Medical insurance Spain FAQ


Medical
insurance
Spain FAQ


Below you will find a list of frequently asked questions on Medical insurance in Spain. The list has been rpovided as a guide only. Different companies may have different policies but it can be a useful starting point. The purpose is to answer some of your questions and get you thinking about what you need to ask the medical insurance provider. Whilst the information has been provided in good faith we do not accept responsibility for any errors or omissions.e

FAQs

When do I need to seek authorisations?

This will depend on the individual company. Examples could be, an ambulance transfer, prosthetics, psychotherapy, admissions to hospital, diagnostic tests or surgery.

The medical personnel should provide you you with the necessary documentation which you forward to the medical insurance company in Spain for authorisation.

Consultations with a doctor do not need authorisation. You can normally organise this directly with the medical centre using the card provided to you by the medical insurance company in Spain.

Authorisations can be obtained by telephone or over the internet. Often your broker will also help out if you have a problem.

Can I cancel the insurance ?

Yes, of course you can. You need to send a letter to cancel the insurance which must arrive at least one month before the renewal date. A letter of cancellation must be received by the insurance company, along with a copy of your NIE document and/or passport, at least one month before the renewal date. You can cancel anytime before that but please make sure the letter arrives at least a month before.

Please note that medical insurance in Spain is a commitment by both the insurer and insured for a 12-month period. This means that if you wish to cancel at any point during the year the insurer is entitled to the remaining premium. If you have paid monthly you are obliged to make the remaining payments of the contract and of course during that time the insurance company will continue to provide cover.

I have heard that a medical insurance company in Spain you work with is cheaper than the company I have. Can you help me change companies?

You can of course change medical insurance company in Spain. However, before you cancel your existing policy you need to consider things very carefully.

If you or another family member have claimed on your existing medical insurance and have received treatment for something such as an operation or serious illness then you might find that a new company will exclude this from a new policy with them. Although another company might be cheaper this issue may well make it an unattractive option.

Also, you need to ensure the new company will accept you. If they do you will need to make sure you provide at least one month's written notice before the renewal date, to the existing company that you intend to leave.

Please see FAQ cancelling the insurance.

In summary you can change but make sure you give plenty of time to enable the new insurer to confirm they will accept you and your family on conditions you are happy with and allow time to cancel the old Company policy.

What is “Co-Pago” or co-payment?

This is the contribution that the client must make for each treatment or visit. The amount will be detailed in the policy contract you have taken out. Excepting a co-payment will decrease the initial annual premium of your insurance. However, if you become ill and require ongoing treatment you will have to make an additional contribution each time you use the services of the medical insurance. The result could be the cost of the insurance is more expensive than paying for a policy without co-payment at the outset.

Please note that if you are applying for Spanish residency or one of the visas then this type of policy will not be accepted by the authorities in Spain. You can find out more on our web pages health insurance for people applying for non-lucrative visas for Spain or Golden visas for Spain or medical insurance Spain for Spanish residency.

Is dental included?

Nearly all medical insurance policies in Spain include some type of dental cover. The cover is often limited to a free check-up, a clean and extractions. Fillings and major dental work may be available under the policy but will all have an excess.

Often the medical insurance companies have negotiated preferential rates with dentists but you will usually have to pay for part of the treatment.

Can I use any doctor or do I have to use one from a specified list?

This depends on the policy you take out. A lot of private Medical Centres have a relationship with one or many insurance companies. The benefit to you is that for routine enquiries such as a first doctors appointment you only need to show your membership card for the medical insurance company and the doctor will claim the cost from the company direct. There is no need to obtain authorisation.

However, it could be that you and the children have a great relationship with a particular doctor and have always visited them. In that case you can either purchase a policy add-on that enables you to reclaim a percentage of the cost, for example 80% or elect for a reimbursement policy.

Whilst most insurance companies have an extensive number of doctors, clinics and hospitals they work with, a reimbursement policy gives you even more freedom to choose. Basically, you can choose whichever medical profesional you wish to see. You must pay the cost and the insurer will reimburse a percentage of the cost. In Spain, it is usually up to 80%. If you opt for a reimbursement policy with worldwide cover then the amount reimbursed would be 90% outside of Spain.

If you are seeking your health insurance in Spain for Spanish residency please visit the page linked in the sentence. Alternatively, if you are seeking health insurance for a non-lucrative or golden visas then click the link.

Immediately, except that some services, such as hospitalisation, transplants or surgery have a grace period before you can use them. These grace periods will be detailed in your policy contract. There are now some companies with policies that waive the usual grace period, which is of particular interest if you want full cover from day one or you are applying for a non-lucrative or golden visa for example.

Is it possible to get a home visit?

This could happen when the doctor has prescribed a home visit or when the condition of the patient makes it is impossible for them to get to the medical centre or hospital.

No. You are normally requested to fill out a basic medical questionnaire when applying for the health insurance in Spain. In addition, you will be asked to provide a contact telephone number. The insurance company may contact you to discuss the questionnaire you completed and may ask you for further information about the answers you gave or ask more information about your health.

Is there any opticians cover?

This is an add-on option with some companies. So whilst not included in the main medical insurance policy in Spain you can request to add cover.

For example, with one of the medical insurance companies we work with you have the option of adding on Optical cover. They offer a 50% reduction on a pair of prescription lenses for your glasses (but not the frames) or set of contact lenses as long as the total cost is no more than 300 euros.

There is a six month grace period after taking the cover before you can make use of it.

Can I pay the Premium monthly ?

Yes, is the short answer. It is cheaper to pay the policy in one annual amount, however, to make it more manageable for people you can opt to pay half-yearly, quarterly or even monthly. It is often the case that by splitting the annual premium the overall cost will increase.

Please note that if you decide to pay in instalments then you are obliged under the insurance contract to make all those payments. Policies for health insurance in Spain run from 1st January to 31 December. If after six months you wish to cancel the policy the insurer is entitled to receive the remaining six months premiums from you. This is common with all the companies. You of course will continue to receive the medical cover. See FAQ cancelling the insurance.

If you are taking out health insurance in Spain as part of the process for Spanish residency or a visa application then you will need to pay the full annual premium upfront. The relevant authorities in Spain will want to see that the cover is in place for at least the first full year. Please see our web page about related to Medical insurance Spanish residency. Alternatively, if you are seeking health insurance for a non-lucrative or golden visas then click this link.

Will the companies insure preexisting conditions?

Generally speaking, the answer is no. That does not mean you will be refused medical insurance in Spain but they might exclude some aspects. For example, if we assume you broke your ankle and then had a metal plate inserted to fix it, the company might agree to provide Spanish health insurance but they could exclude anything related to that particular ankle.

Should I declare if I have had an illness or operation?

Yes, definitely. If you don’t and you subsequently claim you may invalidate your insurance. The company may ask for a test prior to an operation that reveals a previous treatment or condition. If you have not declared this then they are within their rights to refuse to assist.

By not declaring the existing condition or treatment you are not being completely honest with the insurance company.

The company can cancel the treatment and the policy.

I want to reduce the cover I have under my medical insurance policy in order to make it cheaper.

Medical insurance policies in Spain run for 12-month periods. To reduce the level of cover you have to put your request in writing (your broker can help you) at least a month before the renewal date.

How does a reimbursement policy work?

This type of policy allows you to choose whichever professional or health centre you want. Authorisation for services may be necessary first. The medical professional does not have to be on an approved list held by the medical insurance company in Spain.

You will have to pay the bill to the medical centre for any services and the medical insurance company in Spain will reimburse you the agreed percentage in your contract.

Please note that if you are applying for Spanish residency or one of the visas then this type of policy will not be accepted by the authorities in Spain. You can find out more on our web page medical insurance Spain for Spanish residency. Alternatively, if you are seeking health insurance for a non-lucrative or golden visas then click this link.

The policy will automatically renew. This is common across all medical insurance policies in Spain.

If you do not want the insurance to renew then please go to the FAQ cancelling your insurance.

If you want to change the way you pay or the cover you have then please arrange this with your broker, at least a month before the renewal date.

What type of medical insurance in Spain do I need to apply for Spanish residency or if I am applying for a non-lucrative or golden visa?

You have a choice of companies but whichever you settle on the policy must be one without any co-payment. That means the premium you pay for the insurance must cover the consultancy and treatments without any further cost to you. In Spain you can get policies with or without “co-pago”. You must select one without “co-pago” to satisfy the authorities.

Also you cannot elect a policy where you pay the cost up front and the insurer reimburses you later.

Go to our web page relating to medical insurance Spain for Spanish Residency Alternatively, if you are seeking health insurance for a non-lucrative or golden visas then click this link.

Do I have any coverage if I travel abroad?

Most medical insurance policies in Spain include some emergency cover whilst travelling abroad. It varies from company to company and could be, for example up to 12,000 or maybe as high as 25,000 euros.

So for example, if you broke your leg you would be able to make use of this emergency cover. If however, you wanted to see a doctor because you had a heavy cold then you are not covered.

If you travel abroad regularly then you should consider a worldwide medical insurance policy.

It is not a replacement for travel insurance, as travel insurance also covers things like lost luggage and cancellations.

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