This is how health insurance works
We get many questions about health insurance. How it works, who has it and why,
and how it works in relation to tax-financed care. Here we have collected the most common questions and the answers to them.
How does health insurance work?
If you have health insurance and have an injury/illness, call care planning at your insurance company.
It is usually a nurse who answers. Among other things, the nurse asks questions about the problems in order to be able to
make an assessment of what type of support/treatment is appropriate and can also provide medical advice.
Depending on the symptoms, the care planning can directly book an appointment for treatment with a specialist.
It is usually about booked physical visits, but it is becoming more common with e-care as many policyholders prefer it.
Of course, this applies given that it works with the diagnosis you have.
How is health insurance financed?
None of the care provided within the health insurance is financed with tax funds.
The financing only takes place with premiums paid by the policyholders.
The premiums finance the care provided by private care providers, care planning, and administrative costs.
What care is provided within the health insurance?
The most common treatment in health insurance is orthopedics. It can be about visits for treatment to a physiotherapist,
chiropractor, or naprapath, but also about operations. Care in orthopedics accounts for about 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 provided within the health insurance.
Health insurance also does not cover the investigation and treatment of illness covered
by the Communicable Diseases Act.
Other treatments that are not performed in health insurance are,
for example, cosmetic treatment and surgery without special reasons, correction of refractive errors in the eye,
and pregnancy control. Cosmetic treatment/surgery can be performed as breast reconstruction
after a breast cancer operation or with unsightly scars on the face.
Is the care provided within the health insurance necessary?
All efforts in health insurance are preceded by a medical assessment in the same way as in publicly funded care.
The care is only performed if it is established that there is a need for care.
This means that all the care provided within the health care insurance
would otherwise have had to take place within the public care.
Do you get faster care through health insurance compared to tax-financed care?
In the agreements that the insurance companies sign with private care providers,
different time frames apply than in the agreements that regions agree with the private care providers.
In most health insurance, the waiting time for a visit to a specialist is a maximum of 7 working days
and for surgery a maximum of 14–21 working days.
This is a shorter time than what applies under the care guarantee in publicly funded care.
The care guarantee gives the right to care within 90 days.
Many private care providers can normally offer shorter waiting times than that for both regionally funded care and insurance patients.
Which patients are treated first by private caregivers? Those with health insurance or those from publicly-funded care?
All care within the health insurance is performed by private care providers.
Patients who are scheduled for treatment or surgery are prioritized by treating
physicians primarily on the basis of medical priority.
This applies regardless of how the care is financed, by a region or an insurance company.
Thereafter, prioritization is based on what each client requires.
Patients who deteriorate during the waiting period are given higher priority and can be treated or operated on with priority.
The care provided by private care providers, who offer their services to both regions and insurers,
is equivalent and of the same quality. It gives both regions and insurance companies security in equal treatment.
In cases where there are long waiting times, according to the private care providers,
this is not because insurance patients have displaced publicly funded patients,
but because there is a general shortage of certain specialists.
This applies, for example, to allergologists, neurologists, and rheumatologists.