THE ESSENTIALS
Before you start
- The procedure’s number of K units and the euro value of each K are different pieces of information.
- The calculation may establish a fee ceiling without determining the insurer’s final payment.
- The surgeon, assistants and anaesthetist may have separate rules; do not apply one calculation to the entire estimate.
The number of K units expresses the procedure’s relative value
In Allianz Saúde 229–03/2025_1, the table assigns K units according to procedure complexity. This number differs from euros per K.
Tiago does not need to classify his operation using a list found online. Clara asks him to obtain the procedure identification in the estimate and have the insurer explain the table and number of K units considered in its assessment. The provider’s proposed code and the insurer’s accepted classification should be reconciled before he makes a personal estimate.
An illustrative multiplication explains the ceiling, not the payout
SC3 for Base, Standard and Mais uses the procedure’s maximum K units and up to €6.75/K for the surgeon. This is one policy example, without a universal rate or recommendation.
Arithmetic exercise: a hypothetical procedure valued at 100 K units, using the €6.75 per K from that example, gives €675. The 100 K units are fictional and do not represent an assessment of a real operation. The result is not a reimbursement promise: eligible expenses, the reimbursement share, any amounts borne by the customer and the remaining insured limit must still be established under the policy.
Sources: Allianz Saúde — terms 229–03/2025_1, definitions and SC3 A.1(h–k), C/D: K units and fees; passages read 2 November 2026 ↗ · Allianz Portugal — current index: Saúde 229–03/2025_1 in force since 26 March 2025; checked 2 November 2026 ↗
The surgical team does not all fit on the surgeon’s line
Under that condition, assistants have limits linked to the surgeon; anaesthesia uses its own K correspondence. Do not repeat one calculation for the team, operating theatre and materials.
Clara suggests that Tiago obtain an itemised estimate, with a separate line for each professional and another for the remaining costs. Next to each fee, he records the limit or rule actually stated in the insurer’s response. If the estimate contains only a total, he asks for the breakdown needed to understand where any amount payable by him arises.
Tiago asks for an answer he can check
For the surgeon’s line, the question becomes specific: which procedure was considered, how many K units were accepted, what value per K applies and which fees does the result relate to? For assistants and anaesthesia, he asks for their respective rules. Only then does he compare the estimate with the share the insurer expects to bear. This preparation is about understanding costs, not choosing an operation or assessing its clinical necessity.
When comparing future protection, Tiago asks for an explanation of the fee rules as well as the overall hospitalisation limit. For existing insurance, he uses the case reference to clarify the submitted estimate. The public edition consulted was linked in Allianz’s current index on 2 November 2026; it does not, by itself, change another policy or the terms of an earlier contract.
Sources: Allianz Saúde — terms 229–03/2025_1, definitions and SC3 A.1(h–k), C/D: K units and fees; passages read 2 November 2026 ↗ · Allianz Portugal — current index: Saúde 229–03/2025_1 in force since 26 March 2025; checked 2 November 2026 ↗
KEEP THESE QUESTIONS
Your checklist for the next conversation
- Ask for the procedure code, the table used and the number of K units recognised by the insurer.
- Identify the monetary value per K and the fee line to which it applies.
- Check the surgeon, assistants and anaesthesia separately against an itemised estimate.
- Distinguish the calculated ceiling from the eligible expense and the payment expected for your case.
FROM THE ARTICLE TO YOUR SITUATION
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Sources and transparency
Content updated on .
Consultation dates are stated in individual references when available.
Numerical examples are fictional and explain concepts. Editorial interpretations are identified in the text.
- Allianz Saúde — terms 229–03/2025_1, definitions and SC3 A.1(h–k), C/D: K units and fees; passages read 2 November 2026 ↗
- Allianz Portugal — current index: Saúde 229–03/2025_1 in force since 26 March 2025; checked 2 November 2026 ↗
Information from RMACHADO GROUP. This is not an insurance offer or individual advice. Covers, acceptance, exclusions, sums insured and costs depend on the policy. The intermediary does not underwrite the risks.