Health insurance: networks, waiting periods and co-payments explained

Health insurance or a health plan?

A health plan generally gives access to agreed prices within a network, with the customer paying for the services. It is not an insurance contract and is not subject to ASF supervision on the same basis.

With health insurance, the insurer assumes risk within the covers and limits agreed. The word “health” in a product name does not by itself clarify which arrangement you are taking out. Confirm the product’s nature and who bears the risk.

Sources: ASF — Distinction between health insurance and health plans ↗

Test the network against your actual routine

Insurance may operate through direct payment within a network, reimbursement of expenses or a combination. With reimbursement, the customer initially pays the expense and then requests the contribution specified in the policy.

Make a short list of the hospitals, clinics and specialties you use. Confirm the particular provider and service are included, your costs, limits and any prior authorisations. A hospital’s presence in a network does not answer all these questions.

If you regularly travel between towns, compare the network’s usefulness in both. Quotations can look similar on paper but work differently in everyday life.

Sources: ASF — Consumer information on health insurance ↗

Read waiting periods, pre-existing conditions and limits separately

A waiting period is the initial interval during which certain covers are not yet effective. A pre-existing condition is a medical situation predating the policy; its treatment depends on the applicable terms and exclusions. They are not the same concept.

Also confirm available cover limits, per-treatment or annual limits and what happens when they are exhausted. Changing insurer does not mean all previous terms can be assumed to continue.

Answer health questions in the application process correctly. Questions about a medical condition should be clarified through the insurer’s specified channel, without posting health details in comments or general forms.

Sources: ASF — Questions about health insurance ↗

Compare the whole family, person by person

To prepare the assessment, state how many people you want to insure and their dates of birth. Organise the household’s priorities: hospitalisation, consultations, tests or other needs. Diagnoses do not need to be described in the website’s initial request.

Illustrative exercise: quotation A costs €6 more each month and €10 less for each of four planned consultations. In this hypothetical scenario, the extra annual cost of €72 would be partly offset by a €40 difference in consultation costs. This calculation does not assess hospitalisation, limits or exclusions, which must be compared separately.

Ask for the documents, highlight anything unclear and compare the fixed cost under different usage scenarios. It is not possible to guarantee today how much care will be needed during the year.