An illness predates health insurance: does completing the waiting period remove its exclusion?

THE ESSENTIALS

Before you start

An exclusion does not disappear merely because a waiting period ends.
Article 216 permits agreed general or specific exclusions for pre-existing illnesses.
The decision to join should rely on the written terms for the person being insured.

Start with Article 216

Article 216 of Portugal’s Insurance Contract Legal Regime includes known pre-existing illnesses within agreed cover but permits agreed general or specific exclusions. It also allows a waiting period of up to one year for their cover. It neither imposes that period on every policy nor erases an exclusion when it ends.

Sources: Diário da República — Insurance Contract Legal Regime, Article 216, consolidated text read on 30 October 2026 ↗

Separate the timetable from the accepted scope

In a fictional exercise, Sofia finds a 90-day waiting period for a benefit and an exclusion relating to an earlier condition. Clara places the texts on separate lines: one question is when a benefit can operate; the other is what falls outside the accepted scope. Day 91 does not answer the second question merely through a calendar calculation.

The March 2025 Allianz Saúde conditions reviewed include expenses relating to pre-existing illnesses in their general-exclusions clause. This is a specific wording example to read alongside the other contract documents; it is not the acceptance rule for every product.

Sources: Diário da República — Insurance Contract Legal Regime, Article 216, consolidated text read on 30 October 2026 ↗ · Allianz Saúde — Conditions 229–03/2025_1, clauses 1 and 4, pp. 7 and 11; read on 30 October 2026 ↗

Ask for an answer you can compare

Before joining, identify the insured person, proposed module, start date and acceptance terms. Ask for written clarification of any exclusion question, identifying the relevant document and clause. A sales explanation about 'consultations included' does not necessarily explain the treatment of an earlier condition.

Sofia makes two columns: waiting periods by benefit and exclusions or acceptance terms. She adds the document, page and version. Clara suggests marking unresolved points rather than writing ‘included’ on the basis of an expectation. As consultations affect the family budget, the possible personal cost matters alongside the date. A hospital’s presence in a network still does not settle the financial scope.

Answer accurately and protect clinical information

During the application, answer accurately what you are lawfully asked and request instructions when a question is unclear. Do not improvise a clinical classification or coverage decision to finish a form. The insurer must assess the information through the applicable procedure.

To request a quotation from RMACHADO, start with the people to include and protection priorities. Diagnoses and examinations do not belong in public comments or the initial contact form. When clinical information is needed in the dedicated application process, use the indicated channel and retain the acceptance terms received.

KEEP THESE QUESTIONS

Your checklist for the next conversation

Record waiting periods and exclusions separately, with document, page and version.
Seek written clarification of ambiguous terms before assuming reimbursement.
Compare possible personal costs and accepted terms without inferring cover from the network.
Send necessary clinical information only through the designated process.

FROM THE ARTICLE TO YOUR SITUATION

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Sources and transparency

Content updated on 30 October 2026.

Consultation dates are stated in individual references when available.

Numerical examples are fictional and explain concepts. Editorial interpretations are identified in the text.

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.