What Does Health or Medical Insurance Cover?

Health Insurance

Health Insurance: What Does It Cover and How Does It Work?

Do you want to know the main factors and situations covered by medical insurance in Spain? More and more people turn to the private sector to contract this type of health policy, and it is that concern about health has been increasing exponentially in recent years.

We have prepared a complete guide with everything you need about what health insurance covers and what its characteristics are; all with the aim of choosing the rate that best suits your needs. Take a pencil and paper and write down the essentials!

What Is Private Health Insurance and What Does It Consist of?

Private health insurance is a contract that is made between the insurer and the insured, in order to protect the latter by offering health benefits such as specialized tests, specific treatments, and medications.

Therefore, when it comes to knowing what health insurance covers, you should know that there are common parameters for most of the policies on the market, the main difference being in the additional services they offer.

When choosing which is the best medical insurance for your day-to-day life, it is necessary to take into account that these can vary from very general coverage (focusing on primary care) to more technical and specialized attention to specific problems.

Main Aspects Covered by Health Insurance

Now is the time to find out what health insurance covers! Next, we will list the most basic services, both general and special, without having specific coverage that insurance companies may offer.

You must bear in mind that, despite the wide variety of benefits that they put at your disposal, you will only have to hire the one that fits your needs. In other words, it will be useless to acquire a family policy that covers comprehensive medical insurance, if you live alone.

  • Primary care: General practitioner, pediatrics, or nursing
  • Access to medical specialties: Possibility of accessing cardiology, dermatology, traumatology, gynecology and many more.
  • Carrying out diagnostic tests: Any type of clinical analysis, ultrasound, X-ray, MRI, urology or urinalysis, among others.
  • Therapeutic methods: muscular, oncological or respiratory rehabilitation treatments, among them.
  • Surgical interventions (with or without hospital admission)
  • Hospitalization and emergencies
  • Emergency telephone service and medical advice
  • Possibility of online transactions

What Health Insurance Does Not Cover: Exceptions and Limits

The factors that health insurance covers during a lifetime are many, but there are certain exceptions to the rule. In this sense, the clients of an insurer cannot ignore those situations in which they will not have the protection of private health.

  • Pre-existing illnesses or consequences of previous accidents.
  • Any clinical situation that arises as a result of war conflicts, terrorist acts, or work accidents.
  • Voluntary termination of pregnancy.
  • Transplants (except bone marrow or cornea)
  • Aesthetic interventions.
  • When the insured commits fraud or gross negligence, the company may terminate the contract by notifying the policyholder.

Read more: How Financial Education Influences the Perception of Life Insurance

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