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Sanitas Health Plan Complete. General Conditions:
XVI. COMPLAINTS PROCEDURE
A. Control over the Insurance Company's business activity lies with the Spanish State and is exercised through the Directorate General for Insurance and Pension Funds of the Ministry of the Economy.
B. For the settlement of any claim in relation to the insurance company, the Policyholder, Insured, Beneficiary, Aggrieved Third Party or Successor of any of these should write to the following address:
1. The Insurer's Customer Service Department - by means of a letter addressed to Calle Ribera del Loira, 52 (28042 - Madrid - Spain) or to fax + 34 91 585 24 80 or to the email address clientes @ sanitas.es which shall acknowledge receipt in writing and issue a reasoned written decision.
2. Once the Insurer's above-mentioned internal channel has been exhausted, or in the event of not being in agreement with its decision, a claim may be lodged with the Insurance Ombudsman designated by the Insurer in the following cases:
a) in cases of complaints involving an amount of not more than EUROS 21,000 and that are concerned with the interpretation of the Policy
N.B. Complaints connected with the personal or professional performance of doctors, hospitals and medical services in general supplying healthcare to Insureds may not be submitted to the Insurance Ombusdman.b) In cases where even though the complaint does not meet the above criteria, the Insurer consents to submit to the Insurance Ombudsman.
In order to make a complaint to the Insurance Ombudsman, the claimant should remit a written statement to post office box 50072 (28020 - Madrid - Spain) detailing the grounds for his / her claim. In the light of this, the Ombudsman shall give written acknowledgement of receipt and declare himself / herself either competent or non-competent and, after studying the claim, issue - within 1 month of his declaring himself / herself competent (barring exceptions in which this time limit may be extended to the legal maximum of 2 months including the period elapsed since its submission to the Insurer's Client Service Department) - a reasoned ruling, which shall be communicated in writing both to the claimant and to the Insurance Company, for which it shall be binding.
3. A complaint may also be brought before the Directorate General for Insurance. For this purpose, the claimant should establish that the stipulated time limit for the settlement of the claim by the Insurance Ombudsman has expired or that his / her application has been rejected.
4. In any case, a claim may be brought before the relevant Courts and Tribunals in Spain.
| Fax: | (00 34) 91 8032484 |
| 'phone: | (00 34) 609 522 300 |
| Also more information on.. | www.e-healthinsuranceservices.com |
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