Sanitas coverage with the exact clause from the policy

These are the coverage questions we are asked most often at the office. Each answer gives the document, clause and page of the Sanitas General Conditions (condicionado general) it comes from, with the exact wording in the original Spanish, so you can check it yourself. The Condiciones Particulares of your policy (the specific terms of your own contract) take precedence over the General Conditions.

Does Sanitas Más Salud cover physiotherapy and rehabilitation?

Yes, with conditions. Más Salud covers rehabilitation consultations and outpatient physiotherapy for conditions that start in the musculoskeletal system, until you reach the best functional recovery possible, as judged by your rehabilitation doctor. It does not cover chronic or degenerative conditions, maintenance therapy or home physiotherapy. Among other things, it also leaves out neurological rehabilitation, outpatient cardiac rehabilitation, vestibular rehabilitation, aquatic therapy and rehabilitation of the temporomandibular joint. During a hospital stay, it is provided only after orthopaedic surgery, thoracic surgery, an acute myocardial infarction or surgery with extracorporeal circulation. Shock wave therapy for chronic osteotendinous injuries is limited to 5 sessions per joint per year. It needs prior authorisation and has a 10-month waiting period.

«Está comprendida únicamente con carácter ambulatorio y exclusivamente para las afecciones de origen en el aparato locomotor»

Translation of the quote: It is covered solely on an outpatient basis and exclusively for conditions originating in the musculoskeletal system

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, section 4.4. Physiotherapy (pp. 22-23) and section 3.33. Rehabilitation (p. 21)Page: 22

Waiting periods, limits and exceptions

Waiting period:: Physiotherapy as such is not on the list of waiting periods in Clause IV (p. 41). The glossary (p. 11) lists "some types of physiotherapy" among the simple therapeutic procedures. Complex therapeutic procedures have a 10-month waiting period. According to the glossary (pp. 10-11), these include procedures that need laser or shock waves. Hospitalisation also has 10 months. These waiting periods do not apply to accidents or illnesses constituting a life-threatening emergency that arise and are diagnosed after you join the policy.
Limits:: Outpatient only, and only for conditions that start in the musculoskeletal system, until the best functional recovery possible. The temporomandibular joint and the abdominal wall or muscles are not covered. Shock waves: 5 sessions per joint per year, with prior authorisation. During a hospital stay, it is covered only to recover from orthopaedic surgery, and for immediate recovery after thoracic surgery, an acute myocardial infarction or surgery with extracorporeal circulation. Lymphatic drainage after cancer surgery, with prior authorisation (pp. 22-23). Pelvic floor: up to 10 sessions per birth for women with moderate-to-severe urinary incontinence caused by childbirth, within the following year (p. 19). Also 5 sessions after incontinence surgery performed under Sanitas, with prior authorisation (pp. 19 and 22). Respiratory physiotherapy after thoracic surgery, during the hospital stay: up to 5 sessions (3.14, pp. 16-17).
Keep in mind:: The point that prevents the most complaints: cover ends once you reach functional recovery (or the most that is possible), or when the treatment becomes maintenance therapy (4.4, p. 23). Section 4.4 also excludes early intervention (atención temprana), occupational therapy and outpatient cardiac rehabilitation. It excludes respiratory rehabilitation, except after thoracic surgery with a hospital stay. It also excludes ophthalmological rehabilitation, rehabilitation with robotic equipment and neuropsychological rehabilitation or cognitive stimulation. Clause III (pp. 36-37) excludes injuries from before you joined and injuries from work accidents. It excludes injuries from road traffic accidents, except emergency care or if you have taken out the road traffic accident add-on. It also excludes injuries from high-risk sports and from sports competitions, training included. Platelet-rich plasma and hyaluronic acid are excluded as well (p. 38). Page 39 excludes hydrotherapy, pressotherapy and chiropractic as alternative medicine. It also excludes musculoskeletal radiofrequency (except on the joints of the spine) and spas. Ambulance cover does not include trips to physiotherapy (4.1, p. 22). Laser in musculoskeletal physiotherapy is one of the exceptions to the laser exclusion (p. 39). The product sheet sums it up as "therapeutic procedures, both simple (rehabilitation, aerosol therapy, etc.)", without giving limits. The limits in the General Conditions are the ones that apply.
In other products:: Más Salud Plus and Más Salud Óptima (Sanitas_Mas_Salud_Plus__CG and Sanitas_Mas_Salud_Optima__CG, 4.4, p. 22) treat as chronic any condition that has lasted more than 6 months. They exclude all respiratory rehabilitation. During a hospital stay, they do not include recovery after thoracic surgery, and their pelvic floor cover refers only to Obstetrics and Gynaecology. Más Salud Familias and Familias Plus (4.4, pp. 22-23) have the same wording as Más Salud. In Sanitas Profesionales (Sanitas_Profesionales__CG, without page markers), section 4.4 also sets chronic at more than 6 months. Its Protección total cover (guarantee 4.7 "Pronta recuperación", speedy recovery) adds a home physiotherapist for therapies prescribed after an accident or illness. The limit is 20 hours per policy year and per insured person. It applies after a hospital stay of more than 72 hours, or after more than 72 hours confined at home on medical sick leave. It is provided only in Spain.

Does Sanitas cover psychology? How many sessions, and what waiting period?

Yes, with conditions. In Sanitas Más Salud, psychology is covered by Clause II, section 4.10. It is individual psychological care to treat conditions that can be helped by psychological intervention. It must be prescribed by a psychiatrist, family doctor, paediatrician or oncologist from the medical network. It covers up to 15 sessions per insured person per policy year. Psychometric tests are paid by the insured person. There is a 6-month waiting period (Clause IV, p. 41). In Más Salud Familias Plus the limit rises to 20 sessions without prescription or authorisation, plus 40 extra sessions for eating disorders. Psychology does not appear on its list of waiting periods.

«Comprende hasta un máximo de 15 sesiones por asegurado y anualidad del seguro.»

Translation of the quote: It covers up to a maximum of 15 sessions per insured person and policy year.

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, 4. Other care services, 4.10. Psychology (waiting period in Clause IV. Waiting periods, p. 41)Page: 25

Waiting periods, limits and exceptions

Waiting period:: Más Salud: "Psychology: 6 months" (Clause IV, p. 41, periods for the medical network option). According to the same clause, waiting periods do not apply to accidents or illnesses constituting a life-threatening emergency, if they arise and are diagnosed after the policy starts or after the insured person joins. The care must be covered. Familias Plus: psychology does not appear on the list of waiting periods in its Clause IV (p. 46).
Limits:: Más Salud: up to 15 sessions per insured person per policy year. Individual care only, and only to treat a condition that can be helped by psychological intervention. Psychometric tests are paid by the insured person. A written prescription is needed from a network psychiatrist, family doctor, oncologist or paediatrician (Clause V, 1.2, p. 42). Excluded: psychoanalysis, psychoanalytic therapy, hypnosis, treatment of narcolepsy, animal-assisted therapies, and psychosocial rehabilitation or neuropsychiatry services (4.10, p. 25).
Keep in mind:: In Más Salud, each session first needs a written prescription from a network psychiatrist, family doctor, oncologist or paediatrician. The care covered is "individual". Clause III (letter F, p. 37) also excludes care arising from chronic alcoholism, drug addiction, attempted suicide and self-harm. The same applies to intoxication from abuse of alcohol, psychotropic drugs, narcotics or hallucinogens. There is also Blua's digital Psychology programme (p. 33), which is separate from the 4.10 sessions. It gives guidance only remotely (phone, chat or video consultation). It expressly excludes psychotic disorders, severe depression, eating disorders and personality disorders. It also excludes dementia, cognitive decline and the follow-up of morbid obesity.
In other products:: Más Salud Familias Plus (Sanitas_Mas_Salud_Familias_Plus__CG, 4.10, p. 25): up to 20 sessions per insured person per policy year, and "No prescription or authorisation will be required for these sessions". For eating disorders it adds 40 more sessions. These need a psychiatrist's prescription and prior authorisation from Sanitas with a psychiatric medical report. The exclusions are the same, and there is no waiting period for psychology (Clause IV, p. 46). A note on Más Salud Familias without Plus (Sanitas_Mas_Salud_Familias__CG): it has the same 20+40 sessions (p. 25). But its Clause IV (p. 48) does list "Psychology: 6 months", even though its product sheet says "No waiting periods for psychology". The General Conditions prevail. Más Salud Plus and Óptima (4.10, p. 24): a maximum of 4 consultations a month, with a limit of 15 sessions per insured person per policy year. They include simple psychological diagnosis and have a 6-month waiting period (p. 40).

Does Sanitas cover pregnancy and childbirth? What is the waiting period?

Yes, after a waiting period. Sanitas Más Salud includes the specialty of Obstetrics and Gynaecology. It covers vaginal birth or caesarean section in its medical network, with an 8-month waiting period. This waiting period does not apply to a premature birth (under 37 weeks). Nor does it apply to accidents or illnesses constituting a life-threatening emergency that arise and are diagnosed after you join. A midwife attends the birth, and this always takes place with a hospital stay. The Maternal and Child Programme (Programa Materno Infantil) adds antenatal classes. For your baby to be insured, you must ask Sanitas to add them within 30 calendar days of the birth.

«Parto o cesárea salvo parto prematuro (menos de 37 semanas): 8 meses»

Translation of the quote: Vaginal birth or caesarean section, except premature birth (under 37 weeks): 8 months

Document: Condicionado general · Sanitas Más SaludClause: Clause IV. Waiting periodsPage: 41

Waiting periods, limits and exceptions

Waiting period:: Vaginal birth or caesarean section: 8 months in the medical network option (Clause IV, p. 41). It does not apply to premature births under 37 weeks. Nor does it apply to accidents or illnesses constituting a life-threatening emergency that arise and are diagnosed after the policy starts or after the insured person joins. The care must be covered (same page).
Limits:: A midwife attends the birth, and this always takes place with a hospital stay (4.3, p. 22). Non-invasive prenatal screening checks circulating DNA in the mother's blood plasma for trisomies 13, 18 and 21 and the sex chromosomes. It is covered if the risk from the combined first-trimester screening is between 1/50 and 1/250 and you are between weeks 10 and 18. It needs prior authorisation (3.26, p. 19). Pre-eclampsia screening is covered only in the first trimester (p. 19). Pelvic floor rehabilitation is covered only for moderate or severe urinary incontinence caused by childbirth. The limit is 10 sessions per birth, within the following year and with prior authorisation (p. 19). Neonatology includes the check-up, vaccines and routine tests in the first 48 hours. It does not include care for conditions or complications at birth (3.26.2, pp. 19-20). The Maternal and Child Programme includes antenatal classes and health checks for the child. It also includes telephone advice from nurses in the first six months (4.9, p. 25). Blua also includes the digital Pregnancy programme with midwives and nurses. It is remote only: phone, chat and video consultation (Health programmes, pp. 31-33).
Keep in mind:: Water births, home births and births by alternative methods are excluded (Clause III, letter M, p. 40). Voluntary termination of pregnancy and any surgery on the unborn child are also excluded (Clause III, p. 38). No surrogacy costs are covered either, for the mother or for the baby (3.26.3, p. 20). Clause III.A excludes any "medical condition or situation pre-existing at the date of joining". It also asks you to declare tests, treatments and symptoms in the health questionnaire (p. 36). If you are already pregnant when you take out the policy, we will check your case with Sanitas. The baby joins the policy with full rights from birth in two cases. The first is if Sanitas covered the mother's delivery. The second is if the father's enrolment took effect at least 240 days before the birth. You apply with an insurance application form (Solicitud de Seguro) within 30 calendar days of the birth. If you apply late or do not meet the requirements, Sanitas may decline the enrolment (p. 49).
In other products:: Five products in the range share the 8-month waiting period for vaginal birth or caesarean section, except for premature births. They are Más Salud itself, Más Salud Plus (Sanitas_Mas_Salud_Plus__CG, p. 40) and Más Salud Óptima (Sanitas_Mas_Salud_Optima__CG, p. 40). They also include Más Salud Familias (Sanitas_Mas_Salud_Familias__CG, p. 48) and Más Salud Familias Plus (Sanitas_Mas_Salud_Familias_Plus__CG, p. 46). Premium 500.000 (p. 51) and Más 90.000 with co-payments (p. 52) and without co-payments (p. 47) have the 8 months as the medical network waiting period. The reimbursement waiting-period list for these three products does not include childbirth. It covers only psychology, vasectomy and tubal ligation, complex diagnostic tests and complex therapeutic procedures. Under reimbursement, childbirth is paid at the percentages, limits and sub-limits in the Condiciones Particulares. See Premium 500.000, p. 54; Más 90.000 with co-payments, p. 55; without co-payments, p. 50. Under the United States cover, the childbirth sub-limit is €3,610 in Premium 500.000 (p. 37) and €1,900 in Más 90.000 with co-payments (p. 33).

What waiting periods does Sanitas Más Salud have?

Some benefits have waiting periods; everything else is covered from the day the policy starts. Clause IV of the General Conditions sets these periods. Surgery in OMC groups 0 to II has 3 months (the OMC is the Spanish Medical Association, which classifies surgery). Psychology and complex diagnostic tests, such as CT or MRI scans, have 6 months. Vaginal birth or caesarean section has 8 months. Hospitalisation, surgery in groups III to VIII, complex therapeutic procedures, vasectomy and tubal ligation have 10 months. The periods count from the date each insured person joins. They do not apply to premature births (under 37 weeks). Nor do they apply to covered life-threatening emergencies that arise and are diagnosed after you join.

«Los plazos de carencia anteriormente citados no serán exigibles en el caso de accidentes o enfermedades que tengan carácter de urgencia vital»

Translation of the quote: The waiting periods mentioned above will not apply in the case of accidents or illnesses constituting a life-threatening emergency

Document: Condicionado general · Sanitas Más SaludClause: Clause IV. Waiting periodsPage: 41

Waiting periods, limits and exceptions

Waiting period:: Medical network option. 3 months for surgery in OMC groups 0 to II. 6 months for psychology and complex diagnostic tests. 8 months for vaginal birth or caesarean section, except a premature birth under 37 weeks. 10 months for hospitalisation and surgery in OMC groups III to VIII, complex therapeutic procedures, vasectomy and tubal ligation. All other benefits are covered from the day the contract starts.
Limits:: The periods are counted in months from the effective date on which each insured person joins the policy (glossary, "Waiting periods", p. 7). The glossary gives CT and MRI as examples of complex diagnostic tests (p. 11). The Más Salud General Conditions only contain the list for the medical network option.
Keep in mind:: The life-threatening emergency exception has two conditions. First, the accident or illness must have arisen and been diagnosed after the policy started or after you joined. Second, the policy must cover the care. Waiting periods are not the same as pre-existing conditions. Anything that existed before you joined is excluded (Clause III.A, p. 36). The exception is a condition you declared in the health questionnaire that Sanitas did not exclude when the policy was taken out (Clause II, p. 13). The Más Salud product sheet matches the General Conditions.
In other products:: Más Salud Plus and Más Salud Óptima have the same list (Clause IV, p. 40 of each set of General Conditions). Más Salud Familias has the same list and adds speech therapy and phoniatrics at 6 months (Sanitas_Mas_Salud_Familias__CG, p. 48). Más Salud Familias Plus also adds speech therapy and phoniatrics at 6 months. Its list has no waiting period for psychology (Sanitas_Mas_Salud_Familias_Plus__CG, p. 46). Please note: the Familias product sheet says "No waiting periods for psychology", but its General Conditions (p. 48) do list psychology at 6 months. The General Conditions prevail.

Does Sanitas cover conditions I already had before taking out the policy?

No. Sanitas Más Salud excludes illnesses, injuries, congenital defects and any medical situation that existed before each insured person joined. It also excludes the after-effects of accidents or illnesses that began earlier (Clause III, section A, p. 36). Before taking out the policy, you must declare in the health questionnaire any injury, illness, test, treatment or symptom that could be the start of a condition. Sanitas uses this information to assess each case. It may accept the insurance, decline it, or accept it with certain coverages excluded. If anything is concealed, any cover related to it is excluded. At the office we'll help you fill in the questionnaire calmly, step by step.

«situación médica preexistentes a la fecha de alta de cada Asegurado en la póliza»

Translation of the quote: medical situation pre-existing at the date each Insured Person joins the policy

Document: Condicionado general · Sanitas Más SaludClause: Clause III. Excluded coverage, section APage: 36

Waiting periods, limits and exceptions

Waiting period:: A pre-existing condition is not a waiting period but an exclusion (Clause III, section A). The General Conditions set no period after which it becomes covered. For anything that arises after you join, Más Salud applies waiting periods in the medical network (Clause IV, p. 41). Surgery in OMC groups 0 to II: 3 months. Psychology and complex diagnostic tests: 6 months. Vaginal birth or caesarean section: 8 months (except a premature birth under 37 weeks). Hospitalisation and surgery in groups III to VIII, vasectomy and tubal ligation, and complex therapeutic procedures: 10 months. These waiting periods do not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after you join. The care must be covered.
Limits:: The exclusion applies to each insured person separately, based on the date each one joined. It also covers constitutional or congenital defects and deformities. It also covers after-effects of accidents or illnesses that began before the person was included in the policy (p. 36). If Sanitas accepts the policy with certain coverages excluded, we will confirm with Sanitas exactly what is left out in your case.
Keep in mind:: Declare everything, including tests, treatments and symptoms that do not yet have a final diagnosis. Anything related to what was not declared is excluded. In addition, if the questionnaire contains any omission or inaccuracy, Sanitas may cancel the contract within one month of finding out. If a claim arises before then, the benefit is reduced in proportion to the difference in premium. If there was wilful misconduct or gross negligence, Sanitas does not have to pay (Clause VI, 1.2, p. 46). An authorisation slip already issued becomes invalid if there is an undeclared pre-existing illness (Clause V, 1.3, p. 42). The glossary (p. 8) dates pre-existence from when you sign the health questionnaire, but the exclusion (p. 36) uses the date you join. If something arises between those two dates, let us know before your start date and we will check it with Sanitas.
In other products:: The same exclusion (Clause III, section A) appears in Más Salud Plus and Óptima (p. 35), Familias (p. 43), Familias Plus (p. 41) and Premium 500.000 (p. 46). It also appears in Más 90.000 with co-payments (p. 47) and without co-payments (p. 42), Avanza (p. 30), Accede (p. 22), and Profesionales Colectivos (p. 42), Plus (p. 43) and Óptima (p. 45). Residents and Residents Visado (p. 37), Residents Platinum and Platinum Visado (p. 43) and International Students (p. 35) have it too. Top Quantum and Profesionales have the same wording, but their documents have no page markers (no page number). Sanitas Único is the exception: its Clause III (Sanitas_Unico__CG, p. 31) does not include this exclusion. This matches the product sheet, which says "sin preexistencias" (no pre-existing-condition exclusion). In exchange, its section A excludes all hospitalisation and any surgery. The product sheets and the comparison say Único has no health questionnaire. However, its General Conditions keep the clause on the questionnaire as a basis of the contract (Clause VI, 1.1, p. 40). They also keep the rule that an authorisation slip becomes invalid for "undeclared pre-existing illness" (Clause V, 1.3, p. 36). The General Conditions prevail: we will confirm it with Sanitas.

Am I covered by Sanitas if I have an emergency while travelling abroad?

Yes, with conditions. Más Salud includes emergency cover abroad for illness or accident. The care must take place within 90 consecutive days from the start of the trip, with a limit of €12,000 per person per year. Before receiving care, you must ask Sanitas for authorisation on the phone number on the back of your card, unless the emergency is life-threatening. In a life-threatening emergency, go to the nearest centre and notify Sanitas within 7 days of admission, with a copy of the emergency report. Care is given in centres designated by Sanitas, and your premium payments must be up to date.

«cobertura de urgencias en el extranjero por causa de enfermedad o accidente, siempre que la asistencia requerida se produzca dentro de los 90 días consecutivos desde el inicio del viaje»

Translation of the quote: emergency cover abroad due to illness or accident, provided that the care required occurs within 90 consecutive days from the start of the trip

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage — Additional policy coverage: "Emergency assistance cover abroad"Page: 28

Waiting periods, limits and exceptions

Waiting period:: Clause IV (p. 41) sets no specific waiting period for this cover. It lists other waiting periods, for example 10 months for hospitalisation and surgery in groups III to VIII. These do not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after the insured person joins. The cover abroad is subject to the rest of the General Conditions, including their limiting clauses. So if your trip falls in the first months of the policy and the emergency is not life-threatening, we will check your case with Sanitas.
Limits:: Medical expenses, prescribed medicines, hospitalisation and an ambulance ordered by a doctor for a local journey: €12,000 per person per year. This applies only if the care takes place within 90 consecutive days from the start of the trip (p. 28). Within this cover, emergency dental treatment is capped at €300 per insured person. It excludes root canals, cosmetic reconstructions, dental cleaning, prostheses, crowns and implants. Other guarantees (pp. 29-30): - Hotel for a companion during your hospital stay, if they are also insured with Sanitas: €60/day for up to 10 days. - If the stay lasts more than 5 days and no close relative is with you: a return ticket (economy flight or first-class train) for a companion who normally lives in Spain, plus hotel at €60/day for up to 5 days. - An advance of funds of up to €1,500, against a guarantee, repayable within 30 days. - Legal assistance if the insured person is imprisoned or prosecuted over a road traffic accident: up to €1,500. - An advance for criminal bail of up to €10,000, repayable within two months. - Shipping of forgotten items in parcels of up to 10 kg.
Keep in mind:: This cover does not include (p. 28): - medical expenses under €3; - illnesses or conditions already known before the trip, unless there is a clear or unforeseeable complication; - treatments prescribed in Spain; - mental illnesses, or chronic illnesses that have affected the insured person's health. The general exclusions of Clause III also apply (from p. 36). For example: pre-existing conditions; high-risk sports practised as an amateur; work and occupational accidents. Road traffic accidents are also excluded, except emergency care or if you have taken out the road traffic accident add-on. For Sanitas to accept the claim, you must provide proof of travel, a medical report confirming the emergency, invoices and proof of payment. The cover is for trips only. The insurance ends if you move your residence abroad or live in Spain for less than 6 months a year (Clause VI, p. 47). The sales guide mentions "stays of under 3 months" and the product sheets "stays of up to 90 days". The General Conditions prevail: the care must take place within 90 consecutive days from the start of the trip.
In other products:: Más Salud Plus and Más Salud Óptima (p. 27), and Más Salud Familias and Familias Plus (p. 28): same wording and €12,000 limit. Premium 500.000 and Más 90.000, with and without co-payments (p. 28): €12,000. Profesionales Colectivos, Óptima and Plus: €12,000 (the cover starts on p. 28 and the limit is on p. 29). Sanitas Profesionales: €12,000 (its copy of the General Conditions has no page numbers). Top Quantum covers trips of up to 90 days, with €15,000 per insured person per year, worldwide. However, emergency dental care is limited to €60.10 (its copy of the General Conditions has no page numbers). The General Conditions of Accede, Avanza and Único do not include this cover. Residents and Residents Visado: €12,000. Residents Platinum and Platinum Visado: €30,000 per person per year (p. 28). International Students: €12,000 (p. 27). These last three are in CG_extranjeros_y_visados.txt.

Does Sanitas health insurance include any dental cover?

Yes. Sanitas Más Salud includes Sanitas Dental 21 as one of its additional coverages. The services are listed in a document called Prestaciones Dentales Aseguradas (insured dental benefits). It is attached to your Condiciones Particulares, the specific terms of your policy. Some services carry no franquicia (fixed fee): you pay the dentist nothing, except any co-payments your policy has. Others carry a franquicia, the fixed amount that attachment sets for each treatment. The General Conditions set no waiting period for dental care. Clause IV provides benefits from the day the policy starts, and dental care is not among its exceptions. Maxillofacial surgery does not cover treatments that belong to dentistry. At the office we'll go through your policy's attachment with you.

«Las prestaciones aseguradas por esta póliza son las especificadas en el documento Prestaciones Dentales Aseguradas, anexo a las Condiciones Particulares»

Translation of the quote: The benefits insured under this policy are those specified in the document Prestaciones Dentales Aseguradas, attached to the Condiciones Particulares

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage (Additional policy coverage): Sanitas Dental 21Page: 31

Waiting periods, limits and exceptions

Waiting period:: The General Conditions set no waiting period for Dental 21. Clause IV (p. 41) says benefits are provided from the day the contract starts. The exceptions with a waiting period are vasectomy and ligation, psychology, complex diagnostic tests, complex therapeutic procedures, surgery, childbirth and hospitalisation. Dental care is not one of them. The Dental 21 section (p. 31) sets no waiting periods of its own either.
Limits:: Dental 21 covers what is listed in the Prestaciones Dentales Aseguradas attachment. Treatments with a franquicia cost the amount set in that attachment. Outside Spain, the emergency cover abroad (p. 28) includes emergency dental expenses of up to €300 per insured person. The care must be within 90 consecutive days from the start of the trip, with payments up to date and prior authorisation from Sanitas. In a life-threatening emergency, you must notify Sanitas within 7 days. The expenses must arise outside Spain, at centres designated by Sanitas. This cover abroad does not include root canals, cosmetic reconstructions of earlier treatments, dental cleaning, prostheses, crowns or implants.
Keep in mind:: The list of services and each franquicia amount are in the Prestaciones Dentales Aseguradas attachment to your Condiciones Particulares. It is worth checking it, or asking us, before you start any treatment. The Más Salud product sheet mentions "more than 45 dental services" included. The General Conditions refer to that attachment, and the attachment is what applies. If the benefits or franquicia amounts change, Sanitas gives two months' notice. Paying the premium means you accept the change (p. 31). Under Maxillofacial Surgery (Clause II, 3.10, p. 16), dental treatments and cosmetic or functional treatments of the mouth area are excluded. These include orthognathic, pre-implant and pre-prosthetic surgery.
In other products:: Más Salud Plus and Óptima (p. 30 of the PDF), and Familias and Familias Plus (p. 33 of the PDF), have the same Sanitas Dental 21 cover. It refers to the same attachment. In three of them the page number printed at the foot does not match the PDF: Plus 32, Familias 35 and Familias Plus 35. In Óptima it matches (30). Accede (p. 18), Avanza (p. 23) and Único (p. 18) have Dental Básico, which "comprises exclusively consultations, extractions and dental cleaning, carried out in the consulting room". Premium 500.000 (pp. 37-38), Más 90.000 with co-payments (p. 34) and Más 90.000 without co-payments (pp. 33-34) have Sanitas Dental Reembolso. It refunds what you pay at the percentage and within the limits in the Condiciones Particulares. It has an 8-month waiting period for dental cover. That waiting period is set in the dental section of the General Conditions, not in Clause IV. According to the product sheets, treatment in the contracted network is refunded at 80% up to €400 a year in Premium. In Más 90.000 it is 60% up to €200 a year. Top Quantum (General Conditions without page markers) has a Dental section that refers to the same attachment. It adds one dental cleaning a year under preventive medicine (6.7). It also covers dental emergencies abroad up to €60.10, within the limit for medical expenses abroad and with similar exclusions.

How does Sanitas cover hospitalisation? Is there a limit on the number of days?

In Más Salud, hospitalisation takes place in a clinic or hospital. For overnight stays, you have a private room with a bed for a companion, except for psychiatric admissions, ICU and incubator. Sanitas pays for tests, treatments, surgery in the operating theatre, medication, and the stay including meals. The General Conditions set no maximum number of days for general hospitalisation. The only cap is for psychiatric care: 50 days per insured person per year, for acute episodes only. Admission for social reasons is not covered. Hospitalisation and surgery in groups III to VIII have a 10-month waiting period, except in a life-threatening emergency. They also need prior authorisation from Sanitas.

«En caso de pernocta, el enfermo ocupará habitación individual convencional y cama de acompañante excepto en las hospitalizaciones psiquiátricas, en U.V.I. e incubadora»

Translation of the quote: In the case of an overnight stay, the patient will occupy a standard private room with a companion bed, except in psychiatric hospitalisation, ICU and incubator

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, section 5. Hospital carePage: 25

Waiting periods, limits and exceptions

Waiting period:: Hospitalisation and surgery in Groups III to VIII of the Organización Médica Colegial (Spanish Medical Association) classification: 10 months (Clause IV. Waiting periods, p. 41). This does not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after the insured person joins. The care must be covered. It also does not apply to a premature birth (under 37 weeks). The same clause sets 3 months for surgery in Groups 0 to II and 8 months for vaginal birth or caesarean section.
Limits:: Psychiatric hospitalisation: overnight stays only, and only for acute episodes, up to 50 days per insured person per year. For eating disorders, treatment can continue in a day hospital after the hospital stay (Clause II, 3.30 Psychiatry, p. 21). Psychiatry, ICU and incubator stays do not include a private room with a companion bed. Medicines during the stay are used as set out in their summary of product characteristics. Medication without marketing authorisation in Spain is excluded. Therapeutic use of radiopharmaceuticals is excluded, except sodium iodide (131I) for thyroid cancer (p. 25). Emergency hospitalisation abroad (Additional coverage, Emergency assistance cover abroad, p. 28): medical expenses, including hospitalisation, are limited to €12,000 per person per year. The care must take place within 90 consecutive days from the start of the trip. It needs prior authorisation from Sanitas. In a life-threatening emergency, you notify Sanitas within 7 days of admission instead. It does not cover an illness already known before the trip, unless there is a clear or unforeseeable complication. It also excludes treatments prescribed in Spain and mental or chronic illnesses that have affected the insured person's health.
Keep in mind:: Hospitalisation for social reasons is excluded (Clause III, exclusion D, p. 37), and section 5 repeats this (p. 25). The glossary (p. 8) defines a social admission as one for a patient with functional decline or chronic conditions who is past the acute phase. Such a patient needs care, but not as a hospital inpatient. You need express prior authorisation from Sanitas, following a written prescription from its doctors (Clause V, 1.3, p. 42). The authorisation slip is not valid if the policy requirements are not met, for example unpaid premiums or an undeclared pre-existing illness. Conditions that existed before you joined are excluded (Clause III, A, p. 36). Any cost share is shown in the Condiciones Particulares (Clause V, p. 42). The Más Salud sales guide (April 2021) says "Unlimited hospitalisation (except psychiatric)", in line with the General Conditions.
In other products:: Más Salud Plus and Óptima (p. 20), Más Salud Familias and Familias Plus (p. 21), and Premium 500.000 and Más 90.000 with and without co-payments (p. 21) have the same cap for psychiatric hospitalisation: 50 days per insured person per year. Top Quantum limits psychiatric admission to 60 days per insured person per year (Sanitas_Top_Quantum__CG, section 3.30; document without page markers, no page number). Premium 500.000 (p. 36) and Más 90.000 with co-payments (p. 32) and without co-payments (p. 32 of the text; printed page 34) include a Hospitalisation allowance cover. This daily allowance is paid when a hospital stay the policy could cover is not charged to the policy. It is not paid if Sanitas covers the cost. The daily amount and the maximum number of days are set in the Condiciones Particulares. The product sheets FP_Sanitas_Mas_90, FP_Sanitas_Mas_90_Copagos and FP_Sanitas_Premium_500 give a maximum of 90 days a year. Accede (Clause III, B, p. 22) and Avanza (Clause III, B, p. 30) exclude any inpatient or day hospital care and any surgery. Único excludes any inpatient care (Clause III, A, p. 31) and any type of hospitalisation, including social admissions (Clause III, G, p. 32).

Does Sanitas cover surgery for short-sightedness (refractive surgery)?

No. Sanitas Más Salud excludes refractive surgery of any type, whether for short-sightedness (myopia), long-sightedness (hyperopia), presbyopia or astigmatism. The General Conditions say so under Ophthalmology (Clause II, section 3.27, page 20). They say it again among the excluded coverage (Clause III, letter K, page 39), which also excludes glasses and contact lenses. The Ophthalmology section expressly covers laser photocoagulation for the indications it lists. It also covers corneal cross-linking for keratoconus and corneal transplants. In cataract surgery, the simple monofocal intraocular lens is covered (section 4.8, page 24).

«Queda excluida la ortóptica, la pleóptica y la cirugía refractiva de cualquier tipo (para miopía, hipermetropía, presbicia y astigmatismo).»

Translation of the quote: Orthoptics, pleoptics and refractive surgery of any type (for myopia, hyperopia, presbyopia and astigmatism) are excluded.

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, section 3.27 Ophthalmology (and Clause III. Excluded coverage, letter K, p. 39)Page: 20

Waiting periods, limits and exceptions

Waiting period:: Not applicable, because refractive surgery is excluded. Cataract surgery is covered and has the usual waiting periods for surgery. These are 3 months for groups 0 to II and 10 months for groups III to VIII of the Organización Médica Colegial classification, except in a life-threatening emergency (Clause IV, p. 41).
Limits:: Excluded whatever the technique (myopia, hyperopia, presbyopia and astigmatism), along with orthoptics and pleoptics (p. 20). Glasses and contact lenses are also excluded (Clause III, p. 39). Laser photocoagulation is covered only for ischaemic retinopathies, macular oedema, glaucoma and peripheral retinal lesions such as holes or tears (p. 20).
Keep in mind:: If you have cataracts as well as myopia or astigmatism, the policy covers only the simple monofocal intraocular lens. Toric, monofocal plus and extended depth of focus lenses are not covered, nor is any other advanced monofocal lens (Clause II, 4.8 Prostheses, p. 24). So the policy does not pay for a premium lens to correct your prescription during cataract surgery.
In other products:: The same exclusion appears under Ophthalmology and in Clause III of these General Conditions: - Más Salud Plus (pp. 19 and 38) and Más Salud Óptima (pp. 19 and 38) - Más Salud Familias (pp. 20 and 46) and Familias Plus (pp. 20 and 44) - Premium 500.000 (pp. 20 and 49) - Más 90.000 with co-payments (pp. 20 and 50) and without co-payments (pp. 20 and 45) - Avanza (pp. 18 and 32) - Profesionales Colectivos (pp. 19 and 45), Profesionales Plus (pp. 20 and 46) and Profesionales Óptima (pp. 20 and 48) - Residents and Residents Visado (pp. 20 and 40) - Residents Platinum and Platinum Visado (pp. 20 and 46) - Global Care (pp. 21 and 45) - International Students (pp. 19 and 38) Top Quantum and Sanitas Profesionales also exclude it, but their documents have no page markers. Accede (Clause III, letter B, p. 22) and Único (Clause III, letter A, p. 31) exclude any surgery in any care setting. So they do not cover this operation either.

Does Sanitas cover assisted reproduction or IVF?

No. Sanitas Más Salud excludes diagnosis and treatment, including surgery, for sterility or infertility in either sex, such as in vitro fertilisation (IVF) or artificial insemination (Clause III, letter H, page 38). Some specific tests to reach a diagnosis are covered. In gynaecology, these are baseline hormone tests (except anti-Müllerian hormone), ultrasound, hysterosalpingography and hysteroscopy (page 18). In urology, they are baseline hormone tests, basic semen analysis and bacteriological semen cultures (page 22). Once treatment begins, no further related services are covered. Complex diagnostic tests have a 6-month waiting period.

«encaminados a solventar la esterilidad o infertilidad en ambos sexos, excepto las pruebas detalladas en el apartado correspondiente de ginecología y urología (fecundación in vitro, inseminación artificial, etc.)»

Translation of the quote: aimed at resolving sterility or infertility in either sex, except for the tests detailed in the corresponding gynaecology and urology section (in vitro fertilisation, artificial insemination, etc.)

Document: Condicionado general · Sanitas Más SaludClause: Clause III. Excluded coverage, letter H (with the diagnostic scope of Clause II, sections 3.26 Obstetrics and Gynaecology, p. 18, and 3.35 Urology, p. 22)Page: 38

Waiting periods, limits and exceptions

Waiting period:: Clause IV (page 41) sets no specific waiting period for infertility. Complex diagnostic tests have a 6-month waiting period, and the glossary (page 11) gives ultrasound and endoscopy as examples. Waiting periods do not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after the insured person joins.
Limits:: Only the listed tests, and only up to diagnosis (3.26, page 18, and 3.35, page 22). Anti-Müllerian hormone is not covered in gynaecology. Diagnostic tests need a written prescription from a Sanitas network doctor (Clause V, 1.2, page 42). Separately from the infertility tests, gynaecology covers some genetic tests. The karyotype is covered. Factor V Leiden and the prothrombin gene 20210 mutation need prior authorisation from Sanitas. They are covered if you have a personal history of recurrent miscarriage or thromboembolic events (pages 18-19). Any other genetic test is excluded.
Keep in mind:: The same letter H (page 38) also excludes any benefit directly linked to a treatment that the policy did not cover. Clause V (page 42) adds that services needed as a result of an uncovered treatment or technique are not covered either. That is why nothing linked to fertility treatment is included. Once treatment has started, not even the listed tests are covered for that process. The Top Quantum sales guide says "No infertility cover". But its General Conditions do include these diagnostic tests, and the General Conditions prevail.
In other products:: The same exclusion, with the same diagnostic exception, appears in these General Conditions: Más Salud Plus (p. 37), Más Salud Óptima (p. 37), Más Salud Familias (p. 44), Más Salud Familias Plus (p. 43), Premium 500.000 (p. 48), Más 90.000 with co-payments (p. 48), Más 90.000 without co-payments (p. 44), Accede (p. 23), Avanza (p. 31) and Top Quantum (text without page markers). Among the products for foreign residents, it appears in Residents and Residents Visado (p. 39), Residents Platinum and Platinum Visado (p. 45), International Students (p. 37) and Global Care Premium (pp. 40-41). Global Care Premium also sets an 8-month waiting period for infertility diagnosis in its Clause IV (p. 44). The Sanitas Único General Conditions do not mention infertility at all.

Does Sanitas pay for the medicines I buy at the pharmacy?

No. With Sanitas Más Salud, you pay for the medicines you buy at the pharmacy to take at home. The General Conditions exclude medicines given outside a hospital stay or in a day hospital. They also exclude parapharmacy products and medicines not sold in Spain. The policy does cover medicines you receive as an inpatient, used as their summary of product characteristics sets out. It also covers parenteral chemotherapy in the Oncology Day Unit or during a hospital stay. Both have a 10-month waiting period, except in a life-threatening emergency. When travelling, emergency cover abroad includes medicines prescribed by a doctor, up to €12,000 per person per year. Treatments prescribed in Spain are not included.

«Los que sean administrados al paciente fuera del régimen de hospitalización, o en Hospitalización de día salvo la quimioterapia administrada vía parenteral»

Translation of the quote: Those administered to the patient outside hospitalisation, or in day hospital, except chemotherapy administered parenterally

Document: Condicionado general · Sanitas Más SaludClause: Clause III. Excluded coverage, letter L (medicines for human use)Page: 39

Waiting periods, limits and exceptions

Waiting period:: Pharmacy purchases are not covered, so there is no waiting period. Medicines you receive during a hospital stay have the same waiting period as hospitalisation: 10 months. Chemotherapy is a complex therapeutic procedure (glossary, p. 10), so it also has 10 months (Clause IV, p. 41). These waiting periods do not apply to life-threatening emergencies that arise and are diagnosed after you join the policy. They also do not apply to a premature birth (under 37 weeks).
Limits:: Medicines during a hospital stay are used as their summary of product characteristics sets out. Medicines without marketing authorisation in Spain are excluded (Clause II, section 5 "Hospital care", p. 25). Cover is limited to the most efficient treatment for each active ingredient. That means the generic or biosimilar, whenever one is authorised and sold in Spain (glossary, "Medicine", p. 10). Chemotherapy is prescribed by the oncologist and given in a care centre, either in the Oncology Day Unit or during a hospital stay. It covers cytostatics authorised in Spain, used for their approved indication. They must be given parenterally or by bladder instillation (3.28, p. 20). In a day hospital, letter L makes only two exceptions to the exclusion. One is parenteral chemotherapy in network centres; the other is bladder instillation of mitomycin and BCG (p. 39). Emergencies abroad: €12,000 per person per year, within 90 consecutive days from the start of the trip. Care is given in centres designated by Sanitas, with prior authorisation except in a life-threatening emergency (p. 28).
Keep in mind:: Letter L also excludes medicines for ventilotherapy and aerosol therapy, vaccines and other biological medicines, and medicines of human origin. It also excludes advanced therapy medicines, herbal medicines and homeopathic products. Therapeutic radiopharmaceuticals are excluded (except those mentioned under Oncology), as are adoptive cell transfer techniques such as CAR T (pp. 39-40). Under Oncology, the exclusions are hormone therapy, immunostimulants, immunosuppressants and gene therapy. Experimental or compassionate-use treatments and uses not approved in the summary of product characteristics are excluded too (p. 20). As an exception, in neonatology, vaccines for the newborn in its first 48 hours are covered (pp. 19-20). Emergency cover abroad does not include treatments prescribed in Spain (p. 28). Abroad, the medicine delivery service finds the medicine and sends it to you, but you pay for it on presentation of the invoice (p. 30). Under Special Home Care (Atención Especial en Domicilio), the insured person also pays for medicines (p. 22). The Más Salud sales guide says a doctor can prescribe medicines during a video consultation. A prescription does not mean Sanitas pays for the medicine.
In other products:: Premium 500.000 does include "Pharmacy cover" (Sanitas_Premium_500000__CG, p. 34). It reimburses authorised medicines needed to treat conditions the policy covers. You submit the invoice and the doctor's prescription. Compounded medicines are covered only if listed in the Formulario Nacional (Spain's national formulary). Herbal medicine and parapharmacy are excluded. The percentage and limit are set in the Condiciones Particulares; the FP_Sanitas_Premium_500 product sheet gives 50% up to €300. Residents Platinum and Residents Platinum Visado have the same pharmacy cover (Sanitas_Residents_Platinum__CG and Sanitas_Residents_Platinum_Visado__CG, p. 34). The Más 90.000 General Conditions, with and without co-payments, do not include it. Más Salud Plus, Óptima, Familias and Familias Plus have the same exclusion L (pp. 38, 38, 46 and 44 of their General Conditions). Familias and Familias Plus include delivery of medicines to your home in Spain, under Family Assistance (Asistencia Familiar). This applies after a hospital stay of more than 48 hours, or more than 5 days confined at home on medical sick leave. Delivery takes 24 hours at most, with up to 3 deliveries a year. The insured person pays for the medicine on delivery (pp. 30-32 in both). The Familias sales guide mentions 3 hours; the General Conditions are what apply. According to the sales guides, Accede, Avanza and Top Quantum have an optional pharmacy add-on. Their General Conditions do not include it, so we will confirm with Sanitas whether it can be added to your policy.

Does Sanitas cover prostheses and surgical implants?

Yes, with conditions. Más Salud covers only the internal prostheses and implants listed in the General Conditions, including: - the simple monofocal intraocular lens for cataracts; - hip, knee and other joint prostheses; - spinal and bone fixation (osteosynthesis) material; - stents, bypass grafts, pacemakers and aortic endoprostheses; - abdominal meshes; - breast prostheses and expanders, in the cases set out. Sanitas must give prior authorisation after reviewing the medical report. The prostheses must be approved by Sanitas and supplied by its contracted companies. External or custom-made prostheses are excluded. The surgery to fit them has a waiting period of 3 or 10 months, depending on the surgical group, except in a life-threatening emergency.

«Comprende exclusivamente las prótesis internas y materiales implantables internos expresamente indicados a continuación.»

Translation of the quote: It comprises exclusively the internal prostheses and internal implantable materials expressly indicated below.

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, section 4.8 Prostheses (Other care services)Page: 24

Waiting periods, limits and exceptions

Waiting period:: Clause IV (p. 41, medical network option) sets no specific waiting period for prostheses. The waiting period for the surgery used to fit them applies. Surgery in OMC groups 0 to II has 3 months. Hospitalisation and surgery in groups III to VIII have 10 months. These waiting periods do not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after you join. The care must be covered.
Limits:: Closed list: only what section 4.8 lists is covered (pp. 24-25). - Intraocular lens: only the simple monofocal lens for cataracts. Toric, monofocal plus, extended depth of focus and any advanced monofocal lens are excluded. - Bone substitutes: only in spinal surgery and as fillers after tumour surgery. - Meshes: abdominal meshes, and thoracic meshes in cancer surgery, except biological ones. - Pacemakers are covered; defibrillators and artificial hearts are not. - Heart valves are not on the Más Salud list (Plus and Óptima include them). Valves or valve repair devices implanted percutaneously or transapically are excluded. Aortic valved conduits are covered only with open aortic valve surgery. - Breast prostheses and expanders: after tumour surgery, or after a preventive mastectomy indicated by BRCA1/BRCA2. Sanitas must give prior authorisation after reviewing the medical report (4.8; for surgery in general, Clause V 1.3, p. 42). Sanitas may ask for reports and/or quotes. Only prostheses approved by Sanitas and supplied by its contracted companies are covered. If you ask for one that is not approved, Sanitas will tell you about an equivalent approved prosthesis that is covered (p. 25).
Keep in mind:: Clause III (p. 38) excludes prostheses and implants not listed in 4.8. Among others, it excludes: - any external or custom-made prosthesis; - orthopaedic material and external fixators; - biological or synthetic materials and grafts; - implantable drug infusion pumps and spinal cord stimulation electrodes; - defibrillators and artificial hearts. If a prosthesis not approved by Sanitas is fitted, it is not covered. Sanitas then accepts no liability for fitting it or for how it performs (p. 24). For neurosurgery, heart surgery and spinal surgery, Sanitas chooses the centre and the professionals in advance (Clause V 1.5, p. 43). Conditions that existed before you joined are also excluded (Clause III, A, p. 36). The product sheets and sales guides do not contradict the General Conditions on this point.
In other products:: Más Salud Familias and Familias Plus: same section 4.8 as Más Salud (pp. 24-25 of their General Conditions). Más Salud Plus and Más Salud Óptima (4.8, pp. 23-24) add heart valves, except those implanted percutaneously or transapically. They need express authorisation for aortic endoprostheses and do not include thoracic meshes in cancer surgery. Premium 500.000 and Más 90.000, with and without co-payments, have section 4.9 Prostheses (pp. 24-25 of each set of General Conditions). It works the same way: a closed list, prior authorisation and Sanitas approval. Sanitas Único excludes all prostheses and all bone fixation (osteosynthesis), orthopaedic and implantable material, internal or external. It also excludes the care needed to fit, check or remove them (Clause III, p. 33). The Sanitas Accede General Conditions have no prostheses section among their coverage.

Does Sanitas include a second medical opinion?

Yes, with conditions. Sanitas Más Salud includes, as an additional cover, a second opinion on the diagnosis or treatment of serious, chronic illnesses. The illness must need scheduled care, may need new tests or treatments, and must have a poor outlook from the start. Leading specialists, centres, doctors or academics from any country, chosen by Sanitas, give the opinion in a medical report. To request it, call 93 25 40 538 and send your written reports and imaging tests. You receive a report with a summary of your medical history, the experts' opinion and their CVs. A consultant doctor is assigned to your case. Acute illnesses, or those that need an urgent response, are not included.

«Comprende una segunda opinión sobre el diagnóstico o tratamiento médico en el caso de enfermedades graves, de carácter crónico, que necesiten una atención programada»

Translation of the quote: It comprises a second opinion on the diagnosis or medical treatment in the case of serious, chronic illnesses that require scheduled care

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage — Additional policy coverage: Second medical opinion coverPage: 30

Waiting periods, limits and exceptions

Waiting period:: Clause IV (p. 41) sets no specific waiting period for the second opinion. Consultations, tests or treatments that come out of it are covered only under the policy's rules and coverage (p. 31), so their waiting periods apply. For example: 6 months for complex diagnostic tests and 10 months for complex therapeutic procedures. Hospitalisation and surgery in groups III to VIII also have 10 months. These waiting periods do not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after you join. The care must be covered.
Limits:: It applies only to serious, chronic illnesses that need scheduled care. The course of the illness must be likely to need new diagnostic tests or treatments, and the outlook must be poor from the start. Sanitas chooses the experts; the insured person does not. Only written medical information and imaging tests are sent, never biological or synthetic material (pp. 30-31). You receive a report with a summary of your medical history, the opinion of the experts consulted and their CVs.
Keep in mind:: This service excludes acute illnesses and illnesses that need an urgent response (p. 31). The second opinion is only a report. Whatever it recommends is covered only under the policy's rules and coverage (p. 31). That means the medical network, prescription and prior authorisation under Clause V, and the waiting periods. Clause III.A (p. 36) excludes from all cover any illness, injury or medical situation that existed before each insured person joined. If the illness already existed when you took out the policy, it is worth reviewing your case with us. The product sheets call it an "international second medical opinion". That fits the General Conditions, which say "in any country in the world".
In other products:: The same wording appears in other General Conditions: - Más Salud Plus and Óptima, p. 29 - Más Salud Familias and Familias Plus, p. 32 - Premium 500.000, p. 37 - Más 90.000 with and without co-payments, p. 33 - Profesionales Colectivos, Plus and Óptima, p. 35 - Residents and Residents Visado, p. 31 - Residents Platinum and Platinum Visado, p. 38 Top Quantum and Sanitas Profesionales also include it, but their documents have no page markers. The General Conditions of Accede, Avanza and Único do not include this cover.

Does Sanitas cover podiatry?

Yes, with conditions. Sanitas Más Salud covers podiatry for chiropody only, meaning treatment to remove calluses and treat toenail problems. The limit is 12 sessions per insured person per policy year (Clause II, section 4.7, p. 24). You use a podiatrist from the contracted medical network. Each session has the cost share shown in your Condiciones Particulares (the specific terms of your policy). Podiatry is not among the waiting periods in Clause IV, so you can use it from the day the policy starts. Orthoses and orthopaedic products are excluded (Clause III, p. 39).

«Se cubre exclusivamente quiropodia entendiendo como tal el tratamiento para la eliminación de callosidades y alteraciones en las uñas de los pies practicado por un podólogo.»

Translation of the quote: Only chiropody is covered, understood as treatment to remove calluses and toenail problems performed by a podiatrist.

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, 4. Other care services, 4.7. Podiatry (chiropody only)Page: 24

Waiting periods, limits and exceptions

Waiting period:: There is no waiting period. Clause IV (p. 41) states that benefits are available from the day the contract starts, except for those it lists. The list covers vasectomy and ligation, psychology, complex diagnostic tests, complex therapeutic procedures, surgery, childbirth and hospitalisation. Podiatry is not on that list.
Limits:: Maximum 12 sessions per insured person per policy year ("Limited to a maximum of 12 treatment sessions per Insured Person and policy year", section 4.7, p. 24). Only chiropody is covered (calluses and toenail problems). It must be done by a podiatrist from the product's contracted medical network (Clause V, p. 42).
Keep in mind:: Only chiropody is included; section 4.7 does not cover any other podiatry treatment. Orthoses, orthopaedic products and anatomical products are excluded (Clause III, letter H, p. 39). Each service has the cost share set in the Condiciones Particulares (Clause V, p. 42); we don't quote amounts here. To check whether you need a prescription, Clause V refers you to the Guía Orientadora de Médicos y Servicios (the directory of doctors and services). In Más Salud, podiatry is not one of the home services listed in Clause V (p. 43). The Top Quantum sales guide also gives 12 sessions a year for Más Salud, the same as the General Conditions. The General Conditions are the reference.
In other products:: These products have the same limit of 12 sessions, chiropody only: - Más Salud Óptima (4.7, p. 23) - Más Salud Familias and Familias Plus (4.7, p. 24 by the PDF marker; the printed footer says 26) - Más Salud Plus (4.7, p. 23 by the PDF marker; the printed footer says 25) - Premium 500.000 and Más 90.000, with and without co-payments (4.8, p. 24) - Accede (4.4, p. 16), Avanza (4.4, p. 20) and Único (4.5, p. 16) - Profesionales Colectivos (4.7, pp. 23-24), Profesionales Óptima and Plus (4.7, p. 24), and Profesionales (4.7, document without page markers) Top Quantum has a limit of 10 sessions (4.6, document without page markers). Único also includes home podiatry within its Senior Home Services (Servicios a Domicilio Senior). You get up to 3 sessions a year if you are housebound, without gait analysis (p. 21). Some products do not ask for a prescription to reimburse podiatry. These are Premium 500.000 (p. 56), Más 90.000 with co-payments (p. 57), Más 90.000 without co-payments (p. 52) and Top Quantum (document without page markers).

Does Sanitas cover speech therapy?

Yes, with conditions. In Más Salud, speech therapy needs prior authorisation from Sanitas. It also needs a prescription from an ear, nose and throat specialist, or from a neurologist after a stroke. It covers up to 80 sessions a year, only for: - organic conditions of the larynx and vocal cords; - language re-education in the six months after a stroke; - language development in children under 14, up to 20 sessions a year (p. 23). Speech therapy counts as a complex therapeutic procedure, so it has a 10-month waiting period. Más Salud Familias covers up to 20 sessions a year for the larynx, vocal cords and speech defects, with a 6-month waiting period (pp. 23 and 48).

«Se cubren hasta un máximo de 80 sesiones al año por asegurado.»

Translation of the quote: Up to a maximum of 80 sessions per year per insured person are covered.

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, section 4.5 Speech therapy and phoniatricsPage: 23

Waiting periods, limits and exceptions

Waiting period:: Más Salud: Clause IV (p. 41) has no specific waiting period for speech therapy. The glossary lists "language rehabilitation" among the complex therapeutic procedures (p. 10). It lists "language rehabilitation and/or speech therapy" among the complex therapeutic procedures done in consultation (p. 11). These procedures have a 10-month waiting period (Clause IV, p. 41). Más Salud Familias: Clause IV expressly sets "Speech therapy and phoniatrics: 6 months" (Sanitas_Mas_Salud_Familias__CG, p. 48).
Limits:: Más Salud: up to 80 sessions a year per insured person. After an acute stroke, only the first six months are covered. For children under 14, language development has a maximum of 20 sessions per policy year (p. 23). Más Salud Familias: up to 20 sessions a year per insured person (p. 23).
Keep in mind:: In Más Salud, cover is limited to three situations: - organic conditions of the larynx and vocal cords (inflammation, tumours, paresis or paralysis of the cords, congenital malformations); - stroke; - language development in children under 14. Clause III (p. 39) excludes "educational therapy, language education in processes without organic pathology". So for children, we check with Sanitas before starting. In Familias (p. 23), only the larynx, vocal cords and speech defects are covered. Speech defects means articulation, phonological or voice quality disorders. Problems with understanding or using words correctly are not covered, and that clause does not mention stroke. Its Clause III (p. 45) has the same exclusion for language education without organic pathology. Its glossary also lists language rehabilitation and speech therapy as complex procedures (10 months). We check each case with Sanitas. The sales guide differs on one point: it says "Language education under 16". The General Conditions prevail, and they say under 14.
In other products:: Más Salud Plus and Más Salud Óptima (4.5, pp. 22-23 of their General Conditions) have the same authorisation, prescription and limit of 80 sessions a year. They cover language re-education after an acute stroke without the six-month limit. They do not cover language development for children under 14. Premium 500.000 and Más 90.000, with and without co-payments (4.5, pp. 23-24), work like Más Salud. So does Top Quantum (4.5; its text has no page markers). That means 80 sessions, the six months after a stroke and up to 20 sessions for children under 14. Más Salud Familias Plus (4.5, p. 23) works like Familias: 20 sessions and a 6-month waiting period (Clause IV, p. 46). Sanitas Único (4.3, p. 15) covers only the consultation, not treatment, because treatment is a complex therapeutic procedure. Sanitas Accede (4.2, p. 16) does not cover language rehabilitation or speech therapy, for the same reason. Sanitas Avanza (Clause III, p. 31) excludes all speech therapy and phoniatrics sessions.

How does Sanitas cover cancer treatment (chemotherapy, radiotherapy)?

It is covered, with conditions. In Sanitas Más Salud, Sanitas pays for chemotherapy when the Medical Oncology specialist treating you prescribes it. It must be given in a care centre, either in the Oncology Day Unit or as an inpatient. It covers cytostatics authorised in Spain, given parenterally or by bladder instillation, for as many cycles as you need. Radiotherapy is covered only for cancer, with prior written authorisation. The covered techniques are IMRT, 3D conformal, stereotactic (IGRT/SBRT), intraoperative radiotherapy and brachytherapy. Both have a waiting period, because they are complex therapeutic procedures: 10 months. The exception is a life-threatening emergency that arises and is diagnosed after you join.

«Los tratamientos correrán por cuenta de SANITAS, siempre que se apliquen en centro asistencial, tanto en régimen de Unidad de Día Oncológica, como en ingreso cuando éste fuera necesario.»

Translation of the quote: Treatments will be paid by SANITAS, provided they are administered in a care centre, whether in an Oncology Day Unit or as an inpatient when this is necessary.

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, 3.28 Medical Oncology (radiotherapy in 3.32 Radiotherapy, p. 21)Page: 20

Waiting periods, limits and exceptions

Waiting period:: 10 months. The glossary (p. 10) gives radiotherapy and chemotherapy as examples of a "complex therapeutic procedure". Clause IV (p. 41) sets 10 months for these procedures. Other waiting periods often apply during cancer care. Hospitalisation and surgery in OMC groups III to VIII have 10 months. Surgery in groups 0 to II has 3 months. Complex diagnostic tests have 6 months. None of these waiting periods apply to a life-threatening emergency, if it occurs and is diagnosed after the policy starts or after the insured person joins. The care must be covered.
Limits:: Chemotherapy (3.28, p. 20): only cytostatics sold in Spain, used for the indications in their summary of product characteristics. They must be given parenterally or by bladder instillation, in a care centre (Oncology Day Unit or inpatient). As many cycles as needed are covered. Chemotherapy cover also includes: - intraperitoneal chemotherapy (peritoneal carcinomatosis from ovarian or digestive tumours); - intrathecal chemotherapy (high-grade lymphomas or meningeal carcinomatosis); - medicines given during the session to prevent side effects, even if they do not treat the tumour; - iodine-131 for hyperthyroidism and thyroid cancer; - testing for DPD deficiency. Radiotherapy (3.32, p. 21): only for cancer, and only with the techniques listed. Stereotactic radiosurgery is also covered for the listed uses: cancer, brain tumours, cerebral arteriovenous malformations and, as a last resort, trigeminal neuralgia. It needs prior written authorisation after Sanitas reviews the medical report. Ambulance transport to chemotherapy or radiotherapy in a Day Hospital is also covered (4.1, p. 22). It must be by road, with contracted services, and only when your physical condition rules out other transport. You need authorisation from the 24-hour phone line. Ports (reservorios) are covered under 4.8 Prostheses (p. 24).
Keep in mind:: The cover itself excludes experimental or compassionate-use treatments, hormone therapy, immunostimulants, immunosuppressants, gene therapy and off-label uses (3.28, p. 20). It also excludes proton therapy, neutron therapy and radioembolisation with microspheres (3.32, p. 21). Clause III, section L (pp. 39-40), excludes medicines given outside a hospital stay or in a day hospital. There are two exceptions. One is parenteral chemotherapy given by a healthcare professional in a network centre. The other is bladder instillation of mitomycin and BCG. So oral chemotherapy taken at home is not covered. The same section excludes biological medicines and advanced therapy medicines (gene and cell therapy). It also excludes therapeutic radiopharmaceuticals, except the iodine-131 and yttrium-90 mentioned. Adoptive cell transfer (CAR-T, TIL) is excluded too. Section G (p. 37) excludes techniques used within a clinical trial, and section O (p. 40) excludes HIFU. A cancer that began before you joined is excluded (Clause III.A, p. 36) and must be declared in the health questionnaire. If your policy has co-payments, the amounts are in the Condiciones Particulares. The Más Salud product sheet and sales guide match the General Conditions.
In other products:: Más Salud Familias and Familias Plus have the same cover as Más Salud in 3.28 (p. 20) and 3.32 (p. 21). Más Salud Plus and Más Salud Óptima have the same chemotherapy cover (3.28, p. 19). Their radiotherapy (3.32, p. 20) does not include stereotactic radiosurgery, which their Clause III, section Ñ (p. 39), expressly excludes. It also excludes "techniques other than those expressly mentioned", unless Sanitas confirms in writing that they are included. All five Más Salud variants have a 10-month waiting period. Accede excludes "all complex therapeutic procedures without exception" (Clause III.E, p. 22). Avanza also excludes them (Clause III.D, p. 30) and covers only the consultation under 3.29 Radiotherapy (p. 19). Único excludes radiotherapy and giving chemotherapy (Clause III, sections B and D, p. 31). So none of these three covers chemotherapy or radiotherapy. Top Quantum's General Conditions have no page markers. They cover IMRT, 3D, intraoperative radiotherapy, brachytherapy and stereotactic radiosurgery. They do not list IGRT/SBRT stereotactic radiotherapy. The waiting period for complex therapeutic procedures is 6 months (Clause IV). Its sales guide says it does not cover stereotactic radiosurgery and gives an 8-month waiting period. The General Conditions prevail, and it is worth confirming with Sanitas.

Does Sanitas cover ambulance transport?

Yes, with conditions. Sanitas Más Salud covers an ambulance in these cases: - from wherever you are to the hospital where you will be admitted, or where you go for an emergency covered by Sanitas; - back home afterwards; - to another hospital in the medical network, if the first one lacks the resources you need; - to chemotherapy and radiotherapy in a Day Hospital. The ambulance travels by road, within Spain, using contracted services. It is covered when your physical condition rules out a taxi or car. You need authorisation from the Sanitas 24-hour phone line. Pick-up from home needs a medical prescription. It does not cover trips to consultations, diagnostic tests or physiotherapy.

«Serán objeto de cobertura los traslados realizados en ambulancia, desde el lugar donde se encuentre el asegurado hasta aquél hospital donde va a ingresar en régimen de hospitalización»

Translation of the quote: Ambulance transport will be covered from the place where the insured person is to the hospital where they are to be admitted as an inpatient

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, section 4.1 Ambulance (Other care services)Page: 22

Waiting periods, limits and exceptions

Waiting period:: Clause IV (p. 41) sets no waiting period for ambulance transport itself. The trip is covered to an admission or emergency "under SANITAS cover", and that care has its own waiting periods. For example, hospitalisation and surgery in groups III to VIII have 10 months. These periods do not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after you join. Nor do they apply to premature births.
Limits:: By road only, within Spain, using services contracted by Sanitas. It is covered when the insured person's physical condition rules out ordinary transport, such as a taxi or private car. You need authorisation from the 24-hour phone service. It does not cover trips to physiotherapy, diagnostic tests or consultations, or any case not described in section 4.1. Ambulance transport counts as a home service (Clause V, 1.6, p. 43). So it needs a doctor's prescription and is available only in towns where Sanitas has contracted the service. Abroad, the additional emergency cover (p. 28) includes an ambulance ordered by a doctor for a local journey. It applies within 90 consecutive days from the start of the trip. You need prior authorisation by phone, except in a life-threatening emergency. It is provided at centres designated by Sanitas, with a limit of €12,000 per person per year.
Keep in mind:: Always request the ambulance through the Sanitas 24-hour phone line. Services from non-contracted providers are not covered. Nor are services from the public health service, whether regional or national. Sanitas may decline a home service if, on medical grounds, it considers it unnecessary (Clause V, 1.6, p. 43). Exclusion J (Clause III, p. 39) excludes other travel and transport expenses. The Más Salud sales guide (April 2021, no page numbers) says arriving by ambulance involves a co-payment. The General Conditions (Clause VI, 4.5, p. 48) leave whether co-payments apply, and their amounts, to your policy's Condiciones Particulares.
In other products:: Premium 500.000 and Más 90.000, with and without co-payments, have the same section 4.1 Ambulance on p. 22 of their General Conditions. Their reimbursement option adds road ambulance transport to the hospital where you receive emergency care. It needs a medical prescription and is subject to the limits in the Condiciones Particulares (Premium, p. 55; Más 90.000 with co-payments, p. 56; without co-payments, p. 51). Más Salud Plus, Óptima, Familias, Familias Plus and Top Quantum also include section 4.1. Sanitas Único excludes it (Sanitas_Unico__CG, section 4.1, p. 15): "Ambulance services are not covered under any circumstances". Accede and Avanza have no ambulance section among their coverage. However, their Clause V lists the ambulance among home services (Accede, p. 25; Avanza, p. 35). For these products, we will check your case with Sanitas.

Does Sanitas cover tests such as MRI or CT scans? Is there a waiting period?

Yes. Sanitas Más Salud covers MRI and CT scans after a 6-month waiting period. The glossary of the General Conditions lists them as complex diagnostic tests (p. 11). Clause IV sets a 6-month waiting period for this type of test (p. 41). Until the 6 months have passed, the policy will not pay for them. The exception is a life-threatening emergency from an accident or illness that arises and is diagnosed after the policy starts or after you join. You need a written prescription from a Sanitas network doctor (Clause V, p. 42), and the test is done within the medical network. Sanitas pays for the contrast used in CT and MRI scans (section 3.31, p. 21).

«Pruebas diagnósticas complejas: 6 meses»

Translation of the quote: Complex diagnostic tests: 6 months

Document: Condicionado general · Sanitas Más SaludClause: Clause IV. Waiting periodsPage: 41

Waiting periods, limits and exceptions

Waiting period:: 6 months for complex diagnostic tests in the medical network option (Clause IV, p. 41). The glossary (p. 11) gives CT and MRI as examples of this category. It also lists ultrasound, neurophysiology, nuclear medicine, genetics, molecular biology, endoscopy, haemodynamics and interventional radiology. All of these have the same 6 months. The waiting period does not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after the insured person joins. The care must be covered (Clause IV, p. 41).
Limits:: You need a written prescription from a Sanitas network doctor (Clause V, section 1.2, p. 42), and the test is done with contracted services. Except in a life-threatening emergency, Sanitas does not pay for care at centres outside the network (Clause V, section 1.9, pp. 43-44). Sanitas pays for contrast only in CT, MRI, kidney ultrasound for under-18s and interventional radiology (section 3.31, p. 21). CT colonography is covered only for specific indications. It needs prior authorisation from Sanitas after it reviews a medical report. CT coronary angiography is included, but calcium scoring is excluded (p. 21). Multiparametric prostate MRI is included under Urology (section 3.35, p. 21). For each covered service, you pay the cost share shown in the Condiciones Particulares (Clause V, p. 42).
Keep in mind:: Illnesses, injuries or medical situations that existed before the insured person joined are excluded. You must declare diagnostic tests in the health questionnaire. If you do not, any cover related to what was not declared is excluded (Clause III, section A, p. 36). A prescription from a doctor outside the network is not enough; it must come from a network doctor. Some tests also need prior authorisation from Sanitas, where the General Conditions say so. The authorisation slip is not valid if the policy requirements are not met at that time. Examples are unpaid premiums or an undeclared pre-existing illness (Clause V, section 1.3, p. 42). The Más Salud product sheet matches the General Conditions: complex diagnostic tests, 6 months.
In other products:: The same 6-month waiting period for complex diagnostic tests appears in these General Conditions (GC): - Más Salud Plus (p. 40), Más Salud Óptima (p. 40), Más Salud Familias (p. 48) and Familias Plus (p. 46) - Premium 500.000 (p. 51), and Más 90.000 with co-payments (p. 52) and without co-payments (p. 47) - Avanza (p. 33) and Único (p. 35) - Profesionales Colectivos (p. 47), Plus (p. 48) and Óptima (p. 50) In Premium 500.000 and Más 90.000, the 6 months apply both in the medical network and under reimbursement. Top Quantum and Sanitas Profesionales also include them, but their General Conditions have no page markers. Sanitas Único covers only three complex tests: ultrasound, CT and MRI (Único GC, p. 13). Sanitas Avanza covers complex tests unless they are prescribed by certain specialists. These are cardiac electrophysiology, haemodynamics, the pain unit, radiotherapy and interventional radiology (Avanza GC, p. 13). Sanitas Accede does not cover complex diagnostic tests. The only exception is ultrasound and echocardiograms done in the consulting room, so it covers neither MRI nor CT (Accede GC, p. 13). Residents Visado (p. 42) and Residents Platinum Visado (p. 48) state: "This insurance has no waiting periods".

Does Sanitas cover cosmetic surgery?

No. Sanitas Más Salud excludes any procedure, injection or treatment done for aesthetic or cosmetic reasons, even when there are psychological grounds. It also does not cover later complications caused by cosmetic surgery. It does cover some reconstructive surgery. This includes breast reconstruction after a mastectomy for cancer. It also includes reshaping the healthy breast on the other side, within one year of the cancer surgery. Reconstruction after preventive surgery indicated by BRCA1 and BRCA2 results is also covered. All of this needs prior authorisation from Sanitas. The waiting periods are 3 months for surgery in groups 0 to II, and 10 months for hospitalisation and groups III to VIII.

«Las intervenciones, infiltraciones y tratamientos, así como cualquier otra intervención que tenga un carácter estético o cosmético, incluidas las que se fundamenten en razones psicológicas.»

Translation of the quote: Procedures, injections and treatments, as well as any other procedure of an aesthetic or cosmetic nature, including those based on psychological reasons.

Document: Condicionado general · Sanitas Más SaludClause: Clause III. Excluded coverage, letter HPage: 38

Waiting periods, limits and exceptions

Waiting period:: Cosmetic surgery is not covered, so it has no waiting period. Covered reconstructive surgery follows Clause IV (p. 41). Surgery in OMC groups 0 to II has a 3-month waiting period. Hospitalisation and surgery in groups III to VIII have 10 months. These waiting periods do not apply in a life-threatening emergency that occurs and is diagnosed after you join. The care must be covered.
Limits:: Reshaping the healthy breast on the other side must be done within one year of the cancer surgery. It is covered only if the medical report considers it a treatment option. It is limited to breast reduction and breast lift (mastopexy) (3.13, p. 16; 3.26.1, p. 19). Only four reconstruction techniques are covered: expanders and prostheses, latissimus dorsi flap, DIEP and TRAM (3.26.1, p. 19). All of these need prior authorisation from Sanitas after it reviews the medical report.
Keep in mind:: Clause III H (p. 38) also excludes: - any abdominoplasty; - surgery to correct breast hypertrophy or gynaecomastia; - preventive breast surgery that does not meet the criteria in the breast surgery section; - hyaluronic acid and platelet-rich plasma. Page 16 also excludes rhinoseptoplasty (3.10 and 3.13) and lipoedema surgery (3.9 and 3.13). It also excludes "surgery with an aesthetic component" in general surgery (3.9). Rhinoplasty is covered only after trauma or earlier non-cosmetic surgery, always subject to a medical report (3.29, p. 20). For benign breast tumours, surgery is covered but reconstruction is not (3.26.1, p. 19). If the cancer began before you joined, the pre-existing conditions exclusion in Clause III A applies (p. 36). You declare it in the health questionnaire and Sanitas assesses it. The product sheets and sales guides do not contradict the General Conditions. When they mention aesthetic treatment, it is always about dental care.
In other products:: The approach is the same across the range. Más Salud Familias (p. 45) and Familias Plus (p. 43) use the same wording as Más Salud. So do Premium 500.000 (p. 48), Más 90.000 with co-payments (p. 49) and without co-payments (p. 44), and Top Quantum (p. 68). Avanza (p. 31), Profesionales Óptima (p. 47) and Profesionales Plus (p. 45) also use it. Más Salud Plus and Óptima (p. 37), Único (p. 33), Profesionales (p. 66) and Profesionales Colectivos (p. 44) exclude anything "purely aesthetic or cosmetic". Accede excludes all surgery in any care setting (Clause III B, p. 22 of its General Conditions), so it does not cover reconstruction either. Its IPID has no page markers. It also lists "Any aesthetic or cosmetic treatment or procedure" as excluded.

Does Sanitas cover vasectomy or tubal ligation?

Yes, both, after a waiting period. In Sanitas Más Salud, the General Conditions include tubal ligation within family planning, under Obstetrics and Gynaecology (Clause II, section 3.26, page 18). Family planning also covers fitting an IUD, although the insured person pays for the device itself. Vasectomy is listed with tubal ligation among the benefits that have a waiting period in Clause IV (page 41). You can have either procedure once 10 months have passed. Before you book it, ask for authorisation. As a general rule, surgery needs a written prescription from a Sanitas doctor and prior authorisation (Clause V, page 42). We can help you with the paperwork from the office.

«Vasectomía y ligadura de trompas: 10 meses»

Translation of the quote: Vasectomy and tubal ligation: 10 months

Document: Condicionado general · Sanitas Más SaludClause: Clause IV. Waiting periods (tubal ligation also in Clause II, section 3.26 Obstetrics and Gynaecology, p. 18)Page: 41

Waiting periods, limits and exceptions

Waiting period:: 10 months for vasectomy and tubal ligation (Clause IV, p. 41, periods for the medical network option).
Limits:: Under family planning, the insured person pays for the IUD device, whatever its medical purpose (Clause II, 3.26, p. 18). As a general rule, surgery needs a written prescription from a Sanitas doctor and express prior authorisation from Sanitas (Clause V, 1.3, p. 42). For each covered service, you pay the cost share shown in the Condiciones Particulares (Clause V, p. 42). The General Conditions set no age limit and no limit on the number of procedures for these benefits.
Keep in mind:: Section 3.35 Urology does not name vasectomy. The General Conditions mention it only in Clause IV, as a benefit with a waiting period. Tubal ligation, by contrast, is named expressly in section 3.26. These procedures are separate from sterility treatment. Diagnosis and treatment, including surgery, "aimed at resolving sterility or infertility in either sex" are excluded (Clause III, section H, p. 38). The only exception is the diagnostic tests listed under gynaecology and urology. The Más Salud product sheet matches the General Conditions: 10 months.
In other products:: These products have the same family planning wording and the same 10-month waiting period: - Más Salud Plus and Óptima (p. 18 and p. 40) - Más Salud Familias (p. 18 and p. 48) and Familias Plus (p. 18 and p. 46) - Premium 500.000 (p. 19 and p. 51) - Más 90.000 with co-payments (p. 19 and p. 52) and without co-payments (p. 19 and p. 47) - Profesionales Colectivos (p. 18 and p. 47), Plus (p. 18 and p. 48) and Óptima (p. 18 and p. 50) Sanitas Profesionales also has 10 months (Sanitas_Profesionales__CG, document without page markers). Top Quantum names "Vasectomy and Tubal Ligation" in its section 6.9 Family planning, with a 6-month waiting period (Sanitas_Top_Quantum__CG, without page markers). Avanza includes tubal ligation (Sanitas_Avanza__CG, p. 17). However, it covers only surgery in OMC groups 0, 1 and 2 (p. 21) and does not name vasectomy. The General Conditions of Accede and Único do not include family planning. For those products, we will check your case with Sanitas.

Up to what age can I take out Sanitas health insurance?

It depends on the product. Under the General Conditions, the maximum age to take out the policy is: - 75 for Más Salud; - 64 for Premium 500.000 and Más 90.000 (with and without co-payments); - 59 for Accede and Avanza. Único works the other way round: you can take it out from age 60, and its General Conditions set no maximum age. For the other products, you must be younger than the age limit on the date you join, unless otherwise agreed. Once you are insured, reaching a certain age is not a reason for the insurance to end. However, the premium is updated at each renewal based on your age.

«La edad máxima de contratación es 75 años.»

Translation of the quote: The maximum age for taking out the policy is 75.

Document: Condicionado general · Sanitas Más SaludClause: Clause VI. Other aspects of the insurance, section 2. Maximum age for taking out the policyPage: 47

Waiting periods, limits and exceptions

Waiting period:: Not applicable: section 2 (maximum age for taking out the policy) sets no waiting periods.
Limits:: Clause VI, section 2, of each set of General Conditions: - Más Salud: 75 (p. 47) - Premium 500.000: 64 (p. 60) - Más 90.000 with co-payments: 64 (p. 61) - Más 90.000 without co-payments: 64 (p. 56 of the PDF; the printed page number is 58) - Accede: 59 (p. 29) - Avanza: 59 (p. 39) - Único: minimum 60 ("an age equal to or over 60"), with no maximum age (p. 41) For every product with an age limit, you must be younger than the limit on the date you are added, unless otherwise agreed. Additional or complementary coverage may also have its own maximum ages. Children under 14 can join only if the person with parental authority or guardianship is also insured, unless otherwise agreed (section 3.4, on the same pages).
Keep in mind:: The product sheets give the age ranges as "0-75", "0-64" and "From 0 to 59 years (inclusive)". The Top Quantum sales guide says "75 years (inclusive)". But the General Conditions prevail, and they require you to be younger than the limit on the date you are added. If you have already turned 75, 64 or 59 (depending on the product), talk to the office before you apply. We will check your case with Sanitas. The phrase "no maximum age to remain insured" comes from the product sheets and sales guides. The General Conditions do not list age as a reason for termination. Those reasons are death, moving your residence abroad, or actions against staff (section 3.3). Even so, the insurance renews every year and either side may refuse the renewal. Sanitas must give two months' notice and the policyholder one month (section 3.1). At each renewal, the premium changes according to your age (section 4.7).
In other products:: Maximum age by product (Clause VI, section 2): - Top Quantum: 75 (Sanitas_Top_Quantum__CG; document without page markers, so no page number) - Más Salud Plus and Más Salud Óptima: 75 (p. 45) - Más Salud Familias: 75 (p. 54) - Familias Plus: 75 (p. 52) - Profesionales Colectivos: 75 (p. 53) - Profesionales Plus: 75 (p. 54) - Profesionales Óptima: 75 (p. 56) - Sanitas Profesionales: 75 (no page markers, so no page number) - Residents and Residents Visado: 75 (p. 48) - Residents Platinum and Platinum Visado: 64 (p. 57) - Global Care Premium, with and without USA: 74 (p. 51) - International Students: 35 (p. 45) - Estudiantes Europa: 35 (Sanitas_Estudiantes_Europa__CG; document without page markers, so no page number)

How do I add my newborn baby to Sanitas, and are there waiting periods?

The policyholder adds the baby. To do this, they must notify Sanitas within 30 calendar days of the birth by filling in an insurance application form (Solicitud de Seguro). We can help you with this from the office. Your baby is covered with full rights from the date of birth in either of two cases. The first is if the birth was covered by the mother's Sanitas policy. The second is if the father's cover as an insured person started at least 240 days before the birth. The General Conditions set no waiting periods specific to the baby. If you notify late or do not meet these requirements, Sanitas may refuse the baby based on what you declared in the application.

«los hijos recién nacidos podrán ser incluidos en la póliza con todos sus derechos desde la fecha del nacimiento»

Translation of the quote: newborn children may be included in the policy with full rights from the date of birth

Document: Condicionado general · Sanitas Más SaludClause: Clause VI. Other aspects of the insurance, section 5. Newborn enrolmentPage: 49

Waiting periods, limits and exceptions

Waiting period:: Under Clause VI.5 (p. 49), the baby joins "with full rights from the date of birth". The General Conditions set no waiting periods specific to the baby. Clause IV (p. 41) sets out the general waiting periods for the medical network option and does not mention newborns. The periods are: - surgery in groups 0 to II: 3 months; - psychology and complex diagnostic tests: 6 months; - vaginal birth or caesarean section (except a premature birth): 8 months; - vasectomy and tubal ligation, complex therapeutic procedures, and hospitalisation and surgery in groups III to VIII: 10 months. These periods do not apply to a life-threatening emergency that occurs and is diagnosed after joining, as long as the care is covered. If you have questions about a specific benefit for your baby, we'll check your case with Sanitas.
Limits:: The policyholder tells Sanitas about the new member within 30 calendar days of the birth, using an insurance application form (Solicitud de Seguro). One of two conditions must be met. Either the mother's delivery was covered by her Sanitas policy, or the father's cover started at least 240 days before the birth. Neonatal Care cover (Clause II, 3.26.2, pp. 19-20) includes the baby's medical check-up and vaccines. It also includes the routine tests done in the first 48 hours of life.
Keep in mind:: Sanitas covers the newborn's healthcare only once the baby has been added as an insured person with that cover (Clause II, 3.26.3, p. 20; and VI.5, p. 49). Neonatal Care (3.26.2, pp. 19-20) excludes any medical care needed because of a condition or complication at birth. If you notify late or do not meet the requirements, Sanitas may refuse the baby based on what the policyholder declared in the application form. For surrogacy, the deadline is 30 calendar days from registration in the Spanish Civil Registry. Cover begins on the date the baby is added. Expenses before that date are not covered. Expenses before discharge from hospital after the birth are never covered (VI.5, p. 49). Expenses arising from surrogacy are also not covered, for either the mother or the newborn (3.26.3, p. 20). The health product sheets and sales guides do not cover this point, so they do not contradict the General Conditions.
In other products:: The same section (VI.5) appears in the following products, with the same requirements (240 days for the father and 30 calendar days): - Más Salud Plus (p. 47) and Óptima (p. 47) - Familias (p. 56) and Familias Plus (p. 54) - Premium 500.000 (p. 62) - Más 90.000 with co-payments (p. 63) and without co-payments (p. 58) - Profesionales Plus (p. 56), Profesionales Óptima (p. 58) and Profesionales Colectivos (p. 55) - Residents and Residents Visado (p. 50) - Residents Platinum and Platinum Visado (p. 59) Top Quantum and Sanitas Profesionales use the same wording, but their documents have no page markers. Clause VI of Accede, Avanza and Único has no "Newborn enrolment" section. Because their General Conditions do not include it, we'll check your case with Sanitas before the birth.

Does Sanitas cover psychiatry and psychiatric hospitalisation?

Yes, with conditions. In Sanitas Más Salud, psychiatry is one of the medical specialties listed in the General Conditions. Psychiatric hospitalisation is covered with an overnight stay, but only to treat acute episodes. The limit is 50 days per insured person per year (Clause II, section 3.30, page 21). For eating disorders, treatment can continue in a day hospital after an inpatient stay. Hospitalisation has a 10-month waiting period, except in a life-threatening emergency (Clause IV, page 41). It also needs prior authorisation from Sanitas. Care arising from chronic alcoholism, drug addiction, attempted suicide or self-harm is excluded (Clause III, page 37).

«Se cubre la hospitalización con pernocta y sólo comprende el tratamiento de brotes agudos.»

Translation of the quote: Hospitalisation with an overnight stay is covered and only includes treatment of acute episodes.

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, section 3.30 PsychiatryPage: 21

Waiting periods, limits and exceptions

Waiting period:: Hospitalisation and surgery in OMC groups III to VIII: 10 months (Clause IV, p. 41). This waiting period does not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after the insured person joins, as long as the care is covered. Psychology: 6 months. Complex diagnostic tests: 6 months. Psychiatry consultations are not on the list of waiting periods.
Limits:: Inpatient stay with an overnight stay, for acute episodes only, up to 50 days per insured person per year (3.30, p. 21). A day hospital is covered only to continue treating an eating disorder after an inpatient stay (3.30, p. 21). Medicines given in a day hospital are excluded, except parenteral chemotherapy (Clause III, L, p. 39). A private room with a companion bed is not provided for psychiatric stays (Clause II, section 5 Hospital care, p. 25). Hospitalisation needs a written prescription and express prior authorisation from Sanitas (Clause V, 1.3, p. 42). Psychology is covered separately: up to 15 sessions per insured person per policy year. It must be prescribed by a psychiatrist, family doctor, paediatrician or oncologist. The insured person pays for psychometric tests (4.10, p. 25; V 1.2, p. 42).
Keep in mind:: Clause III excludes: - care arising from chronic alcoholism, drug addiction, attempted suicide and self-harm (F, p. 37); - care arising from intoxication through abuse of alcohol, psychotropic drugs, narcotics or hallucinogens (F, p. 37); - conditions that existed before joining, which must be declared in the health questionnaire (A, p. 36); - special education for patients with a mental health condition (H, p. 39); - medicines given outside a hospital stay or in a day hospital, except parenteral chemotherapy (L, p. 39). In psychology, these are excluded: psychoanalysis and psychoanalytic therapy, hypnosis, treatment of narcolepsy, animal-assisted therapy, and psychosocial rehabilitation or neuropsychiatry (4.10, p. 25). The additional emergency cover abroad excludes mental illness (p. 28). If your policy has a co-payment, the amount is shown in the Condiciones Particulares (Clause V, p. 42). The Más Salud sales guide (April 2021) says "unlimited hospitalisation (except psychiatric)", which matches the General Conditions.
In other products:: Más Salud Familias and Familias Plus (GC, p. 21) have the same wording as Más Salud. So do Premium 500.000 and Más 90.000, with and without co-payments (GC, p. 21). This covers overnight stays, acute episodes, 50 days a year and day hospital for eating disorders after an inpatient stay. Más Salud Plus and Más Salud Óptima (GC, p. 20) cover inpatient stays with an overnight stay, for acute episodes only, up to 50 days per insured person per year. Their section 3.30 does not mention day hospital for eating disorders. Top Quantum covers inpatient stays with an overnight stay for acute episodes, with a limit of 60 days per insured person per year (General Conditions without page markers, so no page number).

Does Sanitas cover injuries from high-risk sports?

No. Sanitas Más Salud does not cover care for injuries from high-risk sports practised as an amateur. It also excludes injuries from sports competitions, including training. The General Conditions give examples: air sports, scuba diving, off-piste skiing, climbing, boxing, martial arts and rugby. The list goes on with quad biking, rafting, canyoning, paragliding, hunting, horse riding and any similar risky activity. This exclusion applies to all the cover in the policy. Unlike the exclusion for road traffic accidents, it has no exception for emergency care. The health questionnaire asks about the sports you do, so answer it truthfully and completely.

«Los producidos practicando el Asegurado, como aficionado, deportes de riesgo, como por ejemplo actividades aéreas, pruebas de velocidad con vehículos a motor, submarinismo, esquí fuera de pista»

Translation of the quote: Those occurring while the Insured Person is practising, as an amateur, high-risk sports, such as air activities, speed trials with motor vehicles, scuba diving, off-piste skiing

Document: Condicionado general · Sanitas Más SaludClause: Clause III. Excluded coverage, section BPage: 36

Waiting periods, limits and exceptions

Waiting period:: Not applicable: this is an exclusion under Clause III, not a waiting period.
Limits:: The exclusion applies to all the cover in the policy. Clause III opens with "The following are excluded from all coverage of this policy". There is no exception for emergency care. The exclusion for road traffic accidents, also in section B, does have one: "except necessary emergency care".
Keep in mind:: The list gives examples only and ends with "any other activity of similar risk", so it is not closed. It includes activities many people don't think of as risky, such as hunting or horse riding. The same sentence also excludes "those arising from sports competitions, including training". The wording does not limit this part to high-risk sports. Section B also excludes accidents at work and occupational accidents. The contract is based on the health questionnaire, which asks about "sports activities". You must give "truthful and complete" information (Clause VI, section 1.1, p. 46). The product sheets and sales guides do not cover this point, so they do not contradict the General Conditions.
In other products:: The same wording appears in Clause III, section B, of: - Más Salud Plus (p. 35), Óptima (p. 35), Familias (p. 43) and Familias Plus (p. 41); - Premium 500.000 (p. 46); - Más 90.000 with co-payments (p. 47) and without co-payments (p. 42); - Profesionales Colectivos (p. 42), Plus (p. 43) and Óptima (p. 45); - Residents and Residents Visado (p. 37); - Residents Platinum and Platinum Visado (p. 43); - International Students (p. 35); - Global Care Premium (p. 39). In Accede, the same wording is in section F of Clause III (pp. 22-23). In Avanza (p. 30) and Único (p. 31), it is in section E. The Accede IPID also lists "The practice of high-risk sports" as not covered. Sanitas Profesionales and Top Quantum have the same exclusion in section B. Their texts have no page markers, so no page is given. Top Quantum also has an additional cover, "Healthcare in the event of an Accident". It covers "Work, Occupational, Sports" accidents "within the limits of the guarantee taken out". Its Clause III still excludes high-risk sports practised as an amateur, so confirm with Sanitas how the two rules apply in each case. Its emergency cover abroad also has its own exclusions. These include winter sports, competitions, and activities such as boxing, air sports or adventure sports (rafting, canyoning). In those cases, the insurer only pays expenses from the moment the insured person is receiving treatment in a medical centre.

What percentage does Sanitas Más 90.000 reimburse if I see a doctor outside the network?

With Sanitas Más 90.000, with or without co-payments, you can use a doctor or centre outside the network. Sanitas then reimburses 70% of covered expenses, up to €90,000 a year. The sub-limits in your Condiciones Particulares (the specific terms of your policy) also apply, and you pay the rest. The General Conditions leave the percentage to the Condiciones Particulares, and the product sheet gives 70%. Only reasonable and customary expenses are reimbursed. The coverage and exclusions are the same as in the medical network. You must report the care within 7 days and claim within 90. The waiting periods also apply.

«Con carácter general, SANITAS reembolsará únicamente el porcentaje indicado en las Condiciones Particulares de la Póliza, del importe de los gastos médicos y/u hospitalarios»

Translation of the quote: As a general rule, SANITAS will reimburse only the percentage indicated in the Condiciones Particulares of the Policy, of the amount of medical and/or hospital expenses

Document: Condicionado general · Sanitas Más 90.000 sin copagosClause: Clause V. How services are provided, section 2 "Through the expense reimbursement option", letter B) Reimbursement percentagePage: 51

Waiting periods, limits and exceptions

Waiting period:: Waiting periods also apply under reimbursement (Clause IV, p. 47 without co-payments and p. 52 with co-payments): - psychology: 6 months; - complex diagnostic tests: 6 months; - vasectomy and tubal ligation: 10 months; - complex therapeutic procedures: 10 months; - surgery in groups 0 to II of the Organización Médica Colegial: 3 months; - vaginal birth or caesarean section: 8 months (except a premature birth under 37 weeks); - hospitalisation and surgery in groups III to VIII: 10 months; - bariatric surgery for morbid obesity: 60 months. They do not apply to accidents or illnesses constituting a life-threatening emergency that occur and are diagnosed after the policy starts or after the insured person joins, as long as the care is covered. Nor do they apply to premature births.
Limits:: According to the product sheets, reimbursement is 70%, with a limit of €90,000 a year. The General Conditions (GC) leave the percentages to the Condiciones Particulares. The same applies to the limits and sub-limits for each type of cover (Cl. V, 2 and 2.A, pp. 50-51 without co-payments). Only reasonable and customary expenses are covered. These are expenses no higher than normal local prices for an equivalent treatment (Cl. V, 2.D, p. 52 without co-payments and p. 57 with co-payments). The scope, limits and exclusions are the same as in the medical network. Services that the Condiciones Particulares reserve for the medical network cannot be reimbursed. You cannot use both options for the same service (Cl. I, p. 13). You can use both during the same hospital stay, with prior authorisation from Sanitas (p. 51). Deadlines: report the care within 7 days of knowing about it. For planned surgery or a planned hospital stay, the 7 days run from when you know the date. Claim the reimbursement within 90 days of the care. Documents: you must submit the claim form, itemised invoices, proof of payment and the medical report. You also need the prescription, except for consultations and podiatry. Keep the originals for 5 years from payment. The professional or centre must meet the legal requirements of the country where they practise. Abroad, the amount is converted to euros at the official exchange rate on the date you paid the invoice. The insured person pays for translating the documents (p. 53 without co-payments, p. 58 with co-payments).
Keep in mind:: 1) The General Conditions leave the figure to the Condiciones Particulares. The 70% and the €90,000 annual limit come from the product sheets (FP_Sanitas_Mas_90, FP_Sanitas_Mas_90_Copagos and Sanitas_Mas_90000__ficha). They also appear in the April 2021 Más 90.000 sales guide. They do not contradict the GC. Even so, confirm them in each client's Condiciones Particulares, together with the sub-limits for each type of cover. 2) Waiting periods under reimbursement: see Clause IV (p. 47 without co-payments and p. 52 with co-payments). The "Reimbursement option" heading covers the left-hand column, which ends with 4 periods. The right-hand column continues without a heading of its own. It lists surgery 0-II, childbirth, hospitalisation and surgery III-VIII, and bariatric surgery. The consistent reading is that these periods continue the reimbursement list. The internal note carencias-por-producto.md says reimbursement has no waiting period for childbirth, hospitalisation or surgery. Do not use that note in sales without checking the PDF. 3) The product sheets add "Dental reimbursement: 8 months", which is not in Clause IV of the GC. 4) Do not confuse this with two other types of cover. One is dental reimbursement (60%, up to €200 a year, only in the contracted network). The other is the €69/day allowance for hospital stays outside the network (up to 90 days a year). 5) The internal comparison comparativa-productos.md presents Más 90.000 as "without co-payments". There is also a version with co-payments, which has the same reimbursement wording.
In other products:: Sanitas Premium 500.000 reimburses 90%, with a limit of €500,000 a year, according to its product sheets (FP_Sanitas_Premium_500 and Sanitas_Premium_500000__ficha). FP_Sanitas_Premium_500 also adds 50% reimbursement for medicines, with a limit of €300. Its GC (Sanitas_Premium_500000__CG, Cl. V, B) Reimbursement percentage, p. 55) uses the same wording. It also leaves the percentage to the Condiciones Particulares. Sanitas Top Quantum includes family reimbursement up to €10,000 (FP_Sanitas_Top_Quantum). It covers only general medicine, paediatrics, and gynaecology and obstetrics. Its GC includes the same letter B) on p. 68. The two versions of Más 90.000 have identical wording: p. 51 without co-payments and p. 56 with co-payments.

How does reimbursement work with Sanitas Premium 500.000?

You can use the medical network, or any doctor or centre you choose, even one outside Sanitas's network. If you go outside the network, you pay the invoice and Sanitas refunds a percentage. That percentage and the limits are set in your Condiciones Particulares (the specific terms of your policy). You pay the difference. The same coverage, exclusions and waiting periods apply. Tell Sanitas about the treatment or hospital admission within 7 days of knowing about it. Then claim the reimbursement within 90 days of the care. You will need the claim form, itemised paid invoices, the prescription and the medical report. The product sheet gives 90%, up to €500,000 a year; we'll confirm this in your Condiciones Particulares.

«SANITAS reembolsará únicamente el porcentaje indicado en las Condiciones Particulares de la Póliza, del importe de los gastos médicos y/u hospitalarios en los que incurra realmente el Asegurado»

Translation of the quote: SANITAS will reimburse only the percentage indicated in the Condiciones Particulares of the Policy, of the amount of medical and/or hospital expenses actually incurred by the Insured Person

Document: Condicionado general · Sanitas Premium 500.000Clause: Clause V. How services are provided, section 2 "Through the expense reimbursement option", letter B) Reimbursement percentage (the section spans pp. 54-57)Page: 55

Waiting periods, limits and exceptions

Waiting period:: Clause IV, p. 51, reimbursement option: - psychology and complex diagnostic tests: 6 months; - vasectomy and tubal ligation, and complex therapeutic procedures: 10 months. The list continues in the second column of the page: - surgery in OMC groups 0 to II: 3 months; - vaginal birth or caesarean section: 8 months (except a premature birth under 37 weeks); - hospitalisation and surgery in groups III to VIII: 10 months; - bariatric surgery for morbid obesity: 60 months. These waiting periods do not apply to a life-threatening emergency from an accident or illness that starts and is diagnosed after you join, if the policy covers it. They also do not apply to premature births. The product sheet (FP_Sanitas_Premium_500) adds "Dental reimbursement: 8 months".
Limits:: The reimbursement percentage, the overall limits and the sub-limits for each type of cover are in the Condiciones Particulares (Clause V.2 A and B, pp. 54-55). According to the product sheet, reimbursement is 90%, up to €500,000 a year. The insured person pays the rest (p. 55). Only "reasonable and customary" expenses are reimbursed (p. 56). Several procedures on the same insured person, on the same day, by the same professional, count as one for the limit. If they fall in different OMC groups, the higher group applies (p. 54). For care abroad, the expense is converted to euros at the exchange rate on the day you paid. The insured person pays to translate invoices and reports (p. 57). You must be under 64 to take out the policy (Clause VI.2, p. 60).
Keep in mind:: 1) Services that the Condiciones Particulares reserve for the medical network are not reimbursed. Professionals and centres must meet the legal requirements of the country where they practise (p. 54). 2) You cannot use both options for the same service (Clause I, p. 13). The exception is a single hospital stay, if Sanitas authorises it in advance (p. 55). 3) For planned surgery or a planned admission, notify Sanitas as soon as you know the date, and always within 7 days (p. 55). 4) You need all the documents to be paid. A medical prescription is required, except for consultations and podiatry. Keep the originals for 5 years (p. 56). 5) When choosing a doctor, note these exclusions: - care in Social Security or National Health System centres, and cross-border healthcare (III.C, p. 46); - integrative medicine centres, or centres that offer more than conventional medicine (III.C, pp. 46-47); - care from a doctor who is the spouse of the policyholder or insured person, or a relative up to the 4th degree (III.E, p. 47); - care from a doctor who has a professional, employment or business relationship with them (III.E, p. 47). 6) Illnesses and injuries that existed before the date you joined are excluded. If you do not declare them in the health questionnaire, any related cover is excluded (III.A, p. 46). 7) Travel and transport costs are excluded, except ambulances (III.J, p. 49). 8) Our internal note carencias-por-producto.md says reimbursement has only 4 waiting periods, with none for childbirth, hospitalisation or surgery. However, on p. 51 the "Reimbursement option" list continues in the second column. It includes surgery in groups 0 to II, childbirth, hospitalisation and bariatric surgery. The product sheet does not separate the two options either. Until Sanitas confirms otherwise, do not promise reimbursement without waiting periods. 9) In the General Conditions, €500,000 appears only as the total limit of the United States Cover (p. 37). That cover is provided only in contracted centres and with prior authorisation. The figure of 90% up to €500,000 for reimbursement comes from the product sheet. It is confirmed in the Condiciones Particulares.
In other products:: Sanitas Más 90.000 uses the same reimbursement system. The version with co-payments sets it out in Sanitas_Mas_90000_ConCopagos__CG, Clause V.2 (from p. 55, with the percentage on p. 56). The version without co-payments sets it out in Sanitas_Mas_90000_SinCopagos__CG (from p. 50, with the percentage on p. 51). Its product sheet (FP_Sanitas_Mas_90) gives 70% reimbursement, up to €90,000 a year. Residents Platinum includes the reimbursement option (Sanitas_Residents_Platinum__CG, Clause V.2, p. 51). Its product sheet (FP_Sanitas_Residents_Platinum) gives 90%, up to €500,000. For Residents, the product sheet (FP_Sanitas_Residents) offers reimbursement as an optional add-on of up to €300,000.

What does Sanitas Avanza cover, and what doesn't it?

Sanitas Avanza covers: - primary care and specialists; - emergencies; - simple and complex diagnostic tests; - simple therapeutic procedures; - surgery in OMC groups 0, 1 and 2; - basic dental care, psychology (15 sessions a year) and podiatry (12 sessions a year). It does not cover hospitalisation, day hospital or surgery from group 3 upwards. It also excludes complex therapeutic procedures such as chemotherapy or radiotherapy, as well as prostheses and transplants. Pre-existing conditions are excluded unless you declared them and Sanitas accepted them. Complex tests have a 6-month waiting period and surgery a 3-month one, except in a life-threatening emergency. Each service carries the co-payment set in your Condiciones Particulares (the specific terms of your policy). You can take out the policy up to age 59.

«consultas médicas, pruebas diagnósticas simples, pruebas diagnósticas complejas, métodos terapéuticos simples y las cirugías de grupo 0,1 y 2 de la Organización Médica Colegial de España»

Translation of the quote: medical consultations, simple diagnostic tests, complex diagnostic tests, simple therapeutic procedures and surgery in groups 0, 1 and 2 of the Organización Médica Colegial de España

Document: Condicionado general · Sanitas AvanzaClause: Clause I. Purpose of the insurance (supplemented by Clause II, section 5 Surgery, p. 21, and Clause III. Excluded coverage, pp. 30-32)Page: 13

Waiting periods, limits and exceptions

Waiting period:: Clause IV, p. 33, medical network option: complex diagnostic tests, 6 months; surgery in OMC groups 0 to II, 3 months. These waiting periods do not apply to a life-threatening emergency from an accident or illness that starts and is diagnosed after you join, if the policy covers the care. They also do not apply to premature births (under 37 weeks).
Limits:: Psychology: up to 15 sessions per insured person per policy year. A psychiatrist, family doctor, paediatrician or oncologist must prescribe it. The insured person pays for psychometric tests (Clause II, 4.6, p. 20). Podiatry: chiropody only, up to 12 sessions per insured person per policy year (4.4, p. 20). Physiotherapy: outpatient only, for the musculoskeletal system, and not for chronic or degenerative conditions (4.2, pp. 19-20). Paediatrics: up to age 15 (1.2, p. 13). Basic dental: only consultations, extractions and cleanings in the dentist's surgery (p. 23). Complex tests: not covered if the prescription comes from cardiac electrophysiology, haemodynamics, a pain unit, radiotherapy or interventional radiology (p. 13). Clause III-C (p. 30) also excludes any service, test or treatment prescribed or performed by nuclear medicine, radiotherapy, interventional radiology or haemodynamics. PET scans (nuclear medicine): covered only in the specific cases listed in section 3.19, with prior authorisation (p. 16). Check before booking one. Radiotherapy: consultation only (3.29, p. 19). Authorisation: surgery and consultant doctors need prior authorisation from Sanitas after the prescription (Clause V, 1.3, p. 34). Co-payments: each service carries the co-payment set in the Condiciones Particulares (p. 34). Network: care is provided through the contracted medical network. Sanitas does not pay for care outside it. The only exception is a life-threatening emergency. If it means admission to a hospital outside the network, tell Sanitas as soon as possible so you can be moved to a network hospital (pp. 35-36). Age: the maximum age to take out the policy is 59. Children under 14 can join only if the person with parental authority or guardianship is also insured, unless otherwise agreed (Clause VI, p. 39).
Keep in mind:: 1) Exclusion B of Clause III (p. 30) excludes hospitalisation and day hospital, "as well as any surgery performed in any type of care setting". Accede uses the same wording. However, Avanza also covers surgery in groups 0 to 2 (Clause II, section 5, p. 21), with its own waiting period (p. 33). Read together, these rules mean that such surgery is covered without admission or day hospital. The product sheet says the same: "More than 400 surgical procedures without hospital admission". Before each procedure, you must request prior authorisation, which is mandatory (p. 34), and confirm the cover. 2) The Avanza 2023 sales guide says ultrasounds have no waiting period. However, the General Conditions list ultrasound as a complex test (glossary, p. 11). Clause IV sets 6 months for complex tests, with no exception for ultrasound. The General Conditions prevail, so we don't promise ultrasound without a waiting period until Sanitas confirms it. 3) Dental: the product sheet says "consultations, cleanings, curas (minor treatments) and extractions". The General Conditions cover "exclusively consultations, extractions and dental cleaning" (p. 23). The General Conditions prevail, so check curas with Sanitas before having them done. 4) Age: p. 39 says "The maximum age for taking out the policy is 59". It also says insured persons must be "below the age of 59". The product sheet says "From 0 to 59 years (inclusive)". If you have already turned 59, check with Sanitas. 5) Also excluded (pp. 30-32): - road traffic accidents, except emergency care or if you have taken out the add-on; - accidents at work; - high-risk sports practised as an amateur, and sports competitions; - speech therapy; - laser treatment, except percutaneous laser for kidney stones over 2 cm, listed under Urology with prior authorisation (p. 19); - robotic surgery; - infertility treatment; - orthoses, glasses, contact lenses and hearing aids; - medicines outside hospital. 6) The insurance ends if you move your residence abroad or live in Spain for less than six months a year (p. 39).
In other products:: Sanitas Accede (Sanitas_Accede__CG, Clause III-B, p. 22) excludes hospitalisation and any surgery. It has no waiting periods clause: its index goes straight from Clause III to Clause V. Sanitas Único (Sanitas_Unico__CG, Clause III-A, p. 31) also excludes hospitalisation and surgery. You must be at least 60 to take it out (p. 41). Its only waiting period is 6 months for complex diagnostic tests (Clause IV, p. 35). If you need hospital cover, Sanitas Más Salud includes it (Sanitas_Mas_Salud__CG, Clause II, section 5 Hospital care, p. 25). It also covers surgery during the stay, with its own waiting periods and conditions.

What does Sanitas Accede cover, and what doesn't it?

Accede covers care given in the consulting room, with no hospital stays or surgery. It includes: - family medicine, nursing and paediatrics until age 15; - emergencies at network centres; - consultations and video consultations with the network's specialists; - simple tests and simple therapeutic procedures; - basic radiology, and ultrasound and echocardiograms done in the consulting room; - basic dental care and the Blua programmes. It does not cover hospitalisation or day hospital, or any surgery, even outpatient surgery. It also excludes complex tests such as CT or MRI scans and complex treatments such as chemotherapy. Conditions you had before joining are excluded, unless you declared them in the questionnaire and Sanitas did not exclude them. Accede has no waiting periods. You can take it out up to age 59. Services carry a co-payment set in your Condiciones Particulares (the specific terms of your policy).

«Cualquier tipo de asistencia sanitaria prestada en régimen asistencial de hospitalización u hospitalización de día según se definen éstas en el glosario, así como cualquier intervención quirúrgica»

Translation of the quote: Any type of healthcare provided as an inpatient or in day hospital, as defined in the glossary, as well as any surgery

Document: Condicionado general · Sanitas AccedeClause: Clause III. Excluded coverage, section B (included coverage is in Clause II, pp. 13-18)Page: 22

Waiting periods, limits and exceptions

Waiting period:: None. The Accede General Conditions have no waiting periods clause: the index (p. 4) goes straight from Clause III (p. 22) to Clause V (p. 24). Clause II (p. 13) still mentions "waiting periods indicated below" in general terms, but no section sets any period. The product sheet and the sales guide also present Accede as having no waiting periods.
Limits:: Complex diagnostic tests: only ultrasound and echocardiograms done in the consulting room. Diagnostic imaging: only basic radiology and ultrasound in the consulting room (Clause II, pp. 13-15). Paediatrics: until age 15 (p. 13). Physiotherapy: outpatient only, for the musculoskeletal system, with prior authorisation. Never for chronic or degenerative conditions, and never at home. Laser in musculoskeletal physiotherapy is covered as an exception to the exclusion of complex procedures (pp. 15-16). Psychology: individual sessions with a prescription, up to 15 per insured person per policy year. The insured person pays for psychometric tests (p. 16). Podiatry: chiropody only, up to 12 sessions per insured person per policy year (p. 16). Nutrition: only with a specialist's prescription and when there is a medical condition (p. 16). Infertility: only the listed diagnostic tests, and only up to diagnosis (pp. 14-15). Basic dental: consultations, extractions and cleanings done in the dentist's surgery (p. 18). Age: the maximum age to take out the policy is 59 (Clause VI, p. 29). Co-payments: each service carries a co-payment, with the amount set in the Condiciones Particulares (Clause V, p. 24).
Keep in mind:: Clause III excludes: (1) anything that existed before joining (III.A). Clause II (p. 13) accepts conditions declared in the health questionnaire that Sanitas did not exclude when the policy was taken out; (2) nuclear medicine, radiotherapy, interventional radiology and haemodynamics (III.C); (3) all complex therapeutic procedures (III.E); the glossary on p. 10 lists chemotherapy among them; (4) accidents at work, road traffic accidents (except emergency care) and high-risk sports (III.F); (5) care in Social Security centres (III.G); (6) fertility treatments, orthopaedics, glasses and hearing aids (III.I, p. 23). Other parts of the General Conditions also exclude speech therapy, and neurological, cardiac and respiratory rehabilitation (pp. 15-16). Outside the medical network, only life-threatening emergencies are covered (p. 25). Children under 14 can join only if the person with parental authority or guardianship is also insured, unless otherwise agreed (p. 29). The sales guide, however, lets children from age 3 have their own policy if the policyholder is an adult. We'll check your case with Sanitas. Childbirth is not covered, and exclusion B rules out all hospitalisation. The sales guide expressly excludes childbirth. According to the sales guide, Accede is only for new clients. If you have been with Sanitas before, you must have left at least 6 months ago. The product sheet and sales guide differ from the General Conditions on some points, and the General Conditions prevail: - The product sheet says "Ultrasounds" in general, but only ultrasounds done in the consulting room are covered. The sales guide also excludes the 20-week scan. - The product sheet and sales guide include "curas" (minor treatments) in dental cover, which the General Conditions do not mention. - The sales guide mentions preventive medicine. The General Conditions do not include it, and the IPID excludes it as check-ups. - The product sheet says "up to 60 years", but the General Conditions set 59. - The product sheet says video consultations have no co-payment, but the General Conditions leave co-payments to the Condiciones Particulares.
In other products:: Sanitas Avanza (Sanitas_Avanza__CG) covers only surgery in OMC groups 0, 1 and 2 (Clause II, section 5, p. 21). It has a 6-month waiting period for complex diagnostic tests and a 3-month one for that surgery. Neither applies in a life-threatening emergency (Clause IV, p. 33). Like Accede, it excludes hospitalisation and day hospital (Clause III, section B, p. 30). That section B also mentions surgery, so we will confirm with Sanitas in each case how far surgery is covered in Avanza.

What does Sanitas Único offer from age 60?

You can take out Sanitas Único from age 60, which is its minimum age (Clause VI, p. 41). It covers the following care in Spain: - consultations in family medicine, nursing, emergencies and the specialties in the policy; - all simple diagnostic tests; - three complex tests only: ultrasound, CT and MRI, after a 6-month waiting period; - simple therapeutic procedures; - psychology (15 sessions a year) and chiropody (12 a year); - basic dental, video consultation and health programmes; - senior home services after more than 48 hours in hospital or more than 5 days housebound. Hospital stays, surgery and ambulance transport are not covered (Clause III, p. 31; p. 15).

«todas las pruebas diagnósticas simples y métodos terapéuticos simples y de las pruebas diagnósticas complejas se cubren exclusivamente la ecografía, el TC y la resonancia»

Translation of the quote: all simple diagnostic tests and simple therapeutic procedures are covered, and of the complex diagnostic tests, only ultrasound, CT and MRI

Document: Condicionado general · Sanitas ÚnicoClause: Clause I. Purpose of the insurancePage: 13

Waiting periods, limits and exceptions

Waiting period:: Complex diagnostic tests: 6 months (Clause IV, p. 35). In Único, the only complex tests covered are ultrasound, CT and MRI (Clause I, p. 13). This waiting period does not apply to a life-threatening emergency from an accident or illness that arises and is diagnosed after the policy starts or after you join, as long as the care is covered. You can use all other benefits from the day the contract starts.
Limits:: Psychology: up to 15 sessions per insured person per year. A psychiatrist, family doctor, paediatrician or oncologist must prescribe it, and the insured person pays for psychometric tests (p. 16; Clause V, p. 36). Podiatry: chiropody only, up to 12 sessions a year (p. 16). Physiotherapy: outpatient and musculoskeletal only, with prior authorisation. It does not cover chronic or degenerative conditions or maintenance therapy (p. 15). Speech therapy and pain treatment: consultation only (pp. 15-16). Dental Básico: only consultations, extractions and cleanings in the dentist's surgery (p. 18). Senior home services (pp. 18-21): - a home carer for up to 30 hours a year, with at least 2 consecutive hours per day; - a companion overnight during hospital stays of more than 48 hours: up to 5 nights a year, of up to 8 hours each; - a companion for medical appointments within a 20 km radius; - medicine delivery 3 times a year (the insured person pays for the medicine); - a hairdresser 3 times a year; - home physiotherapy: 5 sessions a year; - home podiatry: 3 sessions a year; - boarding for dogs and cats: up to 30 days and €2,000 a year, plus up to €300 for emergency vet care. Home blood tests: 2 a year, always with a medical prescription (p. 26). Scope: Spain only (p. 13).
Keep in mind:: The General Conditions prevail. The product sheets say "sin preexistencias" (no pre-existing condition exclusion) and "no health questionnaire". However, Clause II (p. 13) limits cover to two kinds of condition. The first is a condition that started after you took out the policy and that you did not know about. The second is an earlier condition you declared that Sanitas did not exclude. Clause VI (p. 40) also refers to the health questionnaire, so we'll check your case with Sanitas. Senior home services do not cover claims caused by an illness you had before taking out the policy (p. 21). The product sheets apply the 6-month waiting period to MRI and CT only. The General Conditions apply it to all complex tests, and their glossary (p. 11) counts ultrasound as one. Clause III (pp. 31-34) excludes: - hospitalisation and any surgery; - chemotherapy, radiotherapy and nuclear medicine; - prostheses, glasses and hearing aids; - genetic tests, laser treatment and medicines; - accidents at work; - road traffic accidents, except emergency care or if you have the road traffic add-on. Ambulance transport is never covered (p. 15). Each service carries a co-payment, set in the Condiciones Particulares (Clause V, p. 36). The General Conditions do not say how many appointment companion services you get each year (p. 20). The insurance ends if the insured person lives in Spain for less than 6 months a year (p. 41).
In other products:: In the same range, you can take out Sanitas Accede and Sanitas Avanza up to age 59 (Sanitas Accede GC, Clause VI, p. 29; Sanitas Avanza GC, Clause VI, p. 39). So in that range, Único is the option from age 60. Other products also accept new members over 60, up to an age limit: - Sanitas Premium 500.000: under 64 (GC, Clause VI, p. 60). - Sanitas Más 90.000 with co-payments: under 64 (GC, Clause VI, p. 61). - Sanitas Más 90.000 without co-payments: under 64 (GC, Clause VI, p. 56). - Sanitas Top Quantum: under 75 (GC, Clause VI, document without page markers).

What does Sanitas Profesionales for the self-employed (autónomos) include besides healthcare?

Besides healthcare, the Sanitas Profesionales General Conditions include these additional covers: - care after a road traffic accident, an accident at work or an occupational illness; - emergencies abroad in the first 90 days of a trip; - a second medical opinion; - Sanitas Dental 21; - accidental death cover (decesos por accidente); - emergency video consultations and remote health programmes. The cover most linked to sick leave is Protección total. It applies if you spend more than 72 hours in hospital, or more than 72 hours housebound on medical sick leave. It then covers a home carer, medicine delivery and taxis for errands and post. It also covers a home physiotherapist and pays the equivalent of your monthly premiums. Each benefit has limits on hours and amounts.

«garantías se encontrarán cubiertas cuando el Asegurado requiera de una hospitalización de más de 72 horas, o se encuentre inmovilizado en su domicilio por convalecencia habiéndose expedido baja médica»

Translation of the quote: guarantees will be covered when the Insured Person requires hospitalisation of more than 72 hours, or is confined at home convalescing, a medical sick leave certificate having been issued

Document: Condicionado general · Sanitas ProfesionalesClause: Clause II. Coverage, section "Additional policy coverage": Protección total cover

Waiting periods, limits and exceptions

Waiting period:: Protección total has no initial waiting period. Its guarantees apply from the date this complementary cover takes effect. For payment protection, the General Conditions set a waiting period between claims: none after an accident, 6 months for the same illness and 1 month for a different illness. Healthcare does have waiting periods in the medical network (Clause IV): - surgery in OMC groups 0 to II: 3 months; - psychology and complex diagnostic tests: 6 months; - vaginal birth or caesarean section: 8 months (except a premature birth under 37 weeks); - hospitalisation and surgery in groups III to VIII, complex therapeutic procedures, vasectomy and tubal ligation: 10 months. These waiting periods do not apply to a life-threatening emergency from an accident or illness that occurs and is diagnosed after you join, as long as the care is covered.
Limits:: Protección total, for those over 16: - a home carer for up to 30 hours within a maximum of one month, with at least 2 consecutive hours per day; - medicine delivery up to twice a week during the first two weeks (the insured person pays for the medicine); - taxis to the office and to collect post: 2 a week each, within a 30 km radius, during the first two weeks; - a home physiotherapist for up to 20 hours per policy year and insured person. Payment protection pays one monthly premium from the third day of temporary incapacity or hospitalisation. If this lasts more than 2 consecutive months, it pays another premium for each full month. The maximum per policy and policy year is "€200 or 3 monthly premium payments". This cover ends on the last day of the month in which the policyholder turns 75. Protección total is provided only in Spain, to insured persons who live in Spain. Emergencies abroad: €12,000 per person per year, within 90 consecutive days from the start of the trip; dental emergencies up to €300 per insured person. Accidental death: €5,250. New insured persons must be under 75 on the date they are added, unless otherwise agreed.
Keep in mind:: Protección total provides services. Its only cash benefit is payment protection, the equivalent of your monthly premium up to the cap above. The product sheet calls it "reimbursement of the insurance premium", but the exact scope is set by the General Conditions. To use it, your premium payments must be up to date and you must tell Sanitas as soon as possible. A Social Security doctor, or equivalent, must diagnose the temporary incapacity. The following, among others, do not count as covered sick leave: - maternity leave; - back pain not confirmed by medical tests; - headaches, and mental or nervous illnesses, including depression and stress, even with medical evidence; - anything caused by an illness you had before taking out the policy; - anything caused by alcohol or drugs that were not prescribed; - playing sport professionally; - attempted suicide in the first year. For emergencies abroad, ask Sanitas for authorisation before receiving care. In a life-threatening emergency, you can instead notify Sanitas within 7 days. Illnesses already known before the trip are not covered, unless there is a clear or unforeseeable complication. Mental illnesses, and chronic illnesses that have affected the insured person's health, are not covered either. The cover for accidents at work and road traffic accidents excludes anything arising from professional sport. The sales guide says Protección Total comes with the Sin Copago and Óptima versions. However, the Profesionales Plus General Conditions include it too.
In other products:: Sanitas_Profesionales_Colectivos__CG is not a separate product. It is the same PDF (CG_Sanitas_Profesionales.pdf), extracted with page markers. In it, Protección total covers pp. 30-35, with the quote on p. 31. Sanitas Dental 21 is on p. 35 and accidental death cover on pp. 36-37. Profesionales Óptima (Sanitas_Profesionales_Optima__CG) has the same block: Protección total on pp. 30-35, Dental 21 on p. 35 and accidental death on pp. 36-37. It also adds Blua (p. 41). Profesionales Plus (Sanitas_Profesionales_Plus__CG) includes Protección total (pp. 30-35) and Blua (p. 39). It has Dental Básico (p. 36) instead of Sanitas Dental 21, and its General Conditions do not include accidental death cover. All three sets of General Conditions include €12,000 for emergencies abroad. They also share the same payment protection cap ("€200 or 3 monthly premium payments").

Does Sanitas Residents Visado meet the requirements for a Spanish visa?

Yes, with conditions. According to its General Conditions, Sanitas Residents Visado is designed to meet the rules for Spanish visas and residence permits. It gives you full, unlimited cover throughout Spain. It uses a medical network for medical, surgical and hospital care. There are no waiting periods, and the minimum term is one year, renewable. If the insured person dies in Spain, it also covers repatriation to their home country. Two conditions are worth knowing. First, you must show Sanitas that you have obtained the visa within two months of taking out the policy. Second, you must live in Spain for at least six months a year.

«ha sido diseñado para cumplir con las condiciones exigidas por la normativa vigente»

Translation of the quote: has been designed to meet the conditions required by current regulations

Document: Condicionado general · Sanitas Residents VisadoClause: Clause II. CoveragePage: 13

Waiting periods, limits and exceptions

Waiting period:: There are no waiting periods. All the cover in the policy is available from the date the contract takes effect (Clause IV. Waiting periods, p. 42; Clause II, p. 13, says the same). Cover starts only once the contract is signed and the first premium is paid (Clause VI, section 4.1, p. 48).
Limits:: Maximum age: you must be under 75 on the date you join, unless otherwise agreed (Clause VI, section 2, p. 48). The full, unlimited cover applies within Spain. Emergencies abroad are an additional cover. They cover care within 90 consecutive days from the start of the trip, up to €12,000 per person per year. Except in a life-threatening emergency, you need prior authorisation from Sanitas (p. 28). Repatriation covers the transfer when death occurs in Spain. The stretch from the airport to the place of burial has a limit of US$1,000. Burial and ceremony costs are excluded. You must notify the transfer in advance to get authorisation (pp. 30-31). A child under 14 can only join if the person with parental authority or guardianship is also insured, unless otherwise agreed (section 3.4, p. 48). You can split the annual premium into two half-yearly payments (section 4.3, p. 49).
Keep in mind:: Pre-existing conditions: Clause III (letter A, p. 37) excludes illnesses, injuries and medical conditions you had before joining. Clause II (p. 13) adds that it covers conditions that start after the policy is taken out, if you did not know about them. It also covers earlier conditions you knew about, if you declared them and Sanitas did not exclude them. So declare everything in the health questionnaire. If you leave anything out, anything related to it is excluded. Sanitas may accept the application, decline it, or accept it with some cover excluded. The sales guide says Residents "has no pre-existing condition exclusions". The General Conditions prevail, so we go through the questionnaire with you in each case. Other exclusions: Clause III also excludes accidents at work, among other things (p. 37). It excludes road traffic accidents too, except emergency care or if you take out the road traffic add-on. When the contract ends: it ends automatically if you do not provide proof of your visa within two months of taking out the policy. For each insured person, it also ends if they move their residence abroad or live in Spain for less than six months a year (Clause VI, 3.3 b and d, p. 48). Co-payments: if co-payments are agreed, the amounts are in the Condiciones Particulares (the specific terms of your policy) (section 4.5, p. 49). The sales guide presents Residents without co-payments. What appears in each policy's Condiciones Particulares prevails. Sales guide requirements: the sales guide sets three requirements for the Visado version. You must pay half-yearly or annually, complete the full health questionnaire, and hold a nationality from outside the EU, the EEA or Switzerland. The General Conditions do not include the nationality requirement, so we'll check your case with Sanitas. Minors: the sales guide lets a minor aged 3 to 18 have their own policy if the policyholder is an adult. The General Conditions require a child under 14 to join with the person who has parental authority or guardianship, unless otherwise agreed (3.4, p. 48). The General Conditions prevail. Visa requirements: the Spanish Ministry of Foreign Affairs sets the requirements for each type of visa on its website, as the sales guide notes.
In other products:: Sanitas Residents Platinum Visado (Sanitas_Residents_Platinum_Visado__CG) is also designed for visas, like Residents Visado (Clause II, p. 13). It has no waiting periods either (Clause IV, p. 48). It also ends if the visa is not proven within two months (Clause VI, p. 57). The difference is that you must be under 64 to take it out (p. 57). Sanitas Residents without the Visado version (Sanitas_Residents__CG) does have waiting periods under its General Conditions (Clause IV, p. 42). They include 6 months for psychology and complex diagnostic tests and 8 months for vaginal birth or caesarean section. Hospitalisation and surgery in groups III to VIII have 10 months. Even so, its product sheet (FP_Sanitas_Residents, without page markers) says it meets the requirements for a residence visa application. When the visa has special conditions, the sales guide recommends Residents for visas.

Does Sanitas Residents include repatriation?

Yes, with conditions. Sanitas Residents and Residents Visado include repatriation if the insured person dies in Spain. Sanitas organises and pays for taking the coffin or ashes to the international airport nearest the place of burial. The destination is the home country named in the Condiciones Particulares (the specific terms of your policy). If the place of burial is more than 30 km from that airport, Sanitas pays up to US$1,000 to get there. It also pays for one close relative who lives in Spain to travel with the deceased. Their return is covered if it is within fifteen days of the death. Burial and ceremony costs are not included. The transfer must be notified and authorised in advance.

«En caso de fallecimiento del Asegurado en España, SANITAS a través de la entidad prestadora que designe, organizará y tomará a su cargo el traslado del féretro»

Translation of the quote: In the event of the Insured Person's death in Spain, SANITAS, through the provider it designates, will organise and pay for the transfer of the coffin

Document: Condicionado general · Sanitas Residents (texto idéntico en Residents Visado)Clause: Clause II. Coverage — Additional policy coverage: Repatriation coverPage: 30

Waiting periods, limits and exceptions

Waiting period:: No waiting period. In Residents, Clause IV (p. 42) says benefits are available from the day the contract starts, except those on a list. Repatriation is not on that list. In Residents Visado, Clause IV (p. 42) says: "This insurance has no waiting periods".
Limits:: From the international airport to the place of burial: a limit of US$1,000. This applies only if the place of burial is more than 30 km from the airport. The same limit applies to the deceased and to the companion. Only one companion is covered: a close relative of the deceased who normally lives in Spain. Their return from the funeral is covered if it is within fifteen days of the death. They can travel by first-class train, economy scheduled flight or another suitable means. Territorial scope: Spain. All of this is on pp. 30-31.
Keep in mind:: This cover applies when the insured person dies in Spain. The destination country is the one shown in the Condiciones Particulares, so check it when you take out the policy. The beneficiaries must say in advance which funeral director will collect the remains at the destination airport. The transfer must also be notified to the provider and authorised in advance. Otherwise, the service is not provided. The following are not covered: - burial and ceremony costs; - transport of organs, tissues, cells and their derivatives, embryos and foetuses; - deaths in war or conflict, and transfers to a country in that situation. You must be up to date with your obligations, especially premium payments. The General Conditions cover repatriation only after death. They do not cover taking a sick or injured insured person back to their country. We'll check your case with Sanitas. Outside Spain, emergency cover abroad applies instead (pp. 28-29). It covers care within 90 consecutive days from the start of the trip. It includes taking a sick or injured person to a centre where they can be treated. If the person dies, it covers the transfer to the country where they normally live, but not funeral and burial costs. The product sheet mentions "full cover". The General Conditions prevail, with the US$1,000 limit and these exclusions.
In other products:: Residents Platinum and Residents Platinum Visado have the same repatriation cover after death in Spain. It includes a companion and the same US$1,000 limit (Sanitas_Residents_Platinum__CG and Sanitas_Residents_Platinum_Visado__CG, additional coverage, p. 37). International Students covers taking the deceased to their home country, with the same US$1,000 limit. However, there is no companion, and the scope is "any country" (Sanitas_International_Students__CG, Repatriation cover). No page number is given for this document because the page marker in the text does not match the printed footer. According to the sales guide, other Sanitas products offer repatriation only as a separate add-on.

What is the difference between Sanitas Residents and Residents Visado regarding waiting periods?

Sanitas Residents has waiting periods and Residents Visado does not. In Residents, the waiting periods are: - 3 months for surgery in groups 0 to II of the Organización Médica Colegial (the Spanish Medical Association); - 6 months for psychology and complex diagnostic tests; - 8 months for vaginal birth or caesarean section; - 10 months for hospitalisation, surgery in groups III to VIII, vasectomy, tubal ligation and complex therapeutic procedures. They do not apply to life-threatening emergencies that arise and are diagnosed after you join, or to premature births. In Residents Visado, all cover is available from the date the policy takes effect. In both products, anything you had before joining is covered only if you declared it and Sanitas did not exclude it.

«Este seguro no tiene periodos de carencia.»

Translation of the quote: This insurance has no waiting periods.

Document: Condicionado general · Sanitas Residents VisadoClause: Clause IV. Waiting periodsPage: 42

Waiting periods, limits and exceptions

Waiting period:: Residents Visado: none. Clause IV, p. 42 of Sanitas_Residents_Visado__CG says so. Clause II, p. 13 says the same: "full and unlimited cover throughout Spain, with no waiting periods". Residents (Sanitas_Residents__CG, Clause IV, p. 42, medical network option): - vasectomy and tubal ligation: 10 months; - psychology: 6 months; - complex diagnostic tests: 6 months; - complex therapeutic procedures (as defined in the glossary): 10 months; - surgery in OMC groups 0 to II: 3 months; - vaginal birth or caesarean section: 8 months, except a premature birth (under 37 weeks); - hospitalisation and surgery in OMC groups III to VIII: 10 months. These waiting periods do not apply to a life-threatening emergency from an accident or illness that occurs and is diagnosed after the policy starts or after the insured person joins, as long as the care is covered. They also do not apply to premature births.
Limits:: The periods are counted in months from the date each insured person's cover takes effect (definition of "Waiting periods", p. 7 of both sets of General Conditions). In both products, you must be under 75 on the date you are added to take out the policy, unless otherwise agreed (Clause VI, section 2, p. 48 of both).
Keep in mind:: No waiting periods does not mean that conditions you had before joining are covered. In both products, Clause III, letter A (p. 37), excludes illnesses, injuries or medical conditions you already had on the date you joined. If you leave them out of the health questionnaire, any related cover is excluded. Under Clause II (p. 13), they are covered only if you declared them and Sanitas did not exclude them when you took out the policy. The sales guide (table "Product codes and information") differs from the General Conditions on one point. It gives Residents a 60-month waiting period for bariatric surgery for morbid obesity. The Residents General Conditions do not include that waiting period, because bariatric surgery for obesity is excluded (Clause III, letter N, p. 41). Residents Visado excludes it too (Clause III, letter N, p. 41). The General Conditions prevail. The sales guide also says only nationals from outside the EU, the EEA and Switzerland can take out Residents Visado. Payment must be half-yearly or annual. These are sales conditions and do not appear in the waiting periods clause.
In other products:: The Platinum range has the same difference. Sanitas Residents Platinum has waiting periods of 3, 6, 8 and 10 months. It also has 60 months for bariatric surgery for morbid obesity, in both the medical network and reimbursement options (Sanitas_Residents_Platinum__CG, Clause IV, p. 48). Residents Platinum Visado has no waiting periods (Sanitas_Residents_Platinum_Visado__CG, Clause IV, p. 48). For both Platinum products, you must be under 64 on the date you are added to take out the policy (Clause VI, section 2, p. 57 of both).

Does Sanitas Residents cover pregnancy and childbirth?

Yes, from the date the policy takes effect, because Residents Visado has no waiting periods. It covers Obstetrics and Gynaecology, antenatal classes and giving birth as a hospital inpatient. It does not cover water births, home births or births by alternative methods. Surrogacy and voluntary termination of pregnancy are not covered either. If you are already pregnant when you take out the policy, declare it in the health questionnaire. The General Conditions exclude medical conditions you had before joining. Sanitas may accept you, decline you or exclude some cover. Your baby can join the policy from birth if Sanitas covered the delivery. You must request this within 30 days of the birth.

«Este seguro no tiene periodos de carencia. Todas las coberturas incluidas en la póliza estarán disponibles desde la fecha de efecto del contrato, conforme a las condiciones estipuladas.»

Translation of the quote: This insurance has no waiting periods. All coverage included in the policy will be available from the contract's effective date, in accordance with the stipulated conditions.

Document: Condicionado general · Sanitas Residents VisadoClause: Clause IV. Waiting periodsPage: 42

Waiting periods, limits and exceptions

Waiting period:: None. Clause IV (p. 42) says this insurance has no waiting periods, and Clause II (p. 13) repeats "with no waiting periods". Childbirth is covered from the date the policy takes effect.
Limits:: All of this is in the Residents Visado General Conditions (GC). - Birth: the midwife attends the birth "in all cases as an inpatient" (Cl. II, 4.3, p. 22). - Antenatal classes: part of the Maternal and Child Programme (4.9, p. 25). - Non-invasive prenatal screening (fetal DNA in the mother's plasma): covered only if the combined first-trimester screening gives a risk between 1/50 and 1/250. It must be done between weeks 10 and 18, with prior authorisation (3.26, p. 19). - Pre-eclampsia screening: first trimester only (3.26, p. 19). - Genetic tests in Obstetrics: the karyotype is covered. Factor V Leiden and prothrombin 20210 are covered with prior authorisation, if you have had repeated miscarriages or thrombosis. Any other genetic test is excluded (pp. 18-19). - Pelvic floor rehabilitation: only for moderate-to-severe urinary incontinence caused by childbirth. Up to 10 sessions per birth, within the following year and with prior authorisation (p. 19). - Neonatology: the baby's check-up, vaccines and routine tests in the first 48 hours. It does not include anything caused by a condition or complication at birth (3.26.2, pp. 19-20). - Newborn care: covered only if the baby is enrolled as an insured person (3.26.3, p. 20). - Hospital stays: need prior authorisation from Sanitas (Cl. V, 1.3, p. 43). - Co-payments: any amount is set in the Condiciones Particulares (the specific terms of your policy), not in the GC (Cl. V, p. 43).
Keep in mind:: 1) Pregnancy that already exists when you take out the policy: the GC does not mention pregnancy directly. However, exclusion A excludes any "medical condition or situation pre-existing at the joining date" (Cl. III, A, p. 37). The GC defines a pre-existing condition as a state of health "not necessarily pathological" that existed before you signed the questionnaire (p. 8). You must declare injuries, illnesses, diagnostic tests, treatments and symptoms in the questionnaire. If you leave anything out, anything related to it is excluded. Sanitas may accept you, decline you or accept you with some cover excluded (p. 37). This is our reading of the text, not an express statement, so we confirm it with Sanitas in each case. 2) Exclusions: - water births, home births and births by alternative methods (Cl. III, M, p. 41); - voluntary termination of pregnancy and surgery on the unborn baby; - infertility treatments such as IVF or insemination; only the diagnostic tests for infertility are covered (p. 39 and 3.26, p. 18); - any surrogacy costs, for the mother or the baby (3.26.3, p. 20). 3) Adding your newborn: the baby joins with full rights from birth in either of two cases. The first is if Sanitas covered the mother's delivery. The second is if the father's cover started at least 240 days before the birth. Apply with an insurance application form (Solicitud de Seguro) within 30 calendar days of the birth. If you apply late, Sanitas may refuse (Cl. VI, 5, p. 50). 4) Documents: the Residents Visado product sheet ("No waiting periods option") matches the GC on waiting periods. So does the sales guide ("No waiting periods", plan 3726). The training sales guide presents Sanitas Residents as having no co-payments. The GC leaves any co-payment to the Condiciones Particulares (p. 43), so we check this in your policy.
In other products:: Sanitas Residents (without the Visado version): 8 months for vaginal birth or caesarean section, except a premature birth under 37 weeks (Sanitas_Residents__CG, Clause IV, p. 42). Sanitas Residents Platinum: 8 months for vaginal birth or caesarean section in the medical network option, except a premature birth under 37 weeks. In the reimbursement option, Clause IV sets no waiting period for childbirth (Sanitas_Residents_Platinum__CG, Clause IV, p. 48). Sanitas Residents Platinum Visado has no waiting periods either (Sanitas_Residents_Platinum_Visado__CG, Clause IV, p. 48).

What does Sanitas International Students cover, and up to what age?

You can take out this policy if you are under 35 on the date you are added. It covers medical, surgical and hospital care in the Sanitas medical network, including: - family medicine and nursing; - emergencies; - specialists and their tests; - hospital stays; - preventive medicine. It also includes: - emergencies abroad in the first 90 days of each trip, up to €12,000 per person per year; - repatriation if you die; - a second medical opinion; - Sanitas Dental 21 and the Blua programmes. The General Conditions set no waiting periods. Exclusions include illnesses you had before joining, unless you declared them and Sanitas did not exclude them. Accidents at work and high-risk sports are also excluded.

«Tan solo podrán incluirse en concepto de Asegurados en la póliza quienes a la fecha de inclusión tengan una edad por debajo de los 35 años»

Translation of the quote: Only those who, on the date of inclusion, are below the age of 35 may be included as Insured Persons in the policy

Document: Condicionado general · Sanitas International StudentsClause: Clause V. Other aspects of the insurance, section 2. Maximum age for taking out the policyPage: 45

Waiting periods, limits and exceptions

Waiting period:: No waiting periods: the General Conditions set none (Clause IV is "How services are provided", p. 40). Clause II (p. 13) mentions "waiting periods indicated below" in general terms. The glossary (p. 7) defines the term. But the document does not set any actual waiting period. The product sheet and the sales guide also say "No waiting periods".
Limits:: Age: under 35 on the date you are added, unless otherwise agreed (Clause V.2, p. 45). Psychology: up to 15 sessions per insured person per policy year. A psychiatrist, family doctor or oncologist must prescribe them. The insured person pays for psychometric tests (Clause II 4.8, p. 24; Clause IV 1.2, p. 40). Psychiatric hospital stays: acute episodes only, up to 50 days per insured person per year (3.28, p. 20). Speech therapy: needs prior authorisation. Up to 80 sessions a year per insured person. For children under 14 who need help with language development, up to 20 sessions per policy year (4.4, pp. 22-23). Podiatry: chiropody only, up to 12 sessions per policy year (4.6, p. 23). Shock wave therapy: 5 sessions per joint per year (4.3, p. 22). Emergencies abroad (p. 27): - care within 90 consecutive days from the start of the trip; - €12,000 per person per year; - emergency dental care up to €300; - prior authorisation needed, except in a life-threatening emergency, which you report within 7 days. It does not cover illnesses you knew about before the trip, unless there is a clear or unforeseeable complication. It also excludes treatments prescribed in Spain, and mental or chronic illnesses that have affected your health. Repatriation (p. 29): Sanitas takes the coffin or ashes to the international airport nearest the place of burial in the home country. If the place of burial is more than 30 km from that airport, it pays up to US$1,000 to get there. Burial and ceremony costs are excluded. Authorisation: surgery and hospital stays need prior authorisation from Sanitas (Clause IV 1.3, p. 40).
Keep in mind:: Exclusions (Clause III, pp. 35-39): - Illnesses, injuries and defects you had before joining. Declare them in the health questionnaire. If you leave anything out, anything related to it is excluded, and Sanitas may accept you with some cover excluded. Under Clause II (p. 13), earlier conditions are covered only if you declared them and Sanitas did not exclude them. - Accidents at work and occupational accidents. - Road traffic accidents, except emergency care or if you have the road traffic add-on. - High-risk sports practised as an amateur, and competitions, including training. - Care in Social Security centres. According to the sales guide, the only add-on available is Road Traffic and Work Accidents. Clause V (p. 45): the insurance ends if you move your residence abroad or live in Spain for less than six months a year (3.3.b). Children under 14 can only join if their parents or guardians are also insured (3.4). The end date is set in the Condiciones Particulares (the specific terms of your policy). When the insurance expires, it ends unless it is expressly renewed (3.1). Primary care covers family medicine and nursing. Paediatrics is not on the list, and the sales guide says "We exclude paediatrics". The product sheet differs from the General Conditions on some points, and the General Conditions prevail: - The product sheet says "Age to take out the policy: 14 - 35 years. Maximum age to remain insured: 35 years". The sales guide also gives 35 as the maximum age to remain insured. The General Conditions only set the age for taking out the policy, not an age limit for staying insured. - The product sheet says "No co-payments". Clause IV (p. 40) leaves the co-payment for each service to the Condiciones Particulares. - The minimum stay of 3 months, the maximum of 1 year and the individual-only policies come from the sales guide, not the General Conditions.
In other products:: Sanitas International Students Colectivos has General Conditions in English (Sanitas_International_Students_Colectivos_EN__CG). It has the same limit of under 35, unless otherwise agreed, in "Clause V, 2. Maximum age for taking out the policy", p. 36. According to the sales guide, closed groups may accept members outside the 14-35 age range (sales guide without page numbers). Sanitas Estudiantes (Sanitas_Estudiantes_Europa__CG) is a different product. According to its product sheet, it is for young people aged 10 to 35 who are going to study outside Spain. Its General Conditions set the maximum age for taking out the policy at 35 (Clause V.2). Its accident guarantee for death or total permanent disability excludes people over 35 (Clause III, 2.2). This exclusion applies only to that guarantee, not to the whole policy. That document has no page markers, so no page number is given (lines 38203 and 38055 of the same .txt).

Do I have 24-hour emergency care with Sanitas, and where?

Yes. With Sanitas Más Salud, emergencies are treated at the 24-hour emergency centres in the Sanitas network. They are listed in the Guía Orientadora de Médicos y Servicios (the directory of doctors and services). When it is justified, the on-call service will come to you wherever you are, in the towns where Sanitas offers it. You also have 24-hour emergency video consultations without an appointment, once you register in Mi Sanitas. The Sanitas 24 horas phone line connects you with a medical team, 365 days a year. If a life-threatening emergency means you are admitted to a centre outside the network, tell Sanitas as soon as possible. Abroad, emergencies are covered within 90 consecutive days from the start of the trip.

«Comprende la asistencia sanitaria en casos de urgencia que se prestará en los centros de urgencia permanente que estén concertados con SANITAS»

Translation of the quote: It comprises healthcare in emergencies, which will be provided at the permanent emergency centres contracted by SANITAS

Document: Condicionado general · Sanitas Más SaludClause: Clause II. Coverage, section 2. Emergencies, and Sanitas 24 horas (p. 14); supplemented by Emergencies by video consultation (p. 34), Emergency assistance cover abroad (p. 28), Clause III, Excluded coverage (p. 36), Clause IV, Waiting periods (p. 41), and Clause V, 1.8 Emergencies, 1.9 and 2. Remote medical consultations (pp. 43-45)Page: 14

Waiting periods, limits and exceptions

Waiting period:: Emergencies are not on the list of benefits with a waiting period in Clause IV (p. 41). You can use them from the day the policy starts. If the emergency leads to other treatment, the waiting periods for that treatment apply: - 3 months for surgery in groups 0 to II; - 6 months for complex diagnostic tests; - 10 months for complex therapeutic procedures, hospital stays and surgery in groups III to VIII. These waiting periods do not apply to a life-threatening emergency from an accident or illness that occurs and is diagnosed after the policy starts or after you join, as long as the care is covered (p. 41).
Limits:: In Spain: only the 24-hour emergency centres in the network listed in this product's Guía Orientadora. The on-call service comes to you only when justified, and only in towns where Sanitas offers it (p. 14). Abroad (p. 28): - care within 90 consecutive days from the start of the trip; - a limit of €12,000 per person per year; - services through centres chosen by Sanitas; - emergency dental care up to €300 per insured person, excluding root canals, cosmetic reconstructions, dental cleaning, prostheses, crowns and implants; - expenses under €3 are not covered.
Keep in mind:: Care in Social Security or National Health System centres is excluded. So are accidents at work and occupational accidents. Road traffic accidents are excluded, except necessary emergency care or if you have the road traffic accident add-on (Clause III, p. 36). Outside the network, Sanitas does not pay any fees or expenses. If a life-threatening emergency means you are admitted to a centre outside the network, tell Sanitas as quickly as possible, in a way you can prove. Sanitas will then move you to a network centre if your condition allows (Clause V, 1.8 and 1.9, pp. 43-44). Abroad, your payments must be up to date. Ask for authorisation first by calling the number on the back of your card. In a life-threatening emergency, go to the nearest centre. Notify Sanitas within 7 days and send a copy of the emergency report. You must also send your travel documents, the medical report and the invoices. Abroad, these are not covered (p. 28): - illnesses you knew about before the trip, unless there is a clear or unforeseeable complication; - treatments prescribed in Spain; - mental illnesses, or chronic illnesses that have affected your health. To use emergency video consultations, register in Mi Sanitas. You cannot choose the doctor, and it does not replace an in-person visit (pp. 34 and 45). For under-18s, their legal representative must give authorisation (p. 44). The product sheet says "for stays of up to 90 days". The General Conditions prevail: 90 consecutive days from the start of the trip, and €12,000. The product sheet says "No co-payments". The General Conditions leave co-payments to the Condiciones Particulares (the specific terms of your policy) (p. 42), so check yours.
In other products:: Más Salud Plus, Óptima, Familias and Familias Plus have the same emergency wording, on p. 14 of their General Conditions (GC). In Sanitas Accede (GC, p. 14), emergency care covers consultations, diagnostic tests and basic therapeutic procedures. In Sanitas Único (GC, p. 14), it covers consultations, simple diagnostic tests and simple therapeutic procedures. In both, care is given at 24-hour emergency centres in the network. The General Conditions of Accede, Avanza and Único do not include emergency cover abroad. Premium 500.000 and Más 90.000, with and without co-payments, do include it (p. 28 of their GC). They cover 90 consecutive days and €12,000 per person per year. Top Quantum also includes it, on different terms: up to €15,000 per insured person per year, for trips of up to 90 days (its GC has no page markers).

Answers prepared by the Oficina Sanitas Majadahonda, exclusive agent of Sanitas (ANYO HEALTH SL, DGSFP registration code C0320B67816207), based on the General Conditions currently in force. Co-payment amounts and the terms of your specific policy are set out in your Condiciones Particulares (the specific terms of your contract).