Sanitas Mundi - Refunds of expenses ( health insurance )

Where the Member suffers any of the consequences provided in the Policy Conditions, which are entitled to refund, the Insurer shall pay the Policyholder or Member, as appropriate, the amount due under the agreed payment terms.

Once all the documentation required has been received and any inquiries deemed appropriate have been made to establish the claim, the Insurer shall proceed to refund or transfer the amount due, depending on the circumstances revealed, within ten working days.

Where health care is required for periods of over three months, the Policyholder or, as appropriate, Member, shall have to forward the invoice(s) for the expenses incurred on a quarterly basis.

Should the Insurer fail to reimburse the amount due within three months as of when the claim was filed for no justifiable reason or for reasons attributable to the aforesaid Insurer, the amount owed shall be subject to the official interest rate applicable on the due date, plus 50 per cent. These interests shall be considered as accrued per day, and no demand for payment shall be called for. Nonetheless, as of 2 years after the claim, the annual interest may not be under 20 per cent (article 20 of the Insurance Policy Act).

Where medical and/or hospital care is administered abroad, the expenses incurred or the amount to be reimbursed shall be computed in euros at the official currency exchange buyer rate of the currency in which the Policyholder or Member paid for the care administered on the day on which the aforesaid Policyholder or Member settled the invoice of the medical and/or hospital expenses for refund. The Member shall be liable for the expenses deriving from translation into Spanish of documents (invoices, reports, etc) drafted in other languages.

Nonetheless, in the event that the Member uses the medical and/ or hospital services recommended by the Insurer the latter shall proceed to make direct payment to cover the fees and medical charges due to the physicians and/ or hospitals administering the care, for which it shall be liable in their entirety as per the provisions of paragraphs B and C of Clause Four.

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For more information your English Sanitas agent is: David Harris

Mobile / cell: (00 34) 609 522 300

email: saniprof@wanadoo.es

Any questions or comments to saniprof@mail.ddnet.es - thanks.

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

Preliminary clause Definitions I. Purpose of the insurance

II. Excluded risks III. Grounds for contract IV. Excess

V. Waiting periods VI. Claims procedure VII. Refunds of expenses

VIII. Term of insurance policy IX. Insurance premiums X. Other obligations and duties of policyholders and / or members

XI. Rights of policyholders and / or members XII. Other obligations of the insurer XIII. Disputes

XIV. Duplicate copies of policy XV. Subrogation XVI. Prescription

XVII. Notifications XVIII. Claims-control and procedure XIX. Others

Apartado (PO Box) 19

28760 Tres Cantos Madrid

Tlf: ( 00 34) 91 804 3802 Fax: (00 34) 91 803 2484

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