Network or reimbursement plan: What to choose in health insurance?

What are the advantages and disadvantages of the conventional network and reimbursement?

When choosing health insurance, one of the main decisions to make is whether to opt for a plan with a network or a reimbursement system. Both options offer advantages, but they differ in how medical expenses are paid and reimbursed.

What is a health insurance with a network of healthcare providers?

Having a network of providers means that the policyholder can use a specific list of hospitals, clinics, and healthcare professionals that have an agreement with the insurer.

With the contracted network, these are the advantages you can access:  

• Reduced or non-existent payments - The insured only pays a portion of the cost of the consultation or treatment. In some cases, there is no additional payment required.

• Easy access - Just schedule the appointment or exam directly at an entity belonging to the network. 

• Simple process - No need to pay the total amount upfront and wait for refunds.  

However, with the network agreement, there is a limited choice, restricted to doctors and institutions that are part of the insurance network, as well as potential waiting times being necessary to wait for availability in the network.

What is a health insurance with a reimbursement system?

With the reimbursement system, the insured can choose any doctor, clinic, or hospital, even if they do not have an agreement with the insurance company. The amount paid will be reimbursed later, in whole or in part, according to the insurance contract.

With the refund system, here are the advantages you have access to:

• Total freedom of choice - You can go to any doctor or healthcare facility, inside or outside the insurer's network.

• Specific specialties - Useful for those who already have trusted doctors who are not part of the conventional network.

• High refund possibilities - Some insurances refund up to 100% of the amounts paid.

However, as disadvantages, the refund system requires payment of the total expense at the moment, only being reimbursed later by the insurer. Also, depending on the insurer, the refund may also take a few weeks.  

In addition, reimbursement may be subject to maximum annual or per medical act ceilings.  

The choice between a conventional network and reimbursement depends on your needs. If you prefer simplicity and reduced costs, the conventional network may be the best option. If you value freedom of choice and are willing to make advance payments, the reimbursement system may be more advantageous.

Some insurances offer mixed plans, combining both systems. Before hiring, compare the conditions, reimbursement values, and the network of providers available to ensure the best choice for you. For this, you can hire the free service of an insurance mediator, such as Poupança no Minuto, which deals with all the bureaucracy and negotiation of conditions with insurers. (source: Poupança no Minuto)

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