The difference between long-term care insurance and private health insurance or supplementary health services: what each covers, when it pays, why holding health insurance does not guarantee long-term care cover, and what is worth checking.
Two entirely different products
Health insurance is meant to cover medical expenses: operations, medicines not in the basket, consultations, transplants, treatment abroad. It pays for medical treatment.
Long-term care insurance does not cover medical treatment at all. It pays a monthly benefit when a person becomes dependent on others in daily activities, or needs supervision because of cognitive decline.
The substantive difference: health insurance responds to a medical event; long-term care insurance responds to a functional condition. A person can be very ill and not dependent on care, or dependent on care with no acute illness at all.
What supplementary health services are
Supplementary health services — the health funds' top-up schemes — provide additional medical services beyond the basic basket: consultations, tests, discounts on medicines and more.
This is a product entirely separate from long-term care insurance, even when it is sold by the same fund and even when the names are similar.
It is a common mistake: a family is sure it has long-term care cover because it has a "premium" or "gold" scheme, and discovers at the claim stage that it is supplementary health services only. So it is important to check explicitly which covers exist, and not to rely on the name of the scheme.
What else may exist in parallel
An average person may hold several covers at the same time, sometimes without knowing. It is worth mapping them all.
- Private health insurance — operations, medicines, transplants
- Supplementary health services through the health fund
- Group long-term care insurance through the health fund
- A private long-term care policy
- A critical illness policy — pays a lump sum according to diagnosis
- Loss of earning capacity insurance — relevant at working age
- Covers through a workplace or an organisation
How to check what really exists
The quickest route is the Capital Market Authority's Insurance Mountain, which helps locate insurance information and shows existing covers.
Alongside it, it is worth checking the personal area of the health fund and of the insurance companies, and going through bank statements to identify standing orders.
When a cover comes to light, do not settle for the product name. Ask for the text of the policy and check exactly what it covers, because a similar name does not indicate similar content.
Frequently asked questions
What is the difference between long-term care insurance and health insurance?
Health insurance covers medical expenses — operations, medicines, consultations. Long-term care insurance pays a monthly benefit when a person becomes dependent on others in daily activities or needs supervision.
We have a 'premium' scheme — does that include long-term care insurance?
Not necessarily. Supplementary health services are a product separate from long-term care insurance, even when sold by the same fund. You have to check explicitly which covers exist.
What other covers may exist in parallel?
Private health insurance, supplementary health services through the fund, group long-term care insurance, a private long-term care policy, a critical illness policy, loss of earning capacity insurance, and covers through the workplace.
How do we check what exists?
Start with the Capital Market Authority's Insurance Mountain, go on to the personal area of the fund and of the insurance companies, and check standing orders on bank statements.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
