1. PRIMARY CARE
- General Medicine (GP).
This includes medical care in a healthcare centre, indication and prescription of basic diagnosis tests and procedures (analysis and general radiology). It includes also home services when your illness is preventing from attending the consulting room.
- Paediatrics – care of children until the y are 15 after they can use a GP.
- Nurse care service: Includes healthcare at the healthcare centre and at home.
- Emergencies: These include healthcare provided in permanent emergency centres that belong to Sanitas.
- Transfer of sick person by ambulance- performed by land.
- Preventive medical check-ups.
2. MEDICAL CARE PROVIDED BY SPECIALISTS
- 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.
- Cobalt therapy, chemotherapy, rehabilitation.
- Obstetric-Gynaecological Nursing (Midwifery)- Care provided by a midwife will be available only for hospital-based child delivery.
- Speech and Language Therapy: It is included only when related with organic processes, to a maximum of 6 months a year per Insured.
- Podiatry (Chiropody exclusively).
3. HOSPITAL CARE
- Surgical intervention.
- Intensive Care Unit.
- Clinical Psychology.
- Single room with bathroom as well as all the expenses arising from hospitalisation.
- Accommodation, meals, medication.
- Bed for companion.
- For all specialities: medical fees, costs arising from surgery.
4. WAITING PERIODS *
This is the period of time (calculated by months elapsed from the effective date of the insurance) during which some of the covers included do not enter into force, these are applied to all new customers that enter the private sector new and standard industry ( applied by all insurers).
- Vital Emergencies: IMMEDIATE (possible death within 24h report required).
- Outpatient surgery: 3 months.
- High technology diagnostic tests: 6 months (ex MRI, PET).
- 20-week scan pregnancy: 6 months.
- Endoscopy and colonoscopy: 8 months.
- Psychology: 6 months.
- Childbirth and C section: 8 months.
- Vasectomy and tubular ligation: 8 months.
- Hospitalisation, including inpatients, day patients 8 months.
- The following Complex Therapeutically Methods: interventional cardiology/ hemodynamic; interventional radiology, radiotherapy and chemotherapy; and lithotripsy: 6 Months
*If transferring from another insurance company in Spain or any of the BUPA GROUP 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.
5. COVER IN THE USA
- This added benefit gives you access to private centres in the USA to one of the most prestigious clinics and hospitals, such services to be accessed, needs to be previously authorised by Sanitas. Basically, for a second medical opinion with leading professionals and US hospitals or treatment with advanced methods diagnostic and therapeutic.
- Limits: US coverage reaches 100% of medical expenses per year with capital insured and listed below:
Total limit in the United States: 30,000 €
- Hospital care to 24,000 € with delivery to sub-limit of € 1,500.
- Outpatient assistance up to 6,000 €To enjoy this service all has to be previously assessed by Sanitas.
A medical report has to be provided and we will arrange cover in the area you are and clinics of our choice.
6. WORLDWIDE EMERGENCY HEALTHCARE.
- Emergency overseas travel assistance: up to a maximum of €10,000 per person and claim provided that the care required occurs within the 90 consecutive days from the start of the trip.
- 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 over 3 euros.
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.
Costs for ambulance services requested by a doctor for a local journey.
To use this cover while abroad you first need to contact Sanitas Emergency Abroad Numbers from the back of your Sanitas membership cards and they will advise where to go in case of emergency in the area you are at that time.
7. CO-PAYMENT CHARGES
These are additional charges applied to Mas Salud Optima and Plus when utilizing the services, these are applied according to the below tables of excess and they are per medical act used ( even if you are going to have one visit to the clinic, within that visit more services can be performed).
Co-payments are charged every month and are based on services/individual tests used. If you don’t use any services you’ll receive no extra charges together with the premium, breakdown of these charges is available either asking us for it or logging into your own sanitas.es private client area.
Home emergencies: €24.00
Hospital emergencies: €24.00
Sanitas 24 hours:€1.00
Intraocular monofocales lens: €11.70
All other services:€12.00
Contracts are annual and if you wish to cancel you will need to send a letter requesting cancellation one month prior to renewal of your policy.
- Medical network speaking English, German and Spanish.
- Bi-lingual customer support – 902 400 232.
- Documents are in English and Spanish: the General Conditions and the Private Conditions of your policy.
- Second medical opinion: when suffering from a serious illness such as cancer, your diagnosis will be sent for a second opinion from top professionals.
- ORL Laser Treatment: a more precise form of surgery which results in a faster recovery time for the patient.
- Monofocal intraocular lens: this treatment is available for cataract surgery (only available if the treatment has been prescribed by a specialist within the Sanitas network of doctors).
- 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 claims.
- Six monthly payments 2% discount and yearly payment 4% discount.