A health card or health plan (cartão de saúde or plano de saúde) is not health insurance. A card gives you discounts on consultations and treatment within a network of providers, but you still pay the bill. Insurance, by contrast, transfers part of the risk to the insurer, which pays, up to the agreed limits, for things like a hospital stay or an operation. Here are the differences, so you know exactly what you are buying.

The difference in one sentence

With a health card, you pay less for what you use. With health insurance, the insurer pays part, often most, of what you use, up to the insured amount.

The Portuguese Health Regulator (ERS) is clear on this: health plans may even be sold by an insurer, but they are not health insurance.

What a health card is

A health card or plan works like a discount card:

You pay a monthly or annual fee, usually modest.
You get access to a network of doctors, clinics and hospitals at reduced or fixed prices.
According to the ERS, there is no prior medical assessment to join.
The price does not usually depend on your age or health history.
You always pay the provider yourself, just at a discount. There is no reimbursement and no insured amount.

What health insurance is

Health insurance is an insurance contract, governed by Portuguese insurance contract law and supervised by the insurance regulator, the ASF (Autoridade de Supervisão de Seguros e Fundos de Pensões):

It has benefit limits (plafonds): the most the insurer will pay under each cover.
Within the network you pay only a co-payment. Outside the network, you may be reimbursed a percentage of the cost, if the policy allows.
It can cover hospital stays, surgery and childbirth, which is where the big bills are.
It usually involves a medical questionnaire, waiting periods and exclusions, and the premium depends on age.

What a card does not do

The difference shows most when a large bill arrives. A health card does not cover hospital stays, surgery or childbirth: at most, it gives you a discount on the price.

A simple example. Imagine an operation with a hospital stay that costs €6,000 in a private hospital:

With a health card giving 15% off, you pay €5,100.
With health insurance that includes hospital cover within the network, you pay the co-payment set in your policy, for example a few hundred euros, and the insurer pays the rest up to the insured amount.

The figures are purely illustrative. The point is this: a card reduces the bill; insurance protects you from it.

This matters particularly if you are new to Portugal. Some products marketed to newcomers look like insurance but are discount plans. If you need proof of health cover for a visa or residence application, check with the relevant authority what type of cover they accept before buying anything.

A common misunderstanding

Many people come to me convinced they have health insurance when what they actually have is a card. Sometimes it came free with a bank card, a mobile phone contract or a subscription; sometimes it was sold over the phone under a name that sounds like insurance.

The problem only shows when you need it: an operation, a hospital stay, a birth. That is when you discover the card gives a discount, but the bill is still yours.

There is also a more delicate case: healthcare service contracts that are sold as if they were health insurance, but are not. They became popular through television advertising and campaigns featuring well-known figures from the entertainment world, so many people sincerely believe they have bought insurance. They have not. These contracts are not insurance policies, are not protected by the legal framework of the insurance contract law, and are not supervised by the ASF. One of the most common problems appears when customers realise that what they signed was not insurance after all and try to cancel: if they do so outside the renewal date or without respecting the notice period set in the contract, they may end up owing money. Before you sign, check that the document you are given is a policy issued by an authorised insurer, and ask me for help if you are in doubt.

If you are not sure what you have, look for the policy. Insurance always comes with a contract setting out general and particular conditions, the insurer’s name and the limits for each cover. If all you have is a card and a price list, it is a discount plan.

When a health card can make sense

That does not mean cards are useless. They can help:

As a top-up, for routine appointments or services your policy does not cover, such as some dental treatment.
For people who can no longer join an insurance policy because of age or health, and want at least to pay less for consultations.
For people who mainly use the SNS (the Portuguese National Health Service) and just want lower prices for some private appointments.

What you should not do is rely on a card to protect you from a serious illness or a hospital stay.

How to tell what you are buying

Before you sign, ask three questions:

Is this an insurance contract, with a policy issued by an insurer authorised by the ASF?
Is there an insured amount, meaning money the insurer pays on my behalf?
Does it cover hospital stays and surgery, and up to what amount?

If the answer to the first question is “no”, you are buying a discount plan, not insurance.

Frequently asked questions

Does a health card cover childbirth?

No. It may give you a discount on some services, but the cost of the birth remains yours. For childbirth to be covered, you need health insurance with maternity cover and the waiting period completed.

Can I have both insurance and a card?

Yes. Some people use the card for services the policy does not cover. It is only worth it if the fee is justified by what you will actually use.

Do health cards have waiting periods?

As a rule, no, because they are not insurance. But read the terms, as each plan has its own rules.

If you would like to know whether what you have today is insurance or a card, and whether it is enough for you, I will review it with no obligation: request your health insurance review here.

Sources

General information only. It does not replace reading your policy conditions or personalised advice.