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.
- Surgical intervention
- Intensive Care Unit
- 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. WAITING PERIODS
Vital emergencies are covered immediately
- Outpatient Surgery: 3 months
- High Technology Diagnostic Tests (example MRI): 6 month
- Psychology: 6 months
- Pregnancy & birth: 8 months
- Hospitalisation with Surgery: 10 months
- Sterilisation or vasectomy: 10 months
Reimbursement (only if using medics out of network) same as above
* If proceeding from another Spanish insurance company by providing a copy of your particular conditions and the last receipt of payment towards your other company, Sanitas will eliminate all waiting periods if you have been with that insurer for more than a year.
5. OVERSEAS EMERGENCY HEALTHCARE.
Emergency overseas travel 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.
6. ASSISTANCE IN THE UNITED STATES
The covers under this policy is provided in the United States via healthcare facilities with agreements in place with, this 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€
7. BASIC GARANTY FOR DEATH OF THE POLICY HOLDER
In the event that the policy holder dies, the other beneficiaries also covered by the policy will not have to pay their premiums for six months.
REIMBURSEMENT LIMITS- MUNDI 1.000.000
Contracted guarantees and limits:
Total CAPITAL INSURED 1,000,000 euros
Within directory in Spain and abroad 100%
Outside directory in Spain and abroad 80%
Third-party hospital and non-hospital services in Spain and abroad 80% and 90%
A. HOSPITAL CARE (total limit) 931,000 euros
B. OUT PATIENT CARE (total limit) 60,000 euros
B1. Land ambulance 6,000 euros
B.2. Dentistry (only extractions, cures and cleaning) 900 euros
B.3. Special home care and services at home 12,000 euros
C. Prosthesis (total limit) 9,000 euros
E. Newly born* – Total for guarantees A, B and C
(*newly born with congenital illnesses, overall maximum limit and for the first year of life) 30,000 euros
D. Psychiatry – Total for guarantees A and B 1 ,210 euros
E. Subsidy payment in case of Hospitalisation: For example for help with expenses of your permanent visitor with their transport and food when using Hospitals outside the Sanitas network. 180 euros/ day (limit 90 days/year).
8. 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.
OTHER EXTRAS INCLUDED
- We speak your language: Use of our special network of doctors speaking English, German and Spanish, all of which are listed in your Guide Book.
- Bi-lingual client help line – you can obtain assistance in English or Spanish for any queries in relation to your Sanitas Health Policy number 902400232.
- PET/CAT: advanced technology to obtain more precise diagnosis for tumours.
- Additional health services: when you are a member of Sanitas you will have access to services such as laser excimer, aesthetic solutions, assisted reproduction or medical check-ups at very beneficial prices.
- Exclusive attention from the Sanitas hospitals and centres, where you can attend consultations or undergo diagnostic tests, all in one centre and using the latest technology
- Sanitas responds: there is a free, personalised health advice and support hotline for people with a medical condition that requires regular follow-ups or on-going care
- Sanitas welcome: a 24-hour service hotline to simplify the processing of claim.
- Travel assistance: Access to the United Health Care professional medical network when travelling in the U.S.A. This comes with 100% cover of medical expenses as long as the service is authorised by Sanitas.
- Age Limits: The maximum contractual age is 64 years. Once the contract is in place, there is no upper age limit for the policy to remain in force.
- Mundi Office: A team of professionals to resolve any doubts you might have, arrange your doctor’s visits and ensure you are reimbursed for your bills within a maximum of 10 working days.
- Health Programmes: In order that you can take care of yourself at every stage of your life, we have programmes such as the Mother & Baby Programme and also special units such as the Congenital Cardiac Disease Unit and the Advanced Unit for Genetic Diagnostics.
- Flexible Contract: You choose whether you use the Sanitas network of doctors or any other doctor and the hospital of your choice worldwide.