When someone asks me for a health quote, the question that comes up most is not what it covers, but "is it worth paying something every time I see a doctor?". It is a fair question, and it is answered with sums, not gut feeling. Let's do them.

What changes between the three copay levels, and what doesn't

The first thing to be clear about: the medical cover is exactly the same in all three levels. Emergency care, primary care, specialists, diagnostic tests, hospitalisation… none of it depends on the level you pick. The only thing that changes is how much you pay each time you use a service and, in exchange, how much you pay in premium each month.

A copay is a fixed amount per service — a consultation, a test, a session. It is not an extra premium or a penalty: it is a way of sharing the cost in exchange for a lower monthly premium. The lower the copay, the higher the premium tends to be, and the other way round.

In one sentence: you choose between paying a bit more each month and never paying per use, or paying less each month and a small amount each time you use a service.

  • ✓Same cover in all three levels: emergencies, specialists, tests and hospitalisation.
  • ✓What changes is what you pay per use and your monthly premium.
  • ✓Lower copay means a higher premium, and the other way round.

You can see the three levels side by side on the Health Insurance page

The three levels, with the real amounts

These are the indicative copay amounts of the current product for the services used most often. They are subject to updates, so I confirm the current ones when we prepare your quote.

  • ✓No Copay €0 for a consultation, an emergency visit and MRI or CT scans. It is the level with the highest premium and the simplest: there are no one-off payments.
  • ✓Reduced Copay general consultation and paediatrics, €2.50; emergency visit, €6; MRI, CT or PET, €10. The middle ground.
  • ✓Standard Copay consultation, €7; emergency visit, €14; MRI, CT or PET, €40. The lowest monthly premium of the three.

Other services have their own amount — nursing and podiatry, rehabilitation, psychotherapy, antenatal classes. The full detail is on the health page and in the policy terms.

This article is for general informational purposes and does not replace the terms of your policy. Copay amounts are indicative figures for the current product and are subject to updates; the premium for each level depends on the age and area of each insured person, and I calculate it for you with no obligation.

Two different years: what you would pay at each level

Let's look at it with two illustrative examples that use the real amounts above. They are examples of copays, not of premiums: the monthly premium is added on top and depends on your age and area.

A quiet year: six consultations, one emergency visit and one MRI scan. With No Copay you pay €0. With Reduced Copay, 6 × €2.50 + €6 + €10 = €31. With Standard Copay, 6 × €7 + €14 + €40 = €96.

A heavy-use year: thirty consultations, four emergency visits and two imaging tests. With Reduced Copay, 30 × €2.50 + 4 × €6 + 2 × €10 = €119. With Standard Copay it would come to 30 × €7 + 4 × €14 + 2 × €40 = €346, but this level has an annual copay limit of €300 per insured person, so what you would pay in copays would not go beyond that.

The conclusion is not that one level is "better": in a quiet year the difference in copays is a few tens of euros, and in a heavy-use year it has a ceiling, whereas the difference in premium is paid all twelve months. That is why it pays to look at both together.

  • ✓Quiet year €0 with No Copay, €31 with Reduced and €96 with Standard.
  • ✓Heavy-use year €0, €119 and a maximum of €300 in copays.
  • ✓The monthly premium is added on top, and it weighs the most over the year.

How to decide: who uses the doctor, and how much

A practical way to decide is to look at the last twelve months: how many consultations, how many emergency visits, whether there were tests. Someone who sees the doctor often, or expects treatment in sessions such as rehabilitation or psychotherapy, will usually value not paying per use. Someone who hardly uses it and wants the lowest premium will usually fit better with Standard Copay. Reduced Copay sits in the middle.

The whole family does not need to be on the same level either. You can include up to 10 people on the same policy and each can have a different copay level depending on how much they tend to see the doctor, so it can make sense for whoever uses it most to have one level and whoever hardly uses it, another.

And it is not a decision for life: at annual renewals you can consider a change of level depending on how your family is using the insurance.

  • ✓Look at the last year consultations, emergency visits and tests for each person.
  • ✓Mix levels up to 10 people per policy, each with their own.
  • ✓Review at each renewal a change of level can be considered.

What the copay doesn't change

Choosing a copay level does not alter the general rules of the insurance. The waiting periods are the same: hospitalisation has 8 months, and benefits such as outpatient surgery, psychotherapy or certain diagnostic tests have 6 months, while emergency care, primary care and specialist medicine are available from day one.

I go through it in detail in Health insurance waiting period: how long do you actually have to wait?

Neither the health questionnaire, which must be truthful, nor the exclusions change: undeclared pre-existing conditions, cosmetic surgery or experimental treatments are left out at all three levels, and care from professionals outside the medical network is only covered in a life-threatening emergency.

  • ✓Waiting periods are the same at all three levels.
  • ✓The health questionnaire must be truthful, whichever level you choose.
  • ✓The exclusions do not depend on the copay either.