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 about the 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 the care planning at your insurance company.

It is usually a nurse who answers. Among other things, the nurse asks questions about the problems to be able to assess 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, 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, 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. The 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 based on 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.

What happens if the regions 'or insurance companies' demand for care increases?

Private care providers within the planned, non-emergency specialist care set aside times and resources to meet the conditions in all types of agreements, regardless of who pays.

The private care providers adapt the size of their clinics to the clients' demands. If they have both regional patients and insurance patients, they adapt their operations to the demand and requirements contained in the respective agreements.

If demand increases, the care provider can recruit more staff, streamline or increase the time worked. Conversely, if demand decreases, for example, because the number of insurance patients decreases, the number of employees or the time worked is reduced.

Why buy health insurance?

Most people who buy insurance see the insurance as a way to increase security for their health and livelihood.

One reason why employers buy health insurance for all their employees is to ensure that they have access to independent expert support in work environment work and as part of the work environment promotion work that they, according to the Work Environment Act, are obliged to fulfill. Many employers have both occupational health care and health insurance for their employees.

Another reason why employers buy health insurance for their employees is based on employers' concerns about being able to continue their business even if an employee becomes ill or has an illness or accident. Smaller companies, in particular, have small margins and find it difficult to manage without key personnel or if the business has to be shut down for a shorter or longer period.

Who can take out health insurance?

There are no general restrictions on who can take out the insurance. For employer-paid health insurance, the employee must be fully fit for work to be covered. For group insurance, there is sometimes a health check, sometimes not. For individually taken out insurance, a health check is always made. It can be about filling in a form.

For a person who has some form of symptom or is undergoing treatment for an injury or illness, the insurance does not cover that injury/illness. It follows that it is not possible to ensure an injury/illness that has already occurred. When the policyholder has been symptom- and treatment-free for 1-2 years, the insurance is fully valid even if the previous injury/illness would cause problems again.

When it comes to the age at which the insurance can be newly taken out, it differs between different companies. Some have a limit of 64 years, others 66 or 70 years.

A person who already has the insurance can often keep the life insurance, but sometimes there are restrictions at the age of 80. For a person who is 71–75 years old, an insurance policy can cost around SEK 1,800 per month with a deductible.

Who has health insurance?

Health insurance is available in many different occupational categories and salary positions.

Most insurances are sold in male-dominated industries such as construction, manufacturing, and more. One effect of this is that more men (64 percent) than women (36 percent) have health insurance.

The insurance is most common among those of working age, ie between 25-64 years. 55% of those covered by health insurance have an income below the limit for paying state tax.

Insurance is more common among smaller companies with up to 30 employees. It is most common in companies with up to 4 employees.

Health insurance is spread throughout the country and is by far the most common in Stockholm County, Västra Götaland County, and Skåne County. Health insurance measured as a proportion of the gainfully employed population is most common in Jämtland County, closely followed by Stockholm and Västra Götaland.

The insured are in all training groups. Those who have health insurance used to lesser extent sickness benefits and sickness compensation from the tax-financed security systems.

How to buy health insurance?

As a private person, you can choose to buy health insurance directly from an insurance company. However, it is more common to buy it through your union, given that it offers health insurance as part of its membership offer.

Within SACO and TCO, several unions offer an opportunity to take out health insurance. If you are a member of, for example, SACO, you can buy insurance for SEK 400 per month if you are 50 years old. When you use the insurance, you pay a deductible for each damage of SEK 750.

The most common is that employers buy health insurance for all their employees. The premium is then paid by the employer and varies depending on the number of employees and their age. The premium is usually between SEK 300-500 per month and employee, but it varies depending on the scope of the insurance and whether it is with or without a deductible. The premium is higher if the insurance is without a deductible.

The employee is taxed on benefits for 60 percent of the premium paid by the employer. The remaining 40 percent refers to preventive or rehabilitative measures. They are tax-free according to the law as they are part of the employer's responsibility according to the Work Environment Act.

Benefit taxation means that if the premium amounts to SEK 500, the employee is taxed on benefits for SEK 300. With a marginal tax of 30 percent, it will be SEK 90 per month. With a marginal tax of 50 percent, it will be SEK 150 per month.

How is care financed and performed in Sweden?

In Sweden, it is the regions that have the main responsibility for offering health and medical care. The municipalities are responsible for certain care, for example for people who live in certain special forms of housing, provided that the municipality has agreed with the region to take over such responsibility.

The region's responsibility as principal covers all care provided in the region, regardless of whether the region performs it under its auspices or whether the region has handed it over to a private care provider.

The regions have the right to levy taxes and the regions' health care is financed for the most part by tax funds and to a lesser extent by fees.

The regions have relatively large freedom to organize the health care for which they are responsible and can choose to conduct all care under their auspices or hand over the execution via an agreement to another actor, for example, a private care provider.

The extent of the care provided by private care providers based on agreements with the region varies between the regions. The Stockholm Region, the Skåne Region, and the Västra Götaland region, for example, buy more care from private care providers compared with other regions. The share amounts to about a quarter of the total expenditure on health care in these three regions.

The care provided within health insurance is mainly about planned specialist care. For an insurance company to be able to offer certain care to its customers, there must be a private care provider, in Sweden or abroad, that provides such care.

The insurance companies sign cooperation agreements with private care providers based on expertise, capacity, price, and quality to carry out the care included in the insurance. An insurance company can have agreements with several hundred different care providers to cover as many specialist areas as possible throughout the country.

Care provided by the region under its auspices, or performed on behalf of the region through agreements with private care providers, is not paid for by private health insurance but by the region. However, health insurance can reimburse patient fees that arise in connection with care provided by or on behalf of the region.

The care is provided by private care providers and the care, care planning, and administrative costs are financed in their entirety through insurance premiums of just over SEK 3 billion per year.