International Health Insurance for Brazilians Living Abroad

A health plan regulated by Brazil's National Supplementary Health Agency (ANS) covers, by law, treatment in Brazil: Law 9,656/1998 defines the reference plan with care "provided exclusively in Brazil." Anyone living or spending long periods abroad should check the contract.

You should also learn whether foreign insurance may be bought (Complementary Law, LC, 126/2007) and remember that Brazilian income tax does not accept health plans paid abroad.

Does a Brazilian health plan cover care outside Brazil?

As a rule, not by law. Art. 10 of Law 9,656/1998 establishes the reference plan or insurance with coverage of childbirth and treatment "provided exclusively in Brazil." Art. 12, II, "e", treats the transfer of a patient to another hospital as coverage "in Brazilian territory, within the geographic limits provided in the contract."

What counts in practice is the contract. Art. 16, X, of the same law requires contracts, regulations and general conditions to state the plan's geographic coverage area. The ANS tells consumers to check the coverage area in the contract and lists as options national, state, group of states, municipalities and group of municipalities. Foreign countries do not appear on that list.

Does a "national" plan work for someone who spends long periods abroad?

It works for Brazilian territory. "National" is one of the geographic areas the ANS presents within the country, alongside state and municipal. The term describes where in Brazil the plan can be used, and it does not offer care in another country.

Before a long stay abroad, ask your plan operator these questions and keep the answers:

1. •Does the contract provide any care outside Brazil? In which cases and with what limits?
2. •Is there transfer or repatriation in an emergency, and who pays?
3. •What happens to the monthly fee and the waiting period if I go months without using the plan?
4. •Can I keep the plan if I change my residence to another country?

If the operator does not answer clearly, treat coverage abroad as nonexistent and look for another solution.

Can I buy health insurance from a foreign insurer?

It depends on who buys and how. Complementary Law 126/2007, art. 20, restricts the purchase of insurance abroad by individuals resident in Brazil to four situations:

For those who travel or spend long periods abroad and remain resident in Brazil, insurance with a term limited to the period abroad (item II) is the framework provided. Continuous international health insurance, without that limitation, requires analysis of the case. The rule speaks of "individuals resident in Brazil"; for that reason, anyone who has already left Brazil permanently should check their residency status before buying. The guide on international tax residency explains how that status is defined on the tax side.

Brazil's insurance supervisory body is Susep (Superintendence of Private Insurance), cited in Decree-Law 73/1966. If in doubt about the framework, consult a registered broker or Susep itself.

How do I evaluate an international health policy?

Evaluate the policy by the contract text, not by the advertising. Premium amounts, limits and hospital networks vary by insurer, by country and by each person's profile; for that reason this guide cites no numbers. Before signing, confirm the points below in writing.

Can I deduct medical expenses incurred abroad on my income tax?

In part. If you file income tax as a Brazilian resident, art. 8, II, "a", of Law 9,250/1995 allows you to deduct payments to doctors, dentists, psychologists, physical therapists and hospitals, among others, relating to your treatment and that of your dependents. Paragraph 2, I, extends the deduction to payments to companies domiciled in Brazil that cover hospitalization, medical and dental expenses.

The income tax manual of Brazil's Federal Revenue Service (Receita Federal) details the case of expenses abroad:

The same law also bars the deduction of expenses reimbursed by an entity of any kind or covered by an insurance contract (art. 8, § 2, IV). It also requires that the payment be proven and itemized, identifying who received it (art. 8, § 2, III). For payment in foreign currency, the manual refers to the Receita page "Payments abroad."

Anyone who has ceased to be a tax resident of Brazil should handle this with an accountant. The guide on permanent exit from Brazil shows the obligations of that stage.

Does the CDAM guarantee public healthcare in Portugal, Cape Verde and Italy?

For those three countries, yes, through an agreement. The Certificate of the Right to Medical Assistance (CDAM) comes from Brazil's social security agreements with Portugal, Cape Verde and Italy and allows you to use the public health system of the destination country as a local citizen, according to the gov.br portal. The service is free for the citizen. For Portugal, the validity is 6 months, 1 year or 5 years, depending on the reason for the trip; for Cape Verde and Italy, it is 1 year.

The certificate is not valid for other destinations. The article on how to keep contributing to INSS while living abroad explains what it requires and how it relates to the social security agreements.

What are the steps before living or spending long periods abroad?

Follow this order so you do not discover a coverage gap in the middle of an emergency:

1. •Reread the Brazilian plan's contract and identify the geographic coverage area.
2. •Ask the operator whether there is coverage, transfer or suspension for someone who stays abroad, and ask for the answer in writing.
3. •Define whether you remain a resident of Brazil or have changed residence, since this affects the insurance you can buy (LC 126, art. 20).
4. •If the destination is Portugal, Cape Verde or Italy, check whether the CDAM fits your situation.
5. •Compare international health policies using the checklist above and keep the contract.
6. •Keep receipts and proof of medical expenses, identifying who received the payment, for your income tax return.
7. •Consider the whole picture: social security, tax residency and health protection influence each other. The offshore guide for Brazilians abroad and the tax planning service help align these decisions.