Claims for out-of-network or foreign treatment

Terms used

• Cuadro médico — The cuadro médico is the insurer's list of doctors, clinics and hospitals you can use under a network policy.
• Reembolso — Reembolso is a plan type that pays back part of what you paid for care outside the insurer's network.
• Traducción jurada — A traducción jurada is a translation certified by a sworn translator, which some insurers ask for on foreign documents.
• Apostille — An apostille is an official stamp that certifies a foreign document so it is accepted in another country.

Key rules

• Emergencies: Call the insurer's 24-hour line as soon as you can after an emergency at a non-network centre.
• Planned care: Outside the network, planned care is usually not paid unless your plan offers reembolso or you have written authorisation first.
• Abroad: Standard policies cover emergencies on temporary trips only, within the days and money limits of your plan.
• Currency: The policy's general conditions say which exchange-rate date and source apply to foreign invoices.

What you can claim back

Your policy type decides almost everything. Check which one you have before you pay for anything.

• Network policy (cuadro médico): genuine emergencies are usually covered at a non-network centre. Planned care outside the network is usually not.
• Reembolso or mixed plan: the insurer pays back part of the bill for care outside the network. This is where most claims succeed.
• Premium plans: some offer worldwide cover with higher limits.

The exact conditions are in your policy's general conditions.

Emergency at a non-network centre in Spain

A real emergency is generally covered when the situation is vital or urgent and you could not reasonably reach a network centre. Do this:

1. Call your insurer's 24-hour phone line as soon as you can. Many insurers expect this within 24 to 48 hours.
2. Once you are stable, expect to be asked to move to a network centre.
3. If you paid, send the invoice, the emergency report and proof of payment. The insurer then decides whether it counts as an emergency.

Some insurers pay the centre directly, so ask before you pay. The policy defines what counts as an emergency and sets the notice deadline, so read both.

Planned care outside the network

Under a network-only policy, non-emergency care outside the network is generally excluded and not reimbursed. Exceptions are usually limited to these cases:

• Your policy explicitly offers reimbursement, as reembolso and mixed plans do.
• The insurer authorises a referral to a non-network centre.
• A specialty you need is not available in the network.

Get written authorisation before the treatment. Without it, a claim is very likely to be refused.

Treatment abroad

A standard Spanish policy is built for treatment in Spain. Many include emergency cover abroad for temporary trips. Typical limits are up to 90 days, or sometimes 30 to 60 days per trip, with a money cap that varies by insurer. Check that your trip fits inside both.

• Planned or elective treatment abroad is normally excluded unless the insurer authorises it.
• Long stays or living abroad are also excluded.
• Some policies sell wider travel assistance as an add-on.
• Some insurers require you to contact their assistance line.

This cover is separate from travel insurance and from the EU health card.

Documents for a claim

Insurers usually ask for the itemised invoice, proof of payment, a medical report, the claim form, proof of your trip dates for care abroad, and your bank details. The documents block below has the full list.

Documents not in Spanish may need a translation. Some insurers ask for a sworn translation (traducción jurada) and others do not, so ask before you pay for one. An apostille is rarely demanded, mostly for large claims or non-EU documents.

Foreign currency bills

Insurers convert foreign invoices to euros. Most use the rate on the invoice or treatment date. Some use the payment date or the date they process the claim. The source is often the European Central Bank reference rate or the insurer's own bank rate. Your policy's general conditions set the date and source, so look there. Note the payment date and the amount in the foreign currency.

The timeline, checklist and questions below walk you through the steps.

Timeline and deadlines

• Call your insurer's 24-hour phone line about an emergency at a non-network centre: as soon as possible, often within 24 to 48 hours

• Move to a network centre if the insurer asks once you are stable: when you are stable

• Send the invoice, emergency report and proof of payment to claim back what you paid: after you pay

• Check that your emergency cover abroad fits the length of your trip: before you travel; many policies cover up to 90 days, or 30 to 60 days per trip

Documents you need

• Itemised invoice from the clinic or hospital, showing each service charged

• Proof of payment, such as a receipt or card statement

• Medical report from the treating doctor with the diagnosis and treatment (for an emergency in Spain, the emergency report)

• The insurer's claim form, filled in

• Proof of your trip dates for treatment abroad, such as tickets or passport stamps

• Your bank details so the insurer can pay you

• Translation of any document that is not in Spanish; some insurers ask for a sworn translation

• Apostille on foreign documents, only if the insurer asks, mostly for large claims or non-EU documents

Insurers differ on translations and extra paperwork, so confirm the exact list with your insurer before sending the claim.

Checklist

• Ask your insurer which documents it needs for a claim for treatment abroad

• Ask for an itemised invoice and a medical report with diagnosis and treatment

• Keep proof of payment and proof of your trip dates

• Ask the insurer whether it wants a sworn translation of documents not in Spanish

• Find the exchange-rate clause in your policy's general conditions to see which date and rate it uses

• Write down the date of payment and the amount in the foreign currency

Frequently asked questions

Can I be reimbursed for non-emergency care outside my network?

Usually no, because a standard network-only policy excludes non-emergency care outside the network. Exceptions are mixed or reembolso (reimbursement) plans, a referral to a non-network centre authorised by your insurer, or a specialty the network does not offer. Get written authorisation before you book the care.

Does my Spanish policy cover treatment I get abroad?

Often only emergency treatment on temporary trips, for example up to 90 days, or sometimes 30 to 60 days per trip, with a money limit that varies by insurer. Planned treatment abroad, long stays and living abroad are normally excluded unless the insurer authorises it. Reembolso and premium plans may offer worldwide cover with higher limits.

Which exchange rate will my insurer use for a foreign invoice?

Most insurers convert at the rate on the invoice date or the treatment date, though some use the payment date or the date the claim is processed. The source is usually the European Central Bank reference rate or the insurer's own bank rate. Your policy's general conditions state the exact date and source.

Will my insurer accept foreign documents without a sworn translation?

Often yes, since only some insurers ask for a sworn translation (traducción jurada) of documents not in Spanish, and English is often accepted. Legalisation or apostille is rarely demanded, mostly for large claims or non-EU documents. Ask your insurer before you send the claim.