Health Plan Complete Cover – SANITAS-BUPA

1. PRIMARY CARE

  • General Medicine (GP).
  • Paediatrics – care of children up to 14 years of age after they can use a GP.
  • Care for new-borns: Covers healthcare to a new-born child at the Company’s partner
    facilities and the related expenses provided the new-born is registered with the Insurer. This cover also includes payment or partial reimbursement by the Insurer of expenses relating to medical and/or hospital care required by a new-born during the 28 days following birth, as a result of any kind of congenital disease.
  • Nurse care service: Includes healthcare at the healthcare centre and at home.
  • Emergencies: These include healthcare provided in permanent emergency centres.
  • Clinical Analyses.
  • Transfer of sick person by ambulance- performed by land.
  • Preventive medical check-ups.
  • Basic Diagnosis tests and procedures: Diagnostic tests are performed by the services designated by the Sanitas. Prior written prescription is required.
  • Allergy and immunology: Autovaccination: the serum at your own expense, the administration of this by one of the nurses is included.

2. MEDICAL CARE PROVIDED BY SPECIALISTS

  • All specialist medical care, including outpatient surgery.
  • Genetic studies: Comprises only those necessary for diagnosis and/or prescription of treatment of affected and symptomatic patients.
  • Additional methods of diagnoses. Radiology, CT scanner, electrocardiogram Ultrasound, allergy tests.
  • Functional tests.
  • Obstetric-Gynaecological Nursing (Midwifery)- Care provided by a midwife will be available only for hospital-based child delivery
  • Speech and Language Therapy: This is only included when it is medically necessary as part of the treatment of an organic process 6 months treatment per insured member per year is covered in our medical network in Spain exclusively, is not covered in the second European country of your choice.
  • Podiatry (Chiropody exclusively): limited to 5 sessions per year
  • Ear, nose and throat: It includes CO2 laser surgery.
  • Chemotherapy, radiotherapy.

3. HOSPITAL CARE

In the Second European Country of Cover, and when not part of our medical network in Spain, a prior prescription from the physician will be written. For hospitalisation in our medical Network in Spain a prior prescription from your physician will be necessary.

  • Hospitalisation
  • Surgical intervention
  • Intensive Care Unit
  • Childbirth
  • Psychiatric hospitalization.
  • Single room with bathroom as well as all the expenses arising from hospitalisation: Accommodation, meals, medication.
  • Bed for companion: only in our medical network in Spain, this in a second European country is not covered.
  • For all specialities: medical fees, costs arising from surgery

4. ASSISTANCE IN THE UNITED STATES

The covers under this policy is provided in the United States via healthcare facilities. has to previously be approved by Sanitas, which will manage and process the covered services.

Coverage in the United States extends to 100 % of medical expenses up to the insurance limits per insured and annual period indicated below:

Total sub-limit for outpatient care: 30.000€

Hospital care up to 24.000 €, with a sub-limit for childbirth of €1.500 € outpatient care up to €6.000€


5. WAITING PERIODS *

  • Vital Emergencies: IMMEDIATE (DEATH WITHIN 24 h)
  • Vasectomy and fallopian tube ligation (in all cases in which cover is included in the policy) : 6 months
  • Psychiatric treatment on both an inpatient and outpatient basis.
  • This qualification period is not applicable in our network in Spain: 2 years
  • Physiotherapy, rehabilitation, laser & pathological anatomy : 3months
  • Childbirth: 8 months (this applies even if proceeding from another company).
  • Hospitalisation and surgery inpatient and outpatient : 3 months
  • Complex therapeutically tests (Radiotherapy, chemotherapy, etc) : 5 months
  • Bariatric surgery: 60 months

* If transferring from another insurance company in Spain and have been with that insurer for more than a year, by providing a copy of your particular conditions and last receipt of the premium with them, Sanitas will eliminate all waiting periods.


6. LIMITS OF THE REIMBURSEMENT OPTION.

The Health plan complete offers reimbursement of 100 % in the second European country of your choice and in medical directory in Spain 100% (you only need to show your medical card in this case) and outside directory in Spain and worldwide 90% reimbursement.

When utilizing the services outside Spain the claims will be sent direct by email:
BUPA LATINAMERICA : sanitas@bupalatinamerica.com

In Spain all claims can be done through your private sanitas.es area.

Maxim annual per person: 500.000€

  1. Ambulatory assistance: 35.000€ (Dental emergency: 500€)
  2. Hospital assistance: 465.000€ ( limit birth 5.000€)
  3. Second medical opinion: covered totally within medical directory and outside.

7. OVERSEAS EMERGENCY HEALTHCARE.

Emergency overseas travel assistance: In collaboration with Europ Assistance, up to a maximum of €10,000 per person, per claim. Covers expenses from doctors, surgeons, hospitals and/or clinics outside Spain as a result of medical attention received abroad, derived from an illness or accident occurring abroad.

  • Doctors’ fees
  • Drugs prescribed by a doctor or surgeon
  • Emergency dentistry fees, excluding endodontics, aesthetic reconstructions from earlier treatments, oral cleaning, prosthesis, crowns and implants, these are covered by the previous amount up to a maximum of €241 per Insured.
  • Hospitalisation costs.
  • Costs for ambulance services requested by a doctor for a local journey

8. SUPPLEMENTS AVAILABLE

BLUA: NEW DIGITAL PRODUCT
Video consultations for more than 12 specialities, emergency line 24 hours through video chat, personal trainer, nutrition programme, medial assessment, home blood tests, and pharmacy module included, Premium 20€ for individual policies and 40€ for two or more insured in the policy.

DENTAL SUPPLEMENT
Its 10, 90€ per person / monthly, not possible to be individually contracted, is 40- 50 services included and 40-50% discounts with respect to the market price.


9. AGE LIMITS:

75 years of age- no upper age to remain once contracted


10. CANCELLATION POLICY

Contracts are annual and if you wish to cancel you will need to send a letter requesting cancelation one month prior to renewal of your policy.


10. OTHER BENEFITS.

  • Second medical opinion specialists worldwide reference in the case of diseases severe chronic.
  • Sanitas 24 h: A telephone service comprising information provided by a medical team that shall answer the Insured’s medical queries on treatments, medication, test reading, etc., 24 hours a day, 365 days a year.
  • Policy documentation available in Spanish and English.