Gibraltar has a two-tier system of health insurance which is comprised of a national health insurance scheme, the Group Practice Medical Scheme (GPMS), and private cover. Overall, healthcare in Gibraltar is of a high standard. However, because the country only has one public hospital, and because you might find yourself having to seek treatment in neighbouring Spain or even be repatriated in the case of a serious illness, many expats choose to take out private health cover for additional peace of mind.We will take a look below at how to keep your health insurance costs in Gibraltar as low as possible if you do opt for private cover, and how to personalize your cover so that you’re not facing high premiums.
The GPMS covers a range of basic primary care treatment, maternity care, mental health care and emergency treatment. You may have to co-pay some prescription costs, but there is a cap on prescription charges.
St. Bernard’s Hospital has both out-patient and in-patient treatment for acute medical and surgical cases. The hospital also contains a maternity unit, a paediatric ward, surgical wards, medical wards, a critical care unit, operating theatres, radiology, pathology and rehabilitation. Two elderly care wards are managed by the Care Agency Elderly Residential Services. Facilities also exist for specialist medical services to be obtained outside Gibraltar if these are beyond the scope of local resources.
If you are British, you will automatically be covered by the national health insurance scheme in Gibraltar, since it is a British Overseas Territory. The cover will apply whether you are a resident or a visitor. If you have private health insurance for the UK, however, check with your provider as to whether you’ll also be covered in Gibraltar as well should you choose to access private sector medical treatment there.
The Rock also has a private hospital: the Hospital Quirónsalud Campo de Gibraltar, although some expats choose to go over the border to private clinics in Algeciras or Marbella.
Check the small print of any private policy to see whether it covers treatments that you may want to access, such as advanced dental care, and also whether it will cover you for treatment both in Gibraltar itself and over the border in Spain.
You should also check whether your potential policy covers pre-existing conditions: the definition of this varies between insurers. Usually the term applies to any conditions which present symptoms or for which you have been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for diagnosis.
You may also want to check out whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You will need to discuss this directly with your insurer.
Take a good look at any potential policy for any cover relating to healthcare which does not apply to you: some policies have provision for maternity care, for instance, and if you are not intending to become pregnant (or prefer to rely on the cover provided by the public maternity system on the Rock), then you may wish to reduce your policy costs by having such options removed.
You may also be able to reduce the cost of your premium through ‘cost sharing’: this means that you and your insurer will share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing, such as the below.
Co-pay: where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance: where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your co-insurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles: where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your GP. However, you would then have to pay the whole amount for 11 such visits (€1000/€85 = 11.8) before your insurance began to pay out to the doctor directly.
You may also need to take a look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met.
Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. You will thus pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000), or about 29 more visits (€500€17 = 29.4). At that point (40 total visits in a year), you would pay nothing more for the remainder of the plan year.
It’s worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
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