When a company asks us to compare health policies, the first conversation is not about price. It's about where the staff actually live, because that determines whether the benefit is perceived as such or ends up being a source of complaints.
The three modalities, without embellishments
Medical network: access to an agreed network at no cost per act or with a small copayment. Reimbursement: freely choose the professional and the insurer refunds a percentage, usually between 80% and 90%, with an annual limit. Mixed: medical network as a base and reimbursement available when wanting to go outside the network. The mixed option works best in heterogeneous staff, and the premium difference compared to the pure network is less than assumed.
The deciding variable: the staff map
An excellent medical network in Barcelona and Madrid can be poor in a province where you have the factory. Before comparing prices, you must cross-check the real address of employees with each insurer's network in those locations, paying special attention to paediatrics, gynaecology, traumatology, and the nearest hospital emergencies. It's an afternoon's work that avoids two years of discontent.
Waiting periods and pre-existing conditions in collective
Here lies the real advantage of contracting through a company. From a certain number of insured, it is common to negotiate the removal of waiting periods and the acceptance of pre-existing conditions without an individual questionnaire, something unattainable when contracting individually. It's the lever that must be expressly requested in the negotiation, because it doesn't come as standard.
What happens when someone leaves the company
It is advisable to agree in advance on individual continuity: the employee who leaves can maintain the policy personally retaining seniority and without new waiting periods. It's easy to negotiate at the start, impossible to achieve later, and is one of the most appreciated things in a departure or retirement.
The clauses that decide the outcome
Three specific points: the annual reimbursement limit and whether it applies per process or per year; the actual dental cover, which is usually basic services and not treatments; and high-tech therapies and tests, where differences between companies are significant. These three explain the majority of internal claims in the first year.
