This bulletin provides information on the types of medical insurance available in Portugal and outside for Portuguese residents.  The immigration authorities require foreigners wishing to take out a resident’s permit to have health insurance protection.  For EU citizens the National Health Service protection from their country of origin is normally adequate.  For non-EU citizens however, private medical insurance is mandatory. Even for EU citizens additional protection may be considered desirable and many such as residents take out private health insurance policies.

This Bulletin discusses some of the factors to consider when choosing a policy.  In all cases AFPOP recommends that members take professional advice before making a final decision.

Types of medical insurance and schemes available

Medical treatment can be expensive and so medical insurance is also expensive.  No private insurance scheme is able to provide for all types of medical treatment.  Some schemes for instance do not cover the long-term treatment of chronic illnesses, such as cancer, or for specialist treatments such as organ transplants.  Insurance schemes therefore provide various levels of cover to meet their clients’ differing needs.

Basic cover normally covers the cost of unexpected hospital internment and surgery, as well as medical expenses and consultation charges up to the level of the policy amount. Some companies apply an excess which the insured party must pay first either per event or per policy term.  In some schemes additional cover can be arranged to include a salary subsidy during hospital internment.  The level of the premiums will relate to the maximum level of payments payable per year and to the amount of excess payable by the policy holder.

The need for medical treatment increases with age.  Many schemes therefore also have premiums that increase with age.  Most schemes also have a maximum age for taking out a new insurance policy (often 55-65 years) and an age beyond which no coverage is provided (sometimes as young as 65 years but more often between 70 and 75 years).

Few medical insurance schemes cover existing conditions, and routine dental treatment, eye treatments and pregnancy are often excluded.  Some schemes still exclude AIDS related symptoms and treatment for persons with HIV infection.

A policy may include coverage for medical expenses during periods of travel outside of Portugal and repatriation back to Portugal in case of illness.  However, this coverage is usually limited to short periods of one to two months.

Portuguese or foreign insurance company?

Most medical insurance schemes offered by Portuguese insurers are aimed at Portuguese citizens and long-term residents.  They are therefore designed for the level of medical costs in Portugal, assume that participants will also have recourse to the National Health Service, and usually do not cover treatment in other countries except when travelling on holiday.  As a result, premiums tend to be considerably cheaper than for schemes provided by international insurers for expatriates.  A Portuguese scheme may therefore be the most appropriate for those who intend to stay in Portugal permanently or who are of an age that will permit them to take out coverage with another company when they leave Portugal.

Schemes provided for expatriates by the larger insurance companies or specialist medical insurance companies are usually flexible and permit the policy-holder to move from one country to another.  They may not cover the policy-holder in their country of nationality and, given the higher cost of medical treatment in the USA, may apply higher premiums for cover in North America or exclude cover all together.

Cover in Portugal from a local insurer for €15,000 hospital expenses and €1,500 medical expenses per year may cost around €175 per year, or for €25,000 and €1,500 around €220 per year.  Similar policies providing international cover may be twice as expensive.

Tax deductions

Medical expenses, including medical insurance premiums, are allowable expenses for deduction against income tax in Portugal.  There are limitations to this, and members should confirm whether a particular policy is tax deductible before taking out the policy.

Selecting a policy provider

Companies like Lloyd & Whyte and Medal offer AFPOP members special group terms and details of these arrangements can be obtained directly from their local agents, whose names and contact details are available from the office. Policies offered by these companies differ in many respects and also vary considerably in price. When considering taking out a new policy, members are advised to examine carefully the terms and ascertain what is included and what is excluded. The rate at which premiums have risen over recent years should also be questioned.

Members who already belong to a medical insurance scheme may have obtained substantial rights in that scheme.  They should therefore think very carefully before deciding to move from one scheme to another and satisfy themselves that the terms of the alternate scheme compensate for the loss of those rights.

While AFPOP can give general guidance on health insurance, the decision to join a particular scheme must be the member’s and the member’s alone. AFPOP cannot accept responsibility for any dispute between a member and the insurer or dissatisfaction with any service provided by the insurer such as the refusal to meet certain claims.