Waiting periods (carencias) on a new health policy

Key rules

• Emergencies: Emergency and urgent care is covered from day one, with no waiting period.
• Clock start: The waiting period counts from the policy's start date, once the first premium is paid, not from the day you sign.
• Maternity: A policy bought during pregnancy will not cover the birth.
• Written proof: Get the start date, waiting periods and any waiver confirmed in writing before you rely on them.

The short version

Emergencies are covered from day one. Routine care is usually open straight away. Bigger, plannable care such as surgery, hospital stays and birth makes you wait. Your policy has a table of these waits, and the table is what counts.

When the clock starts

The wait counts from the policy's start date, once the first premium is paid, not from the day you sign. If the first premium is not paid when due, the insurer can cancel or demand payment, and it does not have to cover anything that happens before you pay. Pay on time and confirm the start date in writing.

What you can use, and when

These are typical waits. Insurers and products differ, so use them as a guide only.

Many insurers apply no waits at all, or only to some services. Maternity cover commonly has a wait of 8 months from the start date, so a policy bought during pregnancy will not cover the birth. If you plan a pregnancy, start the policy well before.

Urgent or planned?

A case is urgent when delay would put your life or serious health at immediate risk, such as an accident or a heart attack. That is covered with no wait. Care you can schedule is planned and is subject to the waits.

Trouble starts when an emergency leads to admission or an operation during a wait. Some insurers cover the emergency stabilisation but not the later scheduled treatment. Check the insurer's definition of urgent care in the general conditions. If you disagree with a refusal, complain first to the insurer's customer service. After that you can go to the insurance regulator or the courts, where unclear clauses are read in your favour.

How to shorten or remove the waits

• Recognition of previous cover. No law forces a new insurer to count time you served with the old one. Many do it as a commercial offer when you switch. Expect to need proof of continuous cover with no gap, often no more than a few weeks to 30 days. Expect a new health questionnaire too, which can exclude pre-existing conditions. If your old cover was richer, only the old level may be recognised, with waits on the extra. Ask for this in writing before you sign.
• Promotions. Some insurers waive waits for new customers for a limited time.
• Company or group policies. These usually have no waits if you join at the start or in the first period.
• Paid supplements. Some insurers let you pay extra to remove or reduce waits.
• Newborns. A baby of insured parents added within a set time after birth, often 30 days, usually has no waits.

A waiver does not usually remove exclusions for pre-existing conditions. Make sure any waiver is written into your personal terms sheet (condiciones particulares).

Reduced or reinstated policies

If a policy is reduced or reinstated, the count may restart. Ask the insurer before you change anything.

The decision, timeline, documents and checklist below help you act on this.

Choosing between options

Should you ask your new insurer to recognise waiting time you already served?

• Ask for recognition of previous cover: You are switching from another insurer or a group policy with no gap, or a gap of no more than 30 days, and you can get a certificate of previous cover.

• Accept the normal waiting periods: You have a gap in cover, no proof of previous cover, or the insurer offers no recognition. Then plan planned care around the waiting periods.

• Pay for a supplement or pick a promotion without waiting periods: You have no previous cover to transfer and want to use planned services sooner.

If you can prove continuous cover, ask for recognition first; if not, compare policies with a promotion or supplement that removes waiting periods, and get any waiver written into the policy.

Timeline and deadlines

• Emergencies and urgent care are covered: from day one

• Consultations, specialist visits and basic tests usually have no wait: usually from the start date

• Advanced tests such as MRI or CT scans become available: after 3 to 6 months

• Surgery and hospitalisation become available: after 6 months, sometimes 8 to 10 months for some operations

• Childbirth and maternity cover begins: after 8 months, with some insurers asking for 10

• Assisted reproduction, transplants and high-cost treatments become available: after 12 months or more

• Ask your old insurer for proof of cover when switching: before you sign the new policy

Documents you need

• Certificate of previous cover (certificado de antigüedad or carta de baja) from your old insurer, showing the dates you were covered. Needed only if you want your served waiting time recognised.

• Your policy's condiciones particulares, the personal terms sheet, showing the start date of cover. Any waiver or recognition of previous cover should be written into it.

Checklist

• Find the waiting-period table in the policy's general conditions and read the months for surgery, hospitalisation and maternity.

• Check the start date of cover in the personal terms sheet (condiciones particulares).

• Pay the first premium on time, because the waiting period counts from the start date once it is paid, not from the day you sign.

• Ask whether advanced tests such as MRI or CT scans have a wait of 3 to 6 months.

• Ask the insurer to confirm the start date and waiting periods in writing.

What if you need treatment before a waiting period ends?

Emergencies are covered from day one, so a waiting period never blocks urgent care. Planned care is the gap, and you have several ways to bridge it.

What counts as an emergency

Urgent care means a delay would put your life or serious health at immediate risk, such as an accident, a heart attack or a sudden acute illness. Planned care is anything that can be scheduled in advance, and the waiting period applies to it.

Problems start when an emergency leads to a hospital stay or surgery during the waiting period. Some insurers cover only the emergency treatment, or only the period of vital risk, and refuse the scheduled treatment that follows. Your policy's general conditions contain the exact definition, so read it before you rely on it.

Your options for planned care

• Pay as a private patient. Ask the provider for the price of that one service. Insurers sometimes let you pay their discounted tariff, but sometimes not.
• Use the public health system. It is free at the point of use, but waiting lists can be long. You can use it only if your social security registration or residency status entitles you to it. Check this with your local health centre.
• Wait. If the treatment is not urgent, schedule it for the day the waiting period ends.
• Ask the insurer for a waiver. Some insurers will shorten a waiting period or add a supplement for a specific treatment. Ask before you assume the answer is no.
• Change policy. A policy with shorter or no waiting periods helps. Switching to an insurer that recognises your earlier cover can also help. Either way, a new insurer may restart some waiting periods and add exclusions, so compare the conditions in writing first.

If you have no access to the public system, paying privately or waiting is likely to be your realistic choice.

If the insurer refuses to cover an emergency

Complain first to the insurer's customer service. If that fails, you can go to the insurance regulator or to court. Courts read unclear policy wording in the insured person's favour. Keep the hospital report that describes why the visit was urgent.

Frequently asked questions

Will my new insurer count the waiting time I already served with my old one?

Maybe: no law forces a new insurer to count waiting time you already served, but many do it as a commercial offer. They usually ask for proof of continuous cover with no gap of more than a few weeks to 30 days, and a certificate of your previous cover from the old insurer.

What happens if an emergency leads to a planned operation during the waiting period?

Some insurers cover the emergency stabilisation but not the scheduled treatment that follows, or only the period of real risk to life. The policy's general conditions define what counts as urgent. If the insurer refuses, complain to its customer service first, then to the DGSFP (the insurance regulator) or the courts.

Can I pay to remove the waiting periods on a new policy?

Yes, some insurers sell a supplement that removes or reduces waiting periods for an extra premium, depending on your age and health declaration. Promotions, company policies and newborns added within about 30 days of birth can also have none.

Do the waiting periods restart if my policy is reduced or reinstated?

Yes, reduced or reinstated policies may restart the count. Ask the insurer in writing before you change or reinstate the policy.