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 Protection... Sanitas - health and dental  insurance plans in Spain Translations (normal / sworn)
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Protección... Seguros médicos y dentales traducciones (normales / juradas)

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since 7/2002

América Latina

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Company Platinum - health plan for employees in Latin America and the Caribbean

"couples"

España

Glossary

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Patrocinadores - América Latina y el Caribe

Sanitas Exterior - 100% hospital and outpatient reimbursement health insurance costs for employees working in 190 countries (when company is based in Spain!)

Spain

US Virgin Islands

 

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www.e-healthinsuranceservices.com

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.

What are the General Conditions? (and introduction)  Definitions I: Purpose of the policy 
II: Exclusions III: Legal Notices IV: Waiting Periods
V: Duration of the policy VI: Premiums VII: Obligations of the policy-holder and/or the insured
VIII: Rights of the policy-holder and / or the insured IX: Insurer's obligations X: Disputes and appeals
XI: Duplicate policy XII: Complaints book XIII: Subrogation
XIV: Prescription XV: Contacting us  
XVII: Call monitoring XVIII: Jurisdiction  

 

Advantages of using the Sanitas network in Spain... BUPA insurance products Contact me...
Emergency care outside Spain In which countries are the benefits included? In-patient benefits
Index - General Conditions Level of reimbursement: In the Sanitas network... Level of reimbursement: Outside the Sanitas network (including second country cover)
Other benefits Out-patient benefits Premiums
Recap Sanitas Health Plan Complete: benefits covered second European Country
Some of the participating European hospitals Waiting periods What benefits are included?
What is the Annual Maximum per membership 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:

Sanitas Health Plan Basic Sanitas Health Plan Classic Sanitas Health Plan Complete 
Treatment in the Sanitas network for outpatient only  Treatment in the Sanitas network for outpatient and inpatient  Treatment in Spain and in a second European country chosen by the member when applying for the policy

 

 

 

 

main index / índice principal

Disclaimer / Aviso  Traducciones juradas (Castellano al inglés) / Sworn translations (English to Spanish)

A Coruña Álava Albacete Alicante Almería Asturias  Ávila Badajoz Balearic Islands Barcelona  Burgos Cáceres
Cádiz Cantabria Castellón de la Plana Ceuta  Ciudad Real Córdoba Cuenca Girona  Granada Guadalajara Guipúzcoa Huelva
Huesca Jaén La Rioja Las Palmas León Lleida  Lugo  Madrid Málaga  Melilla Murcia Navarra
Ourense Palencia Pontevedra Salamanca Segovia  Sevilla Tarragona Tenerife Teruel  Toledo Valencia  
Valladolid Vizcaya Zamora Zaragoza Dental insurance policies Sanitas Health Plan Classic Sanitas Multi Sanitas Mundi Sanitas Health Plan Complete      
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Copyright ©. All rights reserved. 2001- David M Harris
Última modificación: 11 de May de 2008