THE ESSENTIALS
Before you start
- Read mental health cover separately from the general consultations limit.
- Consultations and inpatient care may have different conditions.
- Check the service, provider, personal cost and limits in the contract.
One cover heading, several services
The Médis Mental Health condition, August 2025, p. 30, provides for psychiatry, psychology and psychotherapy consultations when contracted; psychiatric inpatient care requires network treatment and clinical pre-authorisation. Limits and costs refer to the policy schedule. This is a contractual example, neither a product recommendation nor a rule for every insurer.
Clara first asks Sofia to identify the precise service she wants clarified. “I have consultations” is too broad to compare proposals. Find the service in the documents and check that the response addresses it, rather than simply repeating the hospital name or the general cover heading.
Do not copy the price of one specialty to another
Request confirmation for the professional and service, rather than just the clinic’s name. Ask how the contract counts a consultation or session, whether there is an annual session limit and what you pay once it is reached. Do not assume psychology and psychiatry share a limit or that a discount continues after funded benefits are exhausted.
Entirely fictional calculation: a hypothetical schedule allows six sessions with 20 euros payable by the client and charges 50 euros per session beyond that limit. If eight sessions were used on those terms, the cost would be 6 × 20 + 2 × 50 = 220 euros. This only illustrates a limit’s effect; it is neither a market price, usage forecast nor treatment plan. Confirm every component in the actual contract first.
Read the distinctions inside the condition
In that example, waiting periods are 60 days for those consultations and 90 for inpatient care. Exclusions include coaching and vocational or organisational psychology. These terms belong to the cited version; do not copy them into a different policy.
For Sofia, the useful distinction is between the clinical description of a service and a broad commercial label. Ask which service and contractual version the answer concerns. A wellbeing service, discount or online consultation does not prove funding for every form of in-person care.
Sources: Médis — Condições Gerais e Especiais individuais, agosto 2025, Ref.MEDMEDADXALLX20, condição Saúde Mental completa p. 30/58; documento ligado pela página atual, lido01/11/2026 ↗ · Médis — Seguro de Saúde individual, informação sobre Saúde Mental e ligação atual às condições; página consultada01/11/2026 ↗
Use the appropriate channel to clarify insurance
The treating team guides care; the insurance question should identify the service and missing financial information. Keep both conversations moving without delaying necessary care while waiting for an editorial conclusion. Send reports and other health information only through the designated private channel, never in comments or public messages.
For existing insurance, use policy support to confirm your actual contract. To consider a new need, select Saúde under Request a quote on the RMACHADO website. Clara reminds Sofia that a new proposal does not confirm payment for ongoing care or automatically remove earlier conditions.
KEEP THESE QUESTIONS
Your checklist for the next conversation
- Identify psychology, psychiatry and inpatient care separately.
- Check the arrangement, provider, personal cost and limit for the service.
- Read the mental health condition in the version applying to your policy.
- Keep the response and use a private channel for clinical information.
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.
- Médis — Condições Gerais e Especiais individuais, agosto 2025, Ref.MEDMEDADXALLX20, condição Saúde Mental completa p. 30/58; documento ligado pela página atual, lido01/11/2026 ↗
- Médis — Seguro de Saúde individual, informação sobre Saúde Mental e ligação atual às condições; página consultada01/11/2026 ↗
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.