The Portuguese Insurance and Pension Funds Supervisory Authority (ASF) issued a circular establishing “standard conditions” for a network-based health insurance option and associated consumer information expectations for insurers authorised to write the “Disease” class in Portugal. The framework is intended to support transparency and comparability of health insurance cover, premiums and key contractual features. Insurers are expected to make available a health insurance option that matches the annexed standard package, and to provide the information needed for customers to understand coverage and essential service features such as provider networks and reference prices for medical acts. Where a product meets the standard conditions, firms must include a prescribed statement in pre-contractual and contractual documentation, and where additional covers or higher capitals are added they must separate the premium attributable to the standard package from the premium for add-ons. The standard package includes Hospitalisation (capital limit EUR 30,000 with 10% copayment subject to minimum and maximum amounts, and a 180-day waiting period except childbirth), Outpatient (capital limit EUR 1,000 with specified copayments and a 60-day waiting period), Preventive Medicine (one package, no copayment, 60-day waiting period) and Extended Coverage Diseases (capital limit EUR 300,000 with 10% copayment capped, 180-day waiting period), with the latter covering cancer and specified cardiovascular conditions. The annex also includes standardised definitions, territorial scope and a set of exclusions, and specifies that continuity of cover should not be ended on the basis of the insured person’s age. If insurers offer a contract meeting all standard conditions, they must report semi-annually to ASF within 30 days after each semester-end the number of in-force contracts using the standard conditions, the number of insured persons and the total premiums collected for the standard cover set. ASF will publish on its website the insurers that provide a fully compliant offering after each report, with the first report due for the second half of 2025, and it will publish an evaluation report after receiving two rounds of reporting.
Portuguese Insurance Regulator (ASF) 2025-06-03
Portuguese Insurance and Pension Funds Supervisory Authority sets standard conditions for comparable health insurance policies and introduces uptake reporting
The Portuguese Insurance and Pension Funds Supervisory Authority (ASF) mandated "standard conditions" for network-based health insurance in Portugal to enhance transparency and comparability. Insurers must offer a health insurance option aligned with the standard package and provide clear consumer information on coverage and service features. Compliance requires semi-annual reporting to ASF, with the authority publishing compliant insurers and an evaluation report after two reporting rounds.