since 2/2000
Al terrorismo - "NO" / Terrorism "NO"
Company Platinum - health plan for employees in Latin America and the Caribbean
Patrocinadores - América Latina y el Caribe
www.e-agentelocaldeseguros.com
Spain: Sanitas agent (BUPA Group)
Sanitas Multi - General Conditions (English)
WE ANSWER YOUR QUERIES
The general conditions set out here enable the Insured to familiarise themselves with the contractual framework that will govern their relations with Sanitas.
These general conditions clear up the doubts of special interest to the majority of Insured people.
We offer a short preview of those that we consider most enlightening and useful to understand the rights and mutual obligations.
What are the General Conditions?
This is the text that sets forth all the obligations and rights of the Insured and of the Insurer.
When may I request a home service?
There are three cases:
1. Emergencies ( see: "Emergency Home Services ").
2. Patients who are unable to travel ( see "Home Services ").
3. Patients requiring special care but not hospitalisation ( see "Special Home Care ").
What happens if there is no-one in my province who can perform a magnetic resonance on me?
Sanitas will provide you with this service in province of your choice where it is available.
What do I do if I go to a province where there is no Sanitas office?
Request the services at the offices of the Entity with which Sanitas has an agreement and which are listed in your Guidebook to Doctors and Services.
What have I got to do for the paediatrician to make a home visit?
To send for the doctor, you have to telephone him between 9 am and 4pm, in cases when it is not possible - due to disease - to attend his surgery.
Where do I go to request a referral to a specialist?
In general, there is open access to specialists. It is not necessary for you to go first to your family doctor or to our offices (except for consultants).
Does the policy cover family planning?
Yes, you may choose from:
* Oral contraceptives
* IUD placement
* Tubal ligature (or vasectomy)
* Infertility and sterility study and diagnosis
What is being referred to when "outpatient" services are mentioned?
These are services when the patient does not need to be hospitalised, and are undertaken at centres arranged by the Insurer, which the Insured attends by his/her own means.
How are diagnostic tests authorised?
Most are authorised over the 'phone (902 102 400). Some are direct access and in exceptional cases, you may have to go to the Sanitas offices.
What cancer treatments does the policy include?
Linear particle accelerator. Chemotherapy. Radiotherapy. Autoogous bone marrow or peripheral blood parent cell transplant (for haematological tumours only).
What difference is there between medical and paediatric hospitalisation?
Age. The former is for persons over 14 years old and the latter for those under this age. A bed for the accompanying person is not included in the case of newborns and infants.
If I am hospitalised, do I have to pay a supplement to have a bed for an accompanying person?
No. An individual room with an accompanying person's bed is included in the policy cover (except in cases of ICU, incubator and psychiatric hospitalisation)
If I go skiing and break my leg - does Sanitas cover me?
It does, provided that it is not a competitive event. In addition, if it is abroad, it is also covered under the terms of the complementary foreign assistance guarantee.
Is hospitalisation for infectious diseases covered?
Yes, except those illnesses caused by the Human Immunodeficiency Virus. You are entitled to hospitalisation for any other infectious or contagious disease (eg tropical diseases, meningitis etc provided that they are not related to AIDS)
Does Sanitas offer Psychiatry services?
Yes. In the form of consultations and hospitalisation, providing that it is a case of acute attacks not corresponding to chronic conditions. However Psychology is not covered (psychoanalysis, testing, hypnosis, narcolepsy etc) ( see update regarding - Psychology)
What happens if I omit a disease in my health declaration that I had and knew of before I took out the policy?
If the omission was intentional, the Insurer may cancel the policy.
How long do I have to wait to make use of its services?
At Sanitas you may use the services from the first day, except for childbirth (300 day waiting period) and tubal ligature and vasectomy (6 months).
If the policy is for one year and I want to extend it - how do I notify this?
It is not necessary to give any notification. Policies are extended automatically every year, unless terminated by either of the parties within the specified notification period.
How do I pay the premium?
By direct debit, unless some other arrangement is agreed in the particular conditions.
What do I have to do if I lose my Sanitas card?
You should notify us within 48 hours. We will send you a new one.
What documentation am I given when I take out the policy?
The policy document (General and Particular Conditions). Your Sanitas card(s). The Guidebook to Doctors and Services.
What do I do with this set of conditions?
Sign both copies of the particular and general conditions, keep one and send us a signed copy. If you have any query, give us a call, we will be glad to be of service.
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...))