Exclusions, waiting periods and pre-existing conditions

It is for anyone considering, planning or carrying out a move to Spain. After reading, you will know what your policy leaves out, when you can use it, and how to answer the health questionnaire accurately and safely.

Start with "What Spanish health policies exclude, including dental and optical add-ons". It shows you how to spot exclusions and limits before you buy. Then read the page on waiting periods (carencias), so you know when each service becomes available. Next, read how the health questionnaire and pre-existing conditions work.

If your situation is more specific, there are pages on what happens when an insurer adds an exclusion, surcharge or refusal, and on what to do if a broker filled in your questionnaire. Other pages cover whether an insurer can lawfully refuse you, policies with no questionnaire, maternity and fertility terms, and caps on physiotherapy and therapy sessions.

Key rules

• Waiting clock: The waiting period counts from the policy's start date, once the first premium is paid, not from the day you sign.
• Emergency care: Emergency and urgent care is covered from day one, with no waiting period.
• Maternity wait: Maternity cover commonly has a waiting period of about 8 months from the policy start date, so a policy bought during pregnancy will not cover the birth.
• Insurer's reaction time: If the insurer finds an omission or inaccuracy in your answers, it has one month to propose a change or end the policy.
• Exclusions: Cosmetic, experimental and undeclared or pre-existing conditions are commonly excluded.
• Limits: Covered services such as psychology, physiotherapy and prostheses often have a yearly cap.

Exclusions, waiting periods and pre-existing conditions: the whole process, step by step

From comparing policies to using your cover

• Ask for the full policy wording and check exclusions and limits (What Spanish health policies exclude, including dental and optical add-ons): Before you sign

• Answer the health questionnaire fully and keep a copy (How the health questionnaire and pre-existing conditions work): Before the contract is concluded

• Read the insurer's written terms for any declared condition: standard terms, an exclusion, a surcharge, a longer wait or a refusal (When an insurer adds an exclusion, surcharge or refusal for a condition): Before you accept the contract

• If you are switching insurer, ask in writing for your previous waiting periods to be recognised (Waiting periods (carencias) on a new health policy): Before you sign, with proof of continuous cover and usually no gap of more than 30 days

• Ask for any waiver of waiting periods to be written into the policy (Waiting periods (carencias) on a new health policy): Before you sign

• If you are already pregnant, expect pregnancy to be excluded and declare it (Maternity and fertility cover, waiting periods and limits): Before you apply

• Pay the first premium so your cover and waiting-period clock start (Waiting periods (carencias) on a new health policy): At the policy's start date, not the day you sign

• Use emergency and urgent care when needed (Waiting periods (carencias) on a new health policy): From day one

• Use other services as their waiting periods end, such as advanced tests after 3 to 6 months and surgery after 6 months (Waiting periods (carencias) on a new health policy): 3 to 6 months after the start date for advanced tests; commonly 6 months for surgery

• Use maternity cover for a birth (Maternity and fertility cover, waiting periods and limits): 8 months after the policy start date

• Register your newborn on your policy to avoid new waiting periods and a questionnaire (Maternity and fertility cover, waiting periods and limits): Commonly within 15 to 30 days after birth

• If you spot a wrong answer, tell the insurer in writing in a way that leaves proof (Your broker filled in your health questionnaire: what it means): As soon as you notice, ideally before any claim

• Expect the insurer to propose a change or end the policy if it finds an omission (How the health questionnaire and pre-existing conditions work): Within one month of learning of it

• If you are refused or disagree, complain to the insurer's customer service, then to the DGSFP, Spain's insurance regulator (Can an insurer refuse you for a health condition?): The insurer has up to two months to reply; go to the regulator if it refuses or does not answer in that time

Documents you may need

Identity and residence

• Your identity document and any evidence for the case — When an insurer adds an exclusion, surcharge or refusal for a condition

Other documents

• Condiciones particulares — What Spanish health policies exclude, including dental and optical add-ons, Waiting periods (carencias) on a new health policy
• The insurer's written offer of terms — How the health questionnaire and pre-existing conditions work, When an insurer adds an exclusion, surcharge or refusal for a condition
• Cuestionario de salud — What Spanish health policies exclude, including dental and optical add-ons
• Product information summary — What Spanish health policies exclude, including dental and optical add-ons
• Written acceptance of any clause that limits your rights — What Spanish health policies exclude, including dental and optical add-ons
• Certificate of previous cover — Waiting periods (carencias) on a new health policy
• A medical report from your own doctor — When an insurer adds an exclusion, surcharge or refusal for a condition
• Results of extra tests or an exam by the insurer's own doctor — When an insurer adds an exclusion, surcharge or refusal for a condition
• Your written complaint to the insurer's customer service department — When an insurer adds an exclusion, surcharge or refusal for a condition

Exclusions, waiting periods and pre-existing conditions: questions that cross several articles

Can I avoid waiting periods by switching insurer?

Not by right, because insurers do not have to recognise waiting periods you served elsewhere, but many do if you prove continuous cover. See Waiting periods (carencias) on a new health policy.

Does a waiver of waiting periods also remove exclusions for pre-existing conditions?

No, a waiver of waiting periods does not usually remove exclusions for pre-existing conditions. The two are separate, so ask for both in writing. Read Waiting periods (carencias) on a new health policy and When an insurer adds an exclusion, surcharge or refusal for a condition.

What happens if I leave out a health condition I was not asked about?

You are not bound to volunteer what the questionnaire did not ask, and the insurer must prove any concealment. If you did leave out something it asked, the insurer has one month to propose a change or end the policy. Read How the health questionnaire and pre-existing conditions work and Your broker filled in your health questionnaire: what it means.

Where do I complain if an insurer refuses me or rejects a claim?

Start with a written complaint to the insurer's customer service, which has up to two months to reply. If it refuses or stays silent, you can take the complaint to the DGSFP, Spain's insurance regulator, or try mediation or the courts.