The cost of health insurance for companies in Portugal is set to rise by an average of 10,3% next year, according to the study " Costs of Health Insurance for Companies in Portugal, " conducted by Coverflex . This figure represents an increase compared to the 9,9% rise recorded in 2024 and reflects a set of structural and cyclical factors that challenge both the insurance sector and the Portuguese business environment.

The main driver of this growth is medical inflation, which has caused significant increases in the prices of consultations, examinations, specialized treatments, and medical devices. This phenomenon is further reinforced by the concentration of the private sector in large hospital groups, such as CUF, Luz, and Lusíadas, which, with greater negotiating power, directly influence the prices charged to insurance companies.

Furthermore, the difficulties experienced in the National Health Service (SNS) have been pushing more and more users towards the private sector. Currently, more than four million Portuguese people already have health insurance, and this number is expected to exceed five million in the next two to three years. This increase raises the average costs per claim, since private care is generally more expensive.

Another relevant factor is the aging of the working-age population, coupled with the increasing prevalence of chronic diseases. These demographic trends lead to a greater demand for long-term care, further straining insurance expenses. At the same time, constant technological innovation, while improving diagnoses and treatments, brings added costs.

Finally, mental health stands out as an area of additional pressure, with the demand for psychology and psychiatry consultations growing significantly since the pandemic. In response, insurance companies have been integrating broader coverage for emotional well-being, contributing to the overall increase in premiums.

Trends and challenges in health insurance management

The sector faces the challenge of ensuring the technical sustainability of products, that is, maintaining loss ratios compatible with the financial viability of policies. To this end, insurers have been focusing on revisions of co-payments, deductibles, renegotiation of price lists, and the creation of new provider network models.

However, this challenging context has also stimulated the search for innovative solutions, with three main trends standing out:

Digitization and data analysis: Telemedicine, online clinical triage platforms, and artificial intelligence and business intelligence tools are transforming insurance management, enabling near real-time monitoring of claims and identification of usage patterns.
Prevention and health promotion: Companies and insurers are investing in literacy programs, screenings, incentives for physical activity, nutrition, and mental health, with the goal of reducing the incidence of claims in the medium and long term.
Hybrid benefit models: The offering of basic coverage is growing, complemented by optional upgrades financed by the employees themselves, through flexible benefit packages or salary deductions, allowing for flexibility and customization.

Strategies for companies

Rising costs are forcing companies to adopt a strategic approach, or risk damaging their attractiveness as employers. Cutting this benefit can have a direct impact on recruitment, retention, and employee satisfaction, making its efficient management even more relevant.

Among the solutions highlighted by the Coverflex study, the following stand out:

Policy renegotiation: Reviewing contractual conditions, redesigning coverage, and sharing costs with employees through deductibles, co-payments, or co-financing of the premium.
Promoting prevention and health literacy: Encouraging the rational use of health services, reducing accident rates through education and preventive programs.
Flexible benefits: Offering customizable plans that adapt to the different needs of the team and allow for a more balanced distribution of costs between the company and employees.

A strategic benefit, not just a cost.

“ It is true that costs continue to rise and everything indicates that this trend will continue in the coming years. However, it is essential that companies stop viewing health insurance merely as a financial burden. This benefit is a tool for attracting, retaining and valuing talent, as well as boosting productivity ,” emphasizes Paulo Fradinho, Head of Insurance at Coverflex.

The study concludes that, in a scenario of rising costs, the path to sustainability lies in innovation, prevention, and flexibility – positioning health insurance as a key component of the compensation package for Portuguese companies, aligned with the new demands of the labor market.