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Sanitas Health Plan Complete. General Conditions:
I. PURPOSE OF THE INSURANCE
The Insurer hereby assumes, under the terms and conditions of these General Conditions and with the limits set forth in the Membership Certificate and, where applicable, Special Conditions and Policy Supplements that may be issued, cover for the medical and surgical care in Spain and in a second European Country chosen by the Insured when applying for the policy. both on an outpatient and inpatient basis, of the diseases, illnesses or injuries comprised in the Policy.
Eligibility for cover under the Policy is only available to those who have a residence and bank account in Spain, and who have specified a second European country.
As specified in article 103 of the Spanish Insurance Contract Act, the Insurer assumes the necessary Emergency care in accordance with the Policy Conditions.
A) PROVISION OF SERVICES
A.1 In Spain
| A.1.1 Inpatient, Day Case and Out Patient treatment in the Insurer Network |
| A.1.2 Inpatient, Day Case and Out Patient treatment in Spain but outside the Insurer network |
A.2 In the second European country of cover
B) DESCRIPTION OF THE SERVICES
The benefits included in the Policy are:
1. Primary Medicine
| 1.1. General Medicine |
| 1.2. Paediatrics |
| 1.2.1. Newborn care |
| 1.2.2. Child Health Programme in the Insurer Network in Spain |
| 1.3. Nursing Care |
2. Emergencies
In Spain, through the Insurer Network, cover comprises emergency healthcare that will be provided at the permanent emergency centres listed in the Guide to Doctors and Services. The Insured can also get in touch with the Emergency Service using the details included in this Guide. When necessary, family doctor home service will be provided by the round-the-clock emergency services, only in those localities where the Insurer has an arrangement for the provision of this service.
Emergency treatment outside the Insurer Network and in second European country shown on the Membership Certificate is not restricted to those facilities listed in the Guide to Doctors and Services, but may be received at any centre providing eligible emergency medical treatment, or from a local family doctor, or at home, when justified.
3. Medical and surgical specialities and diagnostic tests
| 3.1. Allergy and Immunology |
| 3.2 Clinical analyses |
| 3.3 Anatomic pathology |
| 3.4 Anaesthesiology and resuscitation |
| 3.5 Angiology and vascular surgery |
| 3.6. Digestive System |
| 3.7, Cardiology |
| 3.8 Cardiovascular surgery |
| 3.9. General and gastrointestinal surgery |
| 3.10 Oral and maxillofacial surgery |
| 3.11 Paediatric surgery |
| 3.12 Plastic and repair surgery |
| 3.12 Chest surgery |
| 3.14 Dermatology |
| 3.15. Diagnostic imaging |
| 3.16 Endocrinology |
| 3.17 Geriatrics. Any inpatient admission or care arising out of problems of a social nature is excluded |
| 3.18 Haematology |
| 3.19 Internal medicine |
| 3.20 Nuclear medicine |
| 3.21 Nephrology |
| 3.22 Neo born care |
| 3.23 Respiratory care services |
| 3.24 Neurosurgery |
| 3.25 Neurology |
| 3.26 Obstetrics and gynaecology |
| 3.26.1 Obstetrics |
| 3.26.2. Gynaecology |
| 3.27. Consultants' fees for dentistry |
| 3.28. Ophthalmology |
| 3.29. Oncology |
| 3.30 Ear nose and throat |
| 3.31 Proctology |
| 3.32 Psychiatry |
| 3.33 Rheumatology |
| 3.34. Traumatology and orthopaedic surgery |
| 3.35. Urology |
| 3.36. Senior Consultants |
4. Treatments
5. Other services.
| 5.1. Ambulance |
| 5.2. Podiatry |
| 5.3. Special Home Care / Outpatient hospice care |
| 5.4. Prosthesis |
6. In patient and Day Case treatment: outside the Insurer network in Spain and in the second European country, inpatient and Day Case treatments are included on referral by a Doctor. In the Insurer network in Spain a referral from a Doctor included in the network is needed.
Inpatient and Day Case treatment is covered at a recognised Hospital, with the patient occupying a Private Room with a bed for an accompanying person, except for inpatient Psychiatric treatment, intensive care and incubator inpatient treatment.
Cover is not included for additional accommodation charges for an accompanying person in the second European country.
Total or partial reimbursement is included for treatment and accommodation charges, the Insured's meals, nursing care and drugs and dressings, as well as operating theatre expenses and anaesthetic related expenses.
Cover is included for a second medical opinion on diagnosis or Treatment in the event of a serious Chronic Condition requiring programmed care which requires exceptional diagnostic or therapeutic measures and/or in which survival prognosis is seriously compromised. Such second opinion shall be issued by specialists or healthcare, medical or academic centres of the first order based in any country in the world.
In order to use this service the Insured shall send his/her clinical file to the Insurer, comprising written medical information, x-rays or other diagnostic imaging scans performed, excluding the shipment of any biological or synthetic material. The file shall be delivered in due confidence to the corresponding specialist or centre in accordance with the illness in question.
Telephone information service provided by a team of physicians. The team will advise the Insured regarding health questions on Treatment, medication, test reading, etc 24 hours a day, 365 days a year.
| Fax: | (00 34) 91 8032484 |
| 'phone: | (00 34) 609 522 300 |
| Also more information on.. | www.e-healthinsuranceservices.com |
You can choose the level of cover you need: