What is health insurance and what does it cover?

In general terms, medical insurance is the contract by which a certain insurance company undertakes to cover the health expenses that the insured or their beneficiaries must pay, in exchange for the payment of a premium.

The health insurance covers the costs that come indicated in the policy. Such expenses can be medical, clinical, pharmaceutical or hospitalization.

What is health insurance?

Basically, medical insurance is an agreement that you sign with an insurer so that, in exchange for a periodic premium, it takes care, in whole or in part, of the expenses derived from the medical and health care that you may need. It is, in short, a type of insurance that will provide you with health or assistance coverage in case you suffer from certain ailments or diseases.

Subscribing an insurance of this kind will protect you against high medical and health costs, thus guaranteeing your peace of mind and that of yours, knowing that you have doctors and hospitals at your disposal to provide you with medical assistance.

What does health insurance cover?

Health insurance coverage is the factor that you should prioritize the most when choosing one policy or another. Even starting from the basis that some modalities include more guarantees than others, we can affirm that a complete health insurance would be one that covers the following coverages:

  • Primary medical assistance. This would include consultations for general medicine, pediatric service, nursing service and ambulance service.
  • Access to specialties. It would be interesting if it had at least traumatology, cardiology, dermatology and gynecology.
  • Diagnostic tests. Among others, the insurance should cover analytical tests, ultrasounds and radiology services.
  • Surgical interventions.
  • Hospitalization service with covered expenses for at least 24 hours.
  • 24 hour emergency service.
  • Dental service that includes at least the basic treatments, such as oral cleaning, simple extractions and visit with the dentist.
  • Birth. You should consider both the childbirth preparation service, such as this one in itself and the obstetric services.

Types of health insurance

Within the different types of health insurance, they could be included in insurance with or without copayment, maximum coverage and basic coverage; insurance with reimbursement coverage. the two most important would be the medical chart and the reimbursement one.

Co-pay medical insurance

The health insurance with a copayment must be paid a predetermined amount each time some of the medical services are used.

Medical insurance without copay

Unlike the previous ones, in the medical insurance with co- payment, no additional payments will have to be made, since with the payment of the premium you will be able to use all the medical services you need.

Medical chart

In this option, the insurer puts at your disposal a list of doctors and hospitals that you can go to at no additional cost, since they are arranged with the company.


This modality allows you to visit the doctor you want. You go to their consultation, pay for the services received and then the company reimburses you for the invoice. It offers the advantage of not having to limit yourself to a medical chart, although, in return, in most cases the insurer will not reimburse you for the entire amount paid, but a percentage that usually ranges between 75 and 100% of the invoice.

What must be taken into account when contracting health insurance?

If you are considering taking out private health insurance, you should bear in mind the following elements:

  • Coverages included. Check that the policy you are going to hire includes those benefits that interest you the most and that you may need the most, even if this implies a higher premium.
  • Medical chart. It is essential to know the list of doctors that the insurer makes available to you, as well as the health centers that it has associated with. Likewise, it is important to know which emergency centers you have and if home care is also included.
  • Grace periods. Make sure before hiring health insurance what are the grace periods imposed by the various medical benefits.

Leave a Comment

Your email address will not be published. Required fields are marked *