . OSHC can also supply a wide range of optional products. The possibilities vary from a basic package, which includes the mandatory services listed above, to more complex packages that include services specified in detail in the policy. On the Department of Health website you can find more information as well as a list of the agencies providing the policy and average costs. Remember that the Immigration Department requires international students to maintain the OSHC policy for the duration of their stay . On their website you will find other detailed information.

Private health insurance

Private health insurance

Together with your OSHC you can consider the option of purchasing private health insurance to cover all those occurrences not included in the OSHC. You can take out a private policy just for yourself or include one or more members of your family. Benefits, enrollment fees and eligibility requirements can vary greatly from policy to policy , so always make sure you choose the product that best fits your needs. You can find additional information on the site:

Travel insurance

Travel insurance

Australia has a very well developed tourist sector however canceled flights, lost baggage or other unforeseen eventualities can still occur. If you are traveling with valuables or according to a timetable that you must follow, travel insurance can help you cover any small mishap or canceled flight . You can get travel insurance through a number of agencies including companies that specifically deal with this, airlines and travel agencies.

Insurance on the house and its contents

Insurance on the house and its contents

The insurance on the house and on what it contains covers both the building in which you live and your properties such as furniture, clothes and appliances. If you rent a property, building insurance is the owner’s responsibility and you don’t have to worry about it. However, you should still consider content insurance especially if you have valuables that you could not easily replace if something happened to them.

Vehicle insurance

Vehicle insurance

If you buy a car, a motorbike or any other vehicle, you will have to consider what kind of insurance to take out. Depending on the state or territory of Australia you are in, there may be some types of mandatory insurance that you will need to purchase. For example, in New South Wales you have to purchase the Compulsory Third Party policy which covers you for personal injury caused to someone else in the event of an accident. You should check with the competent government agency of the state in which you are located if there is a mandatory policy to buy and which one is. You can also choose to purchase insurance on the vehicle that protects you from accidental damage, intentional damage, theft, fire, floods and storms. There is a large number of agencies in Australia that provide vehicle insurance so make a thorough search to best evaluate all your options and consider your specific insurance needs before purchasing your policy.

Medicare International: International Health Insurance Company

Medicare International was established in 1980, to focus exclusively on providing international health insurance for traveling expatriates. With a variety of customized solutions it is suitable to meet the expectations of individuals, families, groups and companies. Medicare International will always have a plan for you, whatever your specific needs.

20 years of experience in the sector have helped Medicare to better assess the needs of the constantly evolving market.

With a flexible product line that is expanding regularly, the international expat community has the quality assurance of their health care services anywhere in the world. Its global coverage can range from a regular appointment with your dentist to an elaborate maternity care program.

Get in touch with our staff for a free consultation or a quote.

By providing a series of comprehensive but flexible policies, Medicare proves to be always in touch with the high expectations of expatriates traveling.

His office is located in the UK but Medicare is immediately available through its 24-hour toll-free number. This gives customers the ability to make direct requests and get immediate answers at any time.

Quality of Medicare service

Quality of Medicare service

In addition to providing emergency assistance services, Medicare also helps in normal situations, or there is no danger in life. Their plans allow contractors to choose where they want to be treated for their medical conditions. The company also covers transport costs upon approval by the 24-hour Medicare support team.

Innovation has led the Medicare company to offer coverage against a range of chronic diseases. This novelty was well received by its policyholders.

From the operational point of view, Medicare ensures that all reimbursement requests can be resolved within 10 days by its assistance team, for the tranquility of its customers. The combination of the flexibility to decide when you want to receive treatment and the toll-free number for faster handling of reimbursement requests makes Medicare insurance customers very satisfied.

Health Insurance and Coverage in Australia

Before leaving for Australia, it is good to find out about how your health system works and what are the basic rules for not having to go through exaggerated payments simply for a cold.

Here, health care is partly public and partly private. The Australian public health system is called Medicare and how our Italian system offers basic health care for all citizens.

It includes hospital treatment, the purchase of loanable medicines and visits to the general practitioner. For other services, on the other hand, a portion of the costs is paid as in Italy.

There are agreements between the Italian and Australian governments called ‘ Reciprocal Health Care Agreements ‘, based on which basic health coverage is provided for any illness or accident that occurs during the stay.

Specifically, these agreements provide for different scenarios depending on the type of visa.


  • Tourist Visa – Healthcare coverage is included in the tourist visa (up to a maximum of 3 months).
  • Working Holiday Visa – Healthcare is guaranteed for the first 6 months. On expiry, a new private insurance must be stipulated – if you do not want to incur any medical expenses – by paying this time from your own pocket. Alternatively, it is necessary to leave the country and then return later. To be able to activate the free health insurance for the first six months you must go directly to the Medicare offices in possession of:
    • passport
    • Italian health card
    • seen

At the time of signing the cover, a health card is issued which certifies the successful subscription: it will be a document to always carry with you, just like in Italy.

  • Student Visa – Student Visa holders are obliged to enter into the ‘OSHC (Overseas Student Health Cover) for the duration of their stay in Australia. If the visa is renewed, the insurance must also be extended. There are different types of OSHC insurance, for example Medibank and AHM. The OSHCs cover the costs of medical, hospital, medication and ambulance services. Taking out OSHC private health insurance in Australia is also necessary for those who have exhausted the six months of free Medicare public assistance. The OSHC must cover the student and any other persons included in his visa for the entire duration of the stay in Australia. OSHC private health insurance coverage is similar to that offered by Medicare. OSHC insurances have agreements with some facilities where direct billing can be exercised, or direct reimbursement of expenses. In non-affiliated facilities, on the other hand, it is necessary to anticipate the cost of care and then exercise the claim (reimbursement of health costs incurred).

Standard health insurance (guaranteed by tourist and working holiday visas and by the OSHC) provides free treatment in public hospitals, government subsidized medicines and (limited) reimbursements for private care.



The medical services not covered by Medicare are:

  • Medicines not subsidized by the PBS (Pharmaceutical Benefits Scheme)
  • Organized treatments before arriving in Australia
  • Accommodation and medical care in a private hospital
  • Accommodation and medical care as a private patient in a public hospital
  • Ambulance services
  • Examinations and dental treatments (except for specific cases introduced for combined health services as part of the Chronic Disease Management (CDM) program)
  • Physiotherapy, occupational therapy, speech therapy, ocular therapy, chiropractic services, podiatry or psychology (except for specific cases introduced for joint health services as part of the Chronic Disease Management (CDM) program
  • Acupuncture (unless it is part of a doctor’s consultation)
  • Glasses and contact lenses
  • Hearing aids and other appliances
  • The cost of prostheses
  • Medical expenses for which you are responsible for someone else (for example, an employer or the government)
  • Medical services that are not clinically necessary
  • Surgery solely for aesthetic reasons
  • Exams for life insurance or pension fund
  • Eye therapy
  • Stay at nursing homes

However, all these services can be included by entering into extra policies.



It is possible to obtain medical treatment in private medical offices and / or medical centers in the area. Doctors in these practices charge for their services in one of the following ways:

  1. The doctor bills Medicare directly (‘Bulk bill’)

In this case you will be asked to show your mutual health care card and to sign a Medicare form for bulk billing after seeing the doctor, but you will not need to pay.

Not all doctors apply bulk billing.

  1. The doctor gives the bill to the patient

Doctors who do not take part in the bulk billing system will ask you to pay a certain amount at the time of consultation.

You can immediately pay the amount provided by the service, or you can present your unpaid bill to Medicare.

In the first case it is possible:

  • Ask the reception staff if they can present your Medicare request for you
  • Request reimbursement in person at a DHS service center
  • Send a claim form, including the original doctor’s bill and receipt to the Department of Human Services, GPO Box 9822. They will then send you a check to cover the portion of Medicare.
  • Apply online for self service
  • Make the request by phone by calling 132 011

Instead, to present Medicare with an unpaid bill is necessary:

  • Bring the invoice together with a completed application form to a DHS service center, or send it to the Department of Human Services, GPO Box 9822, in your city. They will send you a check payable to the doctor.
  • Bring the check to the doctor and pay the difference between the Medicare coverage and the total cost of the medical service received.



If you receive essential medical treatment as a public patient in a public hospital, you will not be charged for treatment and / or accommodation.

Simply show your passport or health care card to the reference staff when you arrive at the hospital.

If instead you choose to be treated as a private patient in a public hospital or as a private patient in a private hospital, you will have to pay for both medical care and accommodation.

These charges cannot be claimed by Medicare.

Finally, remember that the insurance is valid only on Australian territory : if you want to be protected in case of a visit to New Zealand or in another state, you need to inquire to make travel insurance.



There are two possibilities:

  1. Take out private health insurance (as in the case of Student Visa) so that they can be fully covered even during the remaining months;
  2. Get out of Australia and return: in this case, just go back to the Medicare office with your passport, which stamps your temporary expatriation from the land of kangaroos. In this way, free health insurance will be renewed for another 6 months.

All clear? Remember that the practices to take out insurance are included in the free Study Search Australia consulting services.

We can help you by taking care of the bureaucracy and getting you a health card from the moment you arrive in Australia, to avoid running any risk.

As regards OSHC insurance, we refer to the Medibank company. Discover all the details on this policy visit this page.

For Medicare insurance specifications instead visit Medicare Australia.