Health Insurance detail

Health insurance –  your protection from unforeseen expenses related to unexpected illness.

Expert Agents Company, as representative of Generali Seguros, offers a series of insurance plans for family or individual insurance.

Individual (for 1 person) health insurance plan SALUD OPCION SINGLE offers complete medical service with guarantee of reasonable value for money service.

The most popular insurance plans SALUD TOTAL and SALUD OPCION FAMILIAR are thought for family insurance. The two plans have significant differences: 

SALUD TOTAL insurance plan enables the client to choose the medical institution and the specialist throughout the territory of Spain from the list of Recommended Medical Centres - PREMIUM, extended.

In these centres, our clients will be attended without any extra charges.

SALUD OPCION FAMILIAR insurance contract also enables our clients to choose the medical centre and doctor in the territory of Spain, but from the OPTIMO category list i.e. it is limited; moreover, the client will have to make an extra payment for every visit or procedure – the payment may vary from 2€ to 25€ depending on the terms of contract and type of service. At the end of the trimester the client’s account will be debited with all the extra charges.

This insurance plan is more economical and suitable for those who do not plan to visit doctors often.

SALUD TOTAL insurance policy also gives a possibility to choose a doctor freely around the world using the reembolso (refund) option. In this case the insurance company will refund up to 80% of the total value of service (taking into account certain restrictions).

This option is not available under SALUD OPCION FAMILIAR insurance option.

  

GUARANTEES COMPARISON CHART (1)

Cover	SALUD OPCION	SALUD ELECCION	SALUD TOTAL	SALUD SELECCION
1. Doctors –specialists	General	General	General	Serious disease
2. Out-patient treatments	General	General	General	Non
3. Assistance abroad	General	General	General	General
4. Emergency aid	Additional	General	General	Non
5. Reimbursement of expenses for emergency aid and obstetrics and gynaecology services in Spain	Additional	General	General	Non
6. Reimbursement of GP’s services expenses	Non	General	General	Serious disease
7. Additional services	Additional	General	Non	Non
8. Compensation due to hospitalisation	Additional	Additional	Without policy expenses	Non
9. Dental care	Additional	Additional	Additional	Additional
10. Freezing and cryopreservation of maternal cells from the umbilical cord	Additional (7)	General	Non	Non
11. Infertility treatment	General	General	Non	Non
12. Psychologist consultations	General	General	General	Non
13. Hospitalisation in psychiatric centre	Non	Non	General	Non
14. Pregnancy and childbirth	Only affiliated centres and specialists from the company’s list	Affiliated centres and specialists from the company’s list and free choice of specialist	Affiliated centres and specialists from the company’s list and free choice of specialist	Non
15. New-born care	Non	Non	General	Non
16. Reimbursement of expenses for diagnostics of serious diseases	No	No	No	Yes (18.031€)
17. Second opinion	No	No	General	General
18. Co-payments	Yes	No	No	No

Legend: General – guarantees provided under basic policy. Additional – additional guarantees apart from the basic policy

  

RATES AND CHARGES COMPARISON CHART (2)

	Age	SALUD OPCION+Additional	SALUD ELECCION (150.000)	SALUD TOTAL (250.000)	SALUD SELECCION
Men	25	665,80 €	792,75 €	720,07 €	120 €
	35	803,45 €	957,88 €	869,60 €	161,29 €
	50	883,5 €	1.089,18 €	967,49 €	433,36 €
Women	25	716,97 €	862,76 €	765,17 €	127,28 €
	35	1.013,81 €	1.244,19 €	1.086,77 €	156.71 €
	50	1.013,81 €	1.388,83 €	1.190,12 €	423,81 €
Maximum age to contract a policy	64	64	64 to 74	60 to 70

Time limits for health insurance services:

Insurant may be hospitalized only after a certain period after the policy was contracted. These periods depend on types of medical services and go as follows: 

-12 months for preventive medicine;

-8 months for all treatments related to pregnancy, childbirth and possible complications, as well as right to “new-born care” guarantees; 

-3 months for cases requiring surgery and hospitalisation, excluding those resulting from accidents, provided for in the insurance policy, or urgent medical treatment for new diseases, diagnosed after the policy was contracted; 

 - 3 months after celebration of insurance contract for the following treatments: 

High-tech diagnostic medical tests, such as catheterisation and other internals tests, including arthroscopy, laparoscopy and amniocenthesis and the following procedures: lithotripsy, radiotherapy, telecobalt therapy or deep fry and chemotherapy, some same-day procedures.

However these time restrictions do not apply in emergency cases or if there is risk to life.

Temporary restrictions to get medical treatments	SALUD OPCION	SALUD ELECCION	SALUD TOTAL	SALUD SELECCION
Surgery and hospitalisation	3 months	3 months	3 months	3 months
Diagnostics	3 months	3 months	3 months	3 months
First aid	3 months	3 months	3 months	3 months
Pregnancy and new-born care	8 months	8 months	8 months	8 months
Infertility treatment	24 months	24 months	No	No

For those who transfer their policy from another insurance company the following limits apply:

• If you transfer from another insurance company with the policy “Asistencia Sanitaria o Cuadro Médico” and use services of the specialists and centres from the insurer´s list, no time restrictions will be applied; 
• If you transfer from another insurance company with policy “Reembolso de gastos” no time restrictions will apply. 
• Time restrictions will apply for all procedures related to pregnancy, childbirth and possible complications, as well as new-born care. 

No insurance is meant to cover expected and planned medical expenses. 

Insurance company excludes previously existing diseases and pathologies; concealment of information about existing diseases and pathologies may be viewed as fraud and grounds for early termination of contract.