Hospital health plan: what is it and how does it work?

Hospital health plan: what is it and how does it work?

The health plan hospital is a simpler hiring mode than traditional plans, but that brings several advantages for those looking for this service – particularly coverage procedures in hospitals, which usually have high cost.

Since many people have doubts about the functioning of this type of plan and the feasibility of hiring, we have prepared this post to clarify the matter. Continue reading and inquire!

What is a hospital health plan?

To understand how this type of plan works, it is important to explain the three types of coverage that exist: outpatient, hospital and reference.

outpatient plan

This type of plan includes procedures performed in offices, clinics and outpatient facilities, such as:

  • unlimited queries, including prenatal care;
  • Additional examinations and other procedures;
  • urgent care and emergency procedures and until the first 12 hours;
  • tests that do not require stay of more than 12 hours in the hospital;
  • special procedures such as dialysis and hemodialysis, chemotherapy, outpatient transfusion medicine and radiotherapy.

However, this type of plan does not cover hospitalization. If necessary the patient hospitalization (greater than 12 hours, if urgent or emergency), shall be his responsibility to pay for the hospital costs.

hospital plan

In the case of hospital plans, coverage only covers the care in hospitals accredited as:

  • medical consultations during hospitalization;
  • unlimited daily;
  • complementary exams in the hospital;
  • ICU admission;
  • Materials used during hospitalization;
  • anesthetic drugs;
  • chemotherapy;
  • radiotherapy;
  • utilization of operating rooms;
  • blood transfusion;
  • special procedures such as dialysis and hemodialysis, chemotherapy and outpatient transfusion medicine, radiation therapy, parenteral nutrition or enteral, embolization and interventional radiology procedures in hemodynamics, physiotherapy;
  • postoperative follow-up in case of kidney transplant and cornea.

Moreover, they are also covered for the emergency attention and generate emergency hospitalization or are critical to the preservation of life, organs or functions of the patient. However, it does not cover consultations and examinations carried out in hospital stay.

benchmark plan

The plans of the standard type are the most complete, including the hospital and outpatient care, with all the special procedures of both.

Who is it for?

The hospital health plan is indicated mainly for those not able to afford a reference plane, which is more complete. Although medical consultations and examinations are needed infrequently, the costs of procedures tend to be smaller when compared to hospital.

Admissions and surgical interventions, for example, usually have a high value and often end up being unviable for the person who does not have health insurance. On the other hand, there are some popular clinics that offer consultations and examinations for more affordable values, and a great alternative for those who just have hospital cover.

What are the differences across types of hospital health plans?

There are different types of hospital health plans that influence the coverage and tuition fees. Understand what changes including:

With or without co-participation

The co-participation in the plan means that the user will pay a rate set in the contract – usually a percentage, with a maximum set value – referring to the procedures that are performed. In such cases the monthly fee is usually lower, considering that the contractor will bear part of the cost of the procedures.

In plans without co-participation, the contractor will pay only the fees fixed in the contract, without having charged additional amounts by the procedures. As a result, the value of tuition is usually higher.

Accommodation infirmary or apartment

When making the hiring of hospital health plan, there are two options regarding the patient’s accommodation in case of hospitalization: nursing and apartment.

When hospitalization is in the ward, the person stays in shared rooms, usually with more restricted visiting hours. In addition, the companion right is guaranteed only to those under 18 or over 60 years.

In plans apartment, the person admitted will have room and private bathrooms, ensuring more comfort and privacy, with a more flexible schedule for visits. In general, the companions can be full-time and without age restrictions, but this can vary in each contract. The particulars of this contract, the cost is higher.

With or without obstetrics coverage

The plan includes all obstetrics hospital procedures already mentioned, besides those related to pregnancy , such as:

  • consultations, exams and prenatal procedures;
  • childbirth care;
  • assistance to the newborn during the first 30 days of life;
  • assistance to the adopted child, within 30 days of the adoption;

In addition, children may be included as dependents in the plan, without lack of compliance if effective within 30 days to make hiring.

In plans without OB, coverage is limited to hospital procedures previously cited, without including those that are related to pregnancy and childbirth.

How this health plan?

To the hiring of hospital health care plan, it is essential to consult a specialist company and contracted by different operators of health plans. Thus, she will analyze your needs and present the best options.

The plans may have different territorial scopes, and difference between the accredited hospitals – that make service to your health plan.


The grace period is a specified period during which new users can not take advantage of established coverages. It is important to note that this period is applicable to hospital health insurance the same way as happens in traditional.

This period may vary for each carrier, but the National Health Agency (ANS) has set the maximum grace period for the following:

  • 24 hours for emergency care;
  • 300 days not to premature births;
  • 24 months for pre-existing illnesses or injuries;
  • 180 days for other cases.


Although the only hospital coverage is more expensive than an outpatient, she usually offer better value for money, in addition to more affordable values ​​than the reference planes.

The fee varies according to each health plan operator, scope and characteristics of the plans. So it is essential to make quotes and see which offer the best conditions. Still, it is crucial to analyze the period of grace , roofing and networks accredited to the plan, to check on hospitals that you can perform the procedures.

So, you can find an advantageous hospital health plan for you and your family, ensuring that they will have assistance whenever needed.

So you’re interested in purchasing a health plan? Contact us – our consultants are ready to help you meet and in choosing the best plan!


Spread the love

No comments.

Leave a Reply