How to compare health insurance quotes in Spain

Terms used

• Cuadro médico — The cuadro médico is the insurer's list of doctors, clinics and hospitals you can use under your plan.
• Copago — The copago is a fixed fee you pay each time you use certain services, in exchange for a lower premium.
• Reembolso — A reembolso plan lets you see any doctor and refunds a percentage of the cost, up to a cap.
• Carencia — A carencia is the waiting period before you can use a given service under a new policy.

Key rules

• Like for like: Ask every insurer to quote the same people, plan type and extras before you compare prices.
• Network: Check each doctor is listed under the exact plan you are quoting, not just the same insurer.
• Health questionnaire: Answer it truthfully, because omissions can lead to cancellation or refused claims.
• Waiting periods: Hospital stays, maternity and similar cover come after a wait, so ask for the waits in writing.

The cheapest quote is rarely the cheapest plan

Compare quotes on network, plan tier, optional extras, copago, waiting periods, exclusions and limits. Only then look at price. Two quotes with the same monthly figure can cover very different things.

The checklist below gives the questions to ask each insurer. This page explains what each item means and what to watch for.

Start with the plan type

Spanish plans usually come in three tiers. Ask every insurer for the same one.

• Basic or copago plan. Lower premium, but you pay a fee each time you use certain services.
• Full plan with no copago. Uses the insurer's network of doctors and clinics, called the cuadro médico.
• Premium reembolso plan. You can see any doctor and get a percentage of the cost refunded, up to a cap.

Hospital-only plans also exist. They are cheap, but they will not cover everyday visits.

Check the extras

Quotes show a base monthly premium that depends on age. Each optional extra (a rider) is a separate line price. Common ones are dental, reimbursement of out-of-network costs, a better hospital room, fertility, international cover, and a capital sum for death or disability.

Dental is often run through a dental clinic chain with set fees. Make sure each quote includes the same extras, or you are not comparing like with like.

Understand copago

Copago is a fixed fee you pay each time you use certain services, such as a consultation, tests or an emergency visit. In return, the premium is lower. The quote shows the monthly premium plus a table of per-service charges.

Typical amounts are a few euros for a consultation and more for specialist tests. Some plans cap total copagos per year. Hospital stays are often free. If you expect to use the doctor often, a copago plan can end up costing more than a full plan. Amounts vary, so read the plan's copago table.

Test the network

A doctor listed under one plan may not be in another plan from the same insurer. Do this for each quote:

1. Open the insurer's online directory or app.
2. Filter by province, town, specialty and hospital.
3. Check that the doctor or centre is listed under the exact product you are quoting.
4. Phone the provider to confirm it accepts that insurer and plan.
5. Ask the insurer to send the cuadro médico for your province in writing or by email.

Directories change often, so keep a dated copy.

Compare waiting periods

A waiting period (carencia) is the time before you can use a service. Typical patterns:

• Emergencies and basic consultations: none.
• Advanced diagnostic tests and some specialist treatments: 3 to 6 months.
• Hospital stays and surgery: around 6 months.
• Childbirth and maternity: 8 to 10 months.
• Fertility, transplants and prostheses: longer.

Accident cover usually has no wait. If you are moving from another insurer and can prove your earlier cover, waits are often waived. Ask for this in writing. Group and promotional policies may also waive them.

Read limits and exclusions

Network plans usually have no euro limit on covered medical care. They do set sub-limits for things like dental, prosthetics, psychology sessions per year, physiotherapy sessions and fertility. Reimbursement plans state an annual cap and the percentage refunded, with scales per service.

Common exclusions include:

• Pre-existing conditions you knew about
• Cosmetic surgery
• Infertility treatment, unless you contract it
• Dental beyond the basics
• Experimental treatment
• Injuries from extreme sports
• Addictions
• In some cases, epidemics declared by the authorities

Exclusions must be clearly highlighted and accepted by you in writing. Look for that before you sign.

Make sure the price is final

Many insurers ask you to fill in a health questionnaire. Answer it truthfully and completely. Leaving things out can lead to the insurer cancelling the policy or refusing claims if it was deliberate or seriously careless. Ask whether each quote is a final price or an estimate that can change after the questionnaire.

Get the paperwork before you decide

Before you sign, the insurer or broker must give you in writing the main terms, coverage, exclusions, premium, payment terms, your right to withdraw and how to complain. They must also give you a short standard summary of what is and is not insured. Read the full policy conditions, because the exclusions and limits are set out there. The documents list below shows what to collect.

The timeline below shows when each type of cover becomes usable. The FAQ covers copago versus reembolso plans, switching insurers and the questionnaire.

Timeline and deadlines

• Emergencies, basic consultations and accident cover can be used straight away: from the start of the policy, no waiting period

• Advanced diagnostic tests and some specialist treatments become available: after 3 to 6 months

• Hospital stays and surgery become available: after around 6 months

• Childbirth and maternity cover begins: after 8 to 10 months

• Fertility, transplants and prostheses become available: after longer waits than the other services, so ask the insurer for the exact time

Documents you need

• Insurance Product Information Document (IPID): a short standard summary of what is and is not insured, limits, where cover applies, your obligations, payment, duration and cancellation. The insurer or broker must give it to you in writing before you sign.

• Written pre-contract information: who the insurer is, the main terms, coverage, exclusions, premium and payment terms, your right to withdraw and how to complain. The insurer or broker must give it to you before the policy starts.

• Policy conditions (condiciones generales and particulares): they set out the exclusions and limits. Exclusions must be clearly highlighted and accepted by you in writing.

• Health questionnaire: the insurer's form about your health, which you complete truthfully when you apply.

Checklist to compare quotes like for like

• Ask every insurer to quote the same people, with the same ages and the same home address.

• Ask for the same type of plan from each insurer, for example full cover with hospital stays or a lighter plan without them.

• Write down the monthly price and the yearly price for each quote, and check whether the price changes as you get older.

• Check whether each quote has a co-payment, a fixed fee you pay each time you use a service, and note the amount.

• Look up the doctors, clinics and hospitals near you in each insurer's network and note how many you would actually use.

• Ask each insurer for the waiting periods, the time before you can use each service, for the treatments you care about.

• Compare the limits and exclusions in each quote, such as caps per treatment, dental or maternity cover, and any conditions you already have.

• Put all the quotes side by side in one table and rule out any that do not match the others on these points.

Frequently asked questions

What is the difference between a copago plan and a reembolso plan?

A copago plan uses the insurer's network and charges a small fixed fee each time you use certain services, while a reembolso plan lets you see any doctor and refunds a percentage up to a yearly cap. Copago plans cost less than full no-copago plans. Reembolso is the premium option.

Can I skip a waiting period when I switch from another insurer?

Yes, waiting periods are often waived if you move from another insurer and can prove your earlier coverage, but ask the new insurer to confirm this in writing.

What happens if I leave something out of the health questionnaire?

If you leave out a condition on purpose or through serious fault, the insurer can cancel the policy or refuse claims. Answer every question truthfully. Conditions you already knew about are commonly excluded anyway.

Do limits apply to network plans that have no euro cap?

Yes, network plans usually have no euro cap on medical care, but they set sub-limits for items such as dental, psychology sessions, physiotherapy sessions and fertility. Check these in the coverage tables of the policy conditions.