Sanitas Multi - Excluded risks ( health insurance )

a) All types of pre-existing and/or congenital diseases, defects or deformations, as a result of accidents or diseases that occurred prior to the date of each Insured's inclusion in the policy; as well as those that may stem from the former, providing that they were known by the Policyholder or Insured and not declared.

At the time of subscribing the insurance proposal / application the Policyholder is obliged to declare, on his own behalf and that of the beneficiaries and / or each of these, if they suffer or have suffered from any type of lesion or disease, especially those of a recurrent or congenital nature, or which require or have required studies, diagnostic tests or treatments of any kind; or at the time of subscription they suffered symptoms or signs that might be considered to be the onset of some pathology. When manifested in this way, the condition will be considered pre-existent and / or congenital and, therefore, excluded from the cover accorded in the insurance contract. If there are pre-existent and / or congenital diseases, the Insurer reserves the right to accept or reject the inclusion of the applicant or applicants, and in the event of acceptance, the corresponding exclusion clause will be added to the particular conditions of the policy regarding the provision of services for pre-existing and / or congenital diseases, defects or deformations, present prior to the date of each Insured's inclusion in the policy; as well as those that may stem from them.

b) Healthcare for diseases or lesions occurring as a result of civil, international or colonial wars, invasions, insurrections, rebellions, acts of a terrorist nature in any of its forms (chemical, biological, neclear, etc), revolutions, mutinies, uprisings, repressions and military manoeuvres, even in peacetime, and officially declared epidemics.

c) Diseases or accidents that may be directly or indirectly connected with nuclear radiation or radioactive contamination, as well as those stemming from such natural disasters as earthquakes, floods, volcanic eruptions and other seismic or meteorological phenomena, barring lightning.

d) Healthcare required for the treatment of industrial and occupational diseases or accidents or ones occurring in sports events, that stemming from the use of motor vehicles covered by Compulsory Motor Insurance, as well as the expenses arising from the healthcare provided at Social Security clinics or centres integrated in the National Health System - including the Autonomous Communities - which are not arranged with the Insurer.

e) Healthcare stemming from chronic alcoholism, drug addiction, intoxications due to abuse of alcohol, psychopharmaceuticals, narcotics or hallucinogens, attempted suicide and self-inflicted injuries, as well as healthcare for diseases or accidents suffered by the Insured with fraudulent intent.

f) Pharmaceutical products outside the hospitalisation regime - barring chemotherapy administered at approved centres - as well as vaccines of all types.

g) All those diagnostic and therapeutic procedures whose safety and efficacy are not duly verified scientifically or have been overtly surpassed by others available and expressly excluded. Likewise, those procedures are excluded that have not sufficiently proven their effective contribution to the prevention, treatment or cure of diseases (alternative medicines, naturopathy, homeopathy, acupuncture, mesotherapy, hydrotherapy, magnet therapy, pressure therapy, etc), maintenance or enhancement of life expectancy, self-sufficiency and eradication or reduction of pain and suffering, and those consisting of mere leisure, rest, comfort or sporting activities (including swimming). Spa therapies and rest cures.

h) Treatments, including surgery, aimed at remedying sterility or infertility in both sexes ("in vitro" fertilisation, artificial insemination, etc) and abortion, as well as diagnostic tests connected with such interruption. Study, diagnosis and treatment (including surgery) of impotence.

i) Transplants of organs, tissues, cells or cell components, except autologous transplant of bone marrow peripheral blood parent cells due to tumours of a haematological strain, and cornea transplant. In the last case, the Insurer is not liable for the cornea to be transplanted.

j) Healthcare stemming from infection by Human Immunodeficiency Virus (H.I.V.), AIDS and the diseases relating to these.

k) Operations, infiltrations and treatments, as well as any other action that is purely for questions of appearance or of a cosmetic nature. Hair treatments for cosmetic purposes are also excluded.

l) Hospitalisation for problems of a social type.

m) General medical check-ups of a preventative nature, except those specified in the description of the services (Clause One C)

n) Everything relating to psychology, psychoanalysis, hypnosis, individual or group psychotherapy, psychological tests, narcolepsy, etc as well as educative therapy, such as language education in congenital processes or special education in patients with mental disease.

ñ) Endodontics, fillings, fitting of dental prostheses, orthodontics, periodontics and implants, as well as dental treatments other than those specified in the description of the services (Clause One C)

o) Prostheses of any kind or nature, except those prostheses listed in the description of the services (Clause One C) point 6.4) Any type of orthopaedic material, biological or synthetic materials, grafts (except bone grafts of biological materials) and artificial hearts are not included and shall be at the Insured's own expense.

p) Chronic dialysis and haemodialysis treatments.

q) Travelling expenses except for ambulances, on the terms specified in the description of the services (Clause One C)

r) Surgical techniques or therapeutic laser therapies, saving photocoagulation techniques in Ophthalmology, surgical laser techniques in peripheral vascular surgery and devices used in musculoskeletal rehabilitation.

s) Genetic map determinations aimed at ascertaining the predisposition of the Insured or his present or future offspring to suffer from certain diseases related to genetic disorders.

Return to Index (English Conditions)

For more information your English Sanitas agent is: David Harris

Mobile / cell: (00 34) 609 522 300

email: saniprof@wanadoo.es or saniprof@mail.ddnet.es - thanks.

(Free messenger service - I cover the whole of Spain (click here...))

Answers to your queries Preliminary clause Definitions

I. Object of the insurance II. Excluded risks III. Bases, loss of rights, cancellation and incontestability of the policy

IV. Waiting periods (moratorium) V. Term of the insurance VI. Insurance premiums

VII. Policy-holder's and / or insured's obligations and duties VIII. Policy-holder's and / or insured's rights IX. Insurer's obligations

X. Duplicate policy XI. Complaints XII. Subrogation

XIII. Prescription XIV. Communications XV. Claim control and authorities

XVI. Other XVII. Jurisdiction

main index / índice principal

Disclaimer / Aviso

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