This is how health insurance works
We get a lot of questions about health insurance. How it works, who has it, and why, as well as how it works in relation to tax-funded care. Here we have collected the most common questions and the answers to them.
How does health insurance work?
If you have healthcare insurance and suffer an injury/illness, call the care planning department at your insurance company.
It is usually a nurse who answers. Among other things, the nurse asks questions about the complaints in order to be able to make an assessment of what type of support/treatment is appropriate and can also give medical advice.
Depending on what the symptoms are, care planning can directly book an appointment for treatment with a specialist. It usually involves booked physical visits, but it is becoming increasingly common with e-care as many policyholders prefer it. Of course, it is a given that it works with the diagnosis you have.
How is healthcare insurance financed?
None of the care provided by the health insurance is financed with tax funds.
The financing takes place solely with premiums paid by the policyholders. The premiums finance the care provided by private care providers, care planning, and administrative costs. Who Can I Add To My Health Insurance?
What care is provided within the health insurance?
The most common treatment in healthcare insurance is in orthopedics. It can be about visits for treatment with a physiotherapist, chiropractor, or naprapath, but also about operations. Care in orthopedics accounts for around 30 percent of care in health insurance.
Other common treatments are in the skin, ears/nose/throat, gynecology/urinary tract, and eyes, which each account for just under 10%.
What care is NOT provided within the health insurance?
Emergency care, palliative care (end-of-life care), or intensive care (IVA) are not covered by health insurance. Health insurance also does not cover the investigation and treatment of diseases covered by the Infection Prevention Act.
Other treatments that are not carried out within healthcare insurance are, for example, cosmetic treatment and surgery without special reasons, correction of refractive error in the eye and pregnancy control. Cosmetic treatment/surgery can be performed as breast reconstruction after breast cancer surgery or for disfiguring scars on the face.
Is the care provided within the health insurance necessary?
All efforts within health insurance are preceded by a medical assessment in the same way as in publicly funded care. Care is only provided if it is established that there is a need for care.
This means that all the care provided within the health insurance would otherwise have had to take place within public care.
Can you get faster care through health care insurance compared to tax-financed care?
In the agreements that the insurance companies sign with private healthcare providers, different time frames apply than in the agreements that regions make with private healthcare providers.
Within most healthcare insurances, the waiting time for a visit to a specialist is a maximum of 7 working days and for an operation a maximum of 14–21 working days.
This is a shorter time than what applies according to the care guarantee in publicly funded care. The care guarantee entitles you to care within 90 days.
Many private care providers can normally offer shorter waiting times than this for both regionally funded care and insurance patients.