How private health insurance companies operate

In Spain, private health care plans exist as a complement to the public health care system

Private health insurance brings peace of mind, as it provides many services and benefits that enable policyholders to receive prompt treatment at times when they most need it: when an illness or other health-related problem arises.

The way a health insurance policy works is really no different from any other type of insurance: the customer pays a premium and, in return, gains access to a range of health care services that are laid out in detail in the policy document.

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This coverage can be provided in two ways: either through the insurance company's medical directory (including hospitals, clinics, and health professionals), or by allowing the policyholder to receive care from any medical center or health professional they choose (the reimbursement option). In Spain the first of these options is more commonly used, although many users appreciate the ability to freely select the location where they will receive services and the professionals who will provide them. This is one of the advantages of private health insurance, although there are others as well, which we will explain in detail below.

What are the advantages of private health insurance?

One of the main reasons why people decide to purchase private health insurance is to ensure faster access to health care. Private hospitals and health care centers pay close attention to this aspect, and they prioritize their ability to offer their policyholders shorter wait times in terms of access to office visits, diagnostics, and treatment. Furthermore, private health insurance plans allow policyholders to make an appointment with a specialist directly, rather than having to get a referral from their primary care physician.

Health care centers and hospitals affiliated with private health insurance plans also tend to have much longer opening hours, making them convenient for all users.

This flexibility also extends to the fact that patients can choose from among the many professionals included in the insurer's medical directory. This means that if the user is not satisfied with a particular physician, or simply wants to be treated by another health professional, they can request this from the insurer.

It is also easy to request a second medical opinion. This is one of the most highly accepted and appreciated services for users and it helps reinforce the effectiveness of the health insurance plan. Whenever an illness or health problem arises, the policyholder will have the peace of mind knowing that their case can be studied by more than one professional.

And to provide even more options, there are an increasing number of health insurance plans that offer access to treatment and health professionals from the field of ‘alternative medicine’. Up until now, access to treatment of this type was restricted to private clinics or consultants, but an increasing number of private medical plans now offer their customers the possibility of adding alternative treatments to their portfolio of services.

Another type of extended coverage, and one that many medical insurance plans are now including, is dental care, which can offer significant savings for the policyholder. Thus, once a private health insurance policy has been purchased, users will have peace of mind knowing that they have quick and easy access to any type of health care service required.

Furthermore, they can feel secure knowing that their health insurance needs will also be met abroad, as many insurance plans offer health care coverage to policyholders who are traveling internationally.

Finally, another advantage of private health insurance plans involves the hospital facilities offered to policyholders. The option of having a single-patient room during a hospital stay, as well as other services for family members who accompany the patient at night during hospitalization is especially appreciated.

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The broad range of health insurance plans currently being offered on the market has led to the cost of premiums becoming very competitive in recent years. However, in order to understand how pricing of these premiums works, it must first be pointed out that the price will vary depending upon the amount of risk that the policyholder is willing to assume, just as with any other type of insurance. Let's take a look at the factors that influence the cost of a health insurance policy:

  • The age of the policyholder: young people are less likely to suffer from illnesses or develop serious health problems, which means that they will pay much less for an insurance policy than older adults will. It is typical for the premium charged for a health insurance policy to continue to increase as the policyholder gets older.
  • Coverage purchased: the price of the premium also depends upon the range of services offered to the policyholder. In most cases, the more extensive the portfolio of services to which the policyholder will have access, the higher the price of the insurance premium.
  • Co-payment: most health insurance policies offer the option of a co-payment system. Essentially, this option means that the policyholders must pay a small amount of money each time they access a service covered by their health insurance plan. In exchange, the monthly or annual premium that the policyholder must pay will be lower. This is a way of reducing the overall cost of the insurance if the user does not expect to make very much use of the health care coverage.

In conclusion, private health insurance, as a complement to the public health care system, provides an efficient and effective option to address any health conditions that may arise.

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