General Policy information
POLICY OUTLINE
About the Policy
This overview highlights key services and treatments in a typical insurance policy. Please refer to your full policy for complete terms and conditions. Pre-existing conditions may be excluded, and coverage is limited to Spain. Coverage outside Spain varies by policy.
A comprehensive health insurance
This insurance policy offers extensive coverage, with low premiums and no deductible (within the medical network). You will have access to private health care in Spain.
Reimbursement Insurance - Access to Services
Reimbursement Insurance allows you to freely choose your hospital and specialist, anywhere in Spain. You may also use the Recommended Services (health care network), where, as an Insured Party, you will not have to pay any amounts whatsoever. You only have to show your health insurance card wiht no out of pocket.
| Medical Care | Recommended Services (Do You Pay?) | Freely Chosen (Do You Pay? Reimbursement) |
|---|---|---|
| OUTPATIENT DOCTOR VISITS | NO | YES - 80% |
| OUTPATIENT TESTS | NO (special tests with prior authorization) | YES - 80% |
| HOSPITAL EXPENSES | NO (prior authorization) | YES - 90% |
| MEDICAL SERVICES FEES | NO (prior authorization) | YES - 90% |
Reimbursement Insurance - General Coverage Overview
This table provides a general overview of the coverage included under the insurance policy. Each section describes the types of services and treatments covered, and the conditions under which they apply. Coverage is subject to the terms and conditions as outlined in the Specific and Individual Insurance Certificate.
| Coverage | Description |
|---|---|
| Legal Framework | The policy is governed by the General, Specific, and Special Conditions, as well as applicable insurance laws. The Insured Party may request adjustments if there are discrepancies between the policy and the proposal within a month of receiving the policy. |
| Purpose and Scope of the Insurance | The insurance reimburses medical expenses for treatments covered under the policy, including medical, surgical, and hospital care provided by Recommended Services in Spain, with all reimbursements made in euros. |
| Hospital and Non-Hospital Coverage | Reimbursement for medical and hospital expenses for illness or injury, including primary care, specialist consultations, and surgeries. Non-hospital coverage also includes emergency care and home visits. |
| Primary Care | Reimbursement for general medicine, pediatric care, diagnostic procedures (e.g., blood tests, basic radiology), and emergency care either at home or in a medical center. Preventive programs for children are included at Recommended Services. |
| Specialized Outpatient Care | Coverage for consultations in a range of specialties such as cardiology, dermatology, endocrinology, gynecology, and many others. Reimbursement includes minor outpatient surgeries and diagnostic imaging when necessary. |
| Hospital Coverage | Reimbursement for hospital stays, including expenses for a private room, medical fees, surgery, medications, ICU care, and ambulance services. Covers major outpatient surgeries and radiation therapies for oncological conditions. |
| Obstetric and Maternity Care | Reimbursement for hospital care related to childbirth, including cesarean section, maternal and fetal monitoring, and midwifery care. Coverage also includes prenatal care provided by specialists and specific maternity-related surgeries. |
| Reimbursement of Pharmacy Expenses | Reimbursement for prescription drugs for illnesses covered under the policy. Vaccines, including those for tetanus and pneumonia, are also covered under this benefit. |
| Second International Diagnosis Coverage | Reimbursement for consultations with globally accredited specialists to confirm diagnoses or explore treatment alternatives, available for specified medical conditions. |
| Dental Coverage | Provides coverage for dental procedures such as exams, cleanings, basic extractions, and x-rays when provided by Recommended Services. Excludes advanced treatments like orthodontics unless a dental supplement is added. |
| Accidental Death | Provides compensation to beneficiaries in the event of the insured's death due to an accident. This coverage applies within 365 days of the accident, subject to exclusions such as participation in risky activities. |
| Non-Hospital Rehabilitation | Rehabilitation coverage for conditions such as Acquired Brain Injury or Spinal Cord Damage, with a limit on the number of treatment days provided during the first 12 months after diagnosis. |
| Acquired Brain Injury and Spinal Cord Damage Treatment | Reimbursement for medical and rehabilitation treatments for specific conditions such as stroke or traumatic brain injury, with limitations on the duration of coverage and specific criteria for treatment. |
| Psychiatric Care | Consultations for acute psychiatric conditions are covered. Treatments for addiction cessation and long-term psychiatric care are excluded. |
| Assisted Reproduction | Coverage for sterility treatment, including artificial insemination and in vitro fertilization. The policy covers two attempts at artificial insemination and one attempt at in vitro fertilization per policyholder. |
| Family and Pregnancy Programs | Reimbursement for family planning services, early breast cancer diagnosis, gynecological health checks, and early detection programs for other health conditions, including coronary disease and diabetes. |
Note: The coverage described here is subject to the terms and conditions outlined in the Specific Conditions and/or Individual Insurance Certificate. Reimbursement limits, co-pays, and exclusions may apply. Always refer to your specific policy documentation for the full details.
Insurance Coverage Summary
This is a typical representation of what an insurance policy might include. However, policies may vary depending on pre-existing conditions and individual needs. Always review your policy details to ensure coverage aligns with your personal requirements.
| Specialty | Coverage |
|---|---|
| Asthma and allergies | |
| Vaccines and autovaccines | ✘ (except for vaccinations in the Healthy Child Program) |
| Drug treatment | ✘ |
| Aerosol therapy | ✔ Yes (At Recommended Services) |
| Oxygen therapy | ✔ Yes (At Recommended Services) |
| Ventilation therapy | ✔ Yes (At Recommended Services) |
| Cardiology | ✔ Yes |
| Cardiovascular Surgery | ✔ Yes |
| Chest Surgery | ✔ Yes |
| Dentistry and/or stomatology | ✘ (Except for services at Recommended Services) |
| Dermatovenereology | ✔ Yes |
| Digestive system | ✔ Yes |
| Endocrinology and nutrition | |
| Illness | ✔ Yes |
| Slimming treatments | ✘ |
| General and Digestive System Surgery | ✔ Yes |
| Geriatrics | ✔ Yes |
| Hematology | ✔ Yes |
| Human Genetics | ✔ Yes |
| Genetic Study | ✔ Yes (includes specific tests for various cancers, genetic disorders, etc.) |
| Internal Medicine | ✔ Yes |
| Maxillofacial Surgery | ✔ Yes (dental treatments at Recommended Services) |
| Nephrology | ✔ Yes |
| Neonatology | ✔ Yes |
| Neurosurgery | ✔ Yes |
| Neurology | ✔ Yes |
| Obstetrics and Gynecology | |
| Epidural anesthesia in vaginal delivery | ✔ Yes (At Recommended Services) |
| Pregnancy, Labor, Cesarean section | ✔ Yes (As per limit) |
| Preparation for childbirth | ✔ Yes (At Recommended Services) |
| Gynecological check-up | ✔ Yes (1 per year, as per limit) |
| Tubal ligation | ✔ Yes (At Recommended Services) |
| Artificial insemination | ✔ Yes (At Recommended Services) |
| In vitro fertilization | ✔ Yes (At Recommended Services) |
| Sterility/infertility (Study and treatments) | ✔ Yes (At Recommended Services) |
| Oncology | ✔ Yes |
| Ophthalmology | |
| Refractive surgery | ✘ |
| Eye test | ✔ Yes (1 per year, as per limit) |
| Osteopathy | ✔ Yes (Maximum 8 sessions per insured party/year, At Recommended Services) |
| Otolaryngology | ✔ Yes (Maximum 20 sessions/year of speech therapy at Recommended Services) |
| Pediatric Surgery | ✔ Yes |
| Pediatrics | ✔ Yes |
| Plastic and Reconstructive Surgery | |
| Accidents (documented emergency care report) | ✔ Yes |
| Esthetic treatments | ✘ |
| Podiatry | ✔ Yes (Maximum 4 chiropody sessions per year, At Recommended Services) |
| Psychiatry | |
| Acute or exacerbated chronic processes (Hospital care) | ✔ Yes (At Recommended Services) |
| Brief or focal Psychotherapy Treatments | ✔ Yes (Maximum 20 sessions per Insured Party/year at Recommended Services) |
| For eating disorders | ✔ Yes (Maximum 40 sessions per Insured Party/year at Recommended Services) |
| For bullying | ✔ Yes (Maximum 40 sessions per Insured Party/year at Recommended Services) |
Note: This coverage is for healthcare in Spain. There is no coverage in the United States.
Please note that some services require a waiting period, which is the time you need to wait before coverage starts from the date the policy becomes effective. This includes the following: outpatient or inpatient surgery (6 months), hospitalization of any type, except extreme or life-threatening emergency (6 months), cardiac CT scan (6 months), magnetic resonance, PET, vascular and interventional radiology, polysomnography, CPAP, BiPAP, nuclear medicine, and radioactive isotopes (6 months), hemodynamics (6 months), dialysis (6 months), lithotripsy (6 months), medical or radiation oncology (6 months), access to the Hospital Network of the United States of America (6 months), rehabilitation and cardiac rehabilitation (6 months), brief psychotherapy consultation/treatments (6 months), osteopathy consultation/treatments (6 months), extended coverage (6 months), genetics (6 months), pregnancy, karyotypes, genotypes, amniocentesis, preparation for giving birth, care at birth or Cesarean section (8 months), study of sterility/infertility and treatment by means of assisted reproduction techniques (48 months), and national and international adoption (48 months).
Note: No waiting period applies if the service is caused by an accident. The waiting period starts from the date of inclusion of each Insured Party in the coverage.
Please note: These amounts shall be reimbursed to the Insured Parties up to the set
limit. Abdominal reconstruction mesh, €600, Biological cardiac valves (per unit), €3,600, Bone grafts (bone bank), €1,000, Bone substitutes, €1,500, Breast expander prosthesis (per unit), €1,200, Breast prosthesis (per unit), €700, Breast tissue expanders (per unit), €1,000, Cemented hip prostheses, €1,200, Cementless hip prostheses, €3,000, Cochlear implant (single implant), €22,000 (Exclusively through the program for early detection and treatment of deafness in children), Disc prosthesis in its entirety, €3,000, Dura mater substitutes, €600, Electrodes and spinal cord stimulators (only pain management), €6,000, Electrodes and transcutaneous stimulators (only pain management), €2,400, Embolizing substances and material (coils and onyx, embospheres, etc.), €3,000 (Total/year), External bone fixators, €1,200, External infusion pumps, €2,400, Hearing aid (one per ear), €2,000 (Exclusively through the program for early detection and treatment of deafness in children), Hormonal IUD, €50, Hydrocephalus valves, €1,500, Implantable Holter monitor, €1,500, Internal infusion pumps, €5,400, Internal spinal fixators (for each additional level), €1,200, Internal spinal fixators (for level 1), €2,400, Interphalangeal prosthesis for fingers, €200, Intraocular lens (for each eye), €180, Intrastromal corneal rings, €70, Kit/material for kyphoplasty (in its entirety/per insured party), €3,000, Kit/material for vertebroplasty (per vertebra), €1,200, Knee prosthesis, €3,300, Material used in ligamentoplasty in its entirety (ligament, screws, anchors, and sutures), €1,800, Mesh for hernias, €600, Mesh for incontinence, €600, Metacarpophalangeal prosthesis, €1,000, Metal cardiac valves (per unit), €4,200, Nucleoplasty kit, €1,200, Osteosynthesis material in fractures, €2,500, Pacemaker, €4,800, Piston or ossicular prosthesis (TOR, POR), €100, Prosthesis for by-pass, €1,800, Reservoirs (in pain management and chemotherapy), €450, Rhizolysis kit, €800, Self-implantable defibrillator, €18,000, Shoulder prosthesis, €3,300, Stent (per unit), €1,600, Testicular prostheses, €600, Thoracic mesh, €600, Valved prosthetic tube, €6,000, Valves for glaucoma, €540, Valvular rings for reconstructing heart valves, €1,600, Vascular endoprosthesis (including atrial closure device), €1,500, Deductibles, In Assisted Reproduction, Application of ICSI or sperm microinjection techniques, €360, Testicular extraction (obtaining spermatocytes), €300, In Brief or Focal Psychotherapy Treatments, Consultation/session, €12, In Osteopathy Treatments, Consultation/session, €12