Health insurance has been gaining weight in Portugal. According to the Portuguese Association of Insurers (ASF), there were 4.0 million people with health insurance at the end of 2024, 255 thousand more than in the previous year. Still, there is a condition present in many policies that continues to raise doubts: the waiting period. During this period of time, even if the insurance is already active, certain medical expenses are still not reimbursed by the insurance company.
According to the ASF, the grace period is the time between the beginning of the contract and the date from which certain coverage effectively begins to take effect. In a financial literacy article, the website states that this period can last up to 270 days. But the contractual documentation currently available on the market shows that, depending on the coverage and policy, there are waiting periods of 60, 90, 180, 365 and up to 540 days.
What changes during the grace period
It is known that how it works varies depending on the type of coverage included in the policy. According to the ASF, waiting periods are not the same for all coverage. There are products where certain expenses come into effect sooner and others where the wait lasts several months, especially in areas such as hospitalization, childbirth, serious illnesses or specific procedures.
This mechanism exists to prevent insurance from being taken out only when the client already knows that they will need expensive treatments or interventions. This is the explanation given by the ASF for the application of waiting periods in health insurance.
Not everything is reimbursed at the beginning
There are coverages with shorter terms and others with longer waits. In the pre-contractual documentation currently available in Portugal, there are, for example, 60 days for outpatient care and prosthetics in some products, 90 days for hospitalization in others, 180 days for certain coverages, 365 days for childbirth and 360 or 540 days for some specific situations. Therefore, before joining, it is essential to understand exactly which medical procedures are subject to temporary limitations.
Furthermore, certain interventions require pre-authorization by the insurer. According to the ASF, this happens especially in more complex and differentiated procedures, often involving hospitalization.
Risk of assuming the expense
One of the most common mistakes occurs when the customer believes that simply activating the policy guarantees total protection. During the grace period, this may not happen. If a medical need arises covered by coverage that is still suspended, the insurance will not reimburse this expense.
Still, this does not always mean paying the “list” price outside of any network. In some policies, such as Allianz, the customer can continue to access the agreed network at negotiated prices, even during the grace period or after the contracted capital has been exhausted. What is at stake, in these cases, is the insurance company’s contribution.
How health insurance works
Health insurance helps support clinical expenses and can fully or partially cover consultations, exams, surgeries and hospitalizations. Payment can be made via refund or through an agreed network.
In cases of reimbursement, the customer first pays the expense and then sends the documentation to the insurance company to recover the contributed portion. In the accredited network system, the insured person uses contracted providers and only pays the portion that is their responsibility, such as co-participation, deductible or part not covered.
There are important differences between policies
Not all insurance works the same way. Some modalities work with fixed deductibles, while others only assume a percentage of the medical expense. The coverage included, the capital available, the network of hospitals and clinics and the possibility of including the family in the same policy also vary.
These variables directly influence the final price of the insurance and the practical usefulness of the policy at the time a real medical need arises. Apparently cheap insurance may end up being less advantageous if you have long waiting periods, reduced capital or a more limited network.
What you should consider before choosing
Before joining, it is important to compare coverage, grace periods, reimbursement limits, capital, reimbursement conditions and pre-authorization requirements. The ASF also recalls that health insurance is subject to the legal regime of the insurance contract, provided for in Decree-Law No. 72/2008, which regulates, among other points, pre-existing illnesses and the effects of non-renewal.
In the case of pre-existing illnesses, the ASF explains that they are considered covered if they are not expressly excluded in the contract. The law also allows the policy to provide for a waiting period of up to one year for these situations.
There are also differences in terms of age. Some insurers impose entry limits and, in some products, stay limits. But the ASF approved standard conditions for health insurance in 2025 that provide for no exclusion from permanence solely based on age, although insurers’ adherence to this model is voluntary.
Therefore, before subscribing, it is not enough to look at the monthly premium. It is essential to understand when each coverage actually starts to work, what is excluded, which acts depend on authorization and to what extent the policy remains appropriate to the client’s age and health status.
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