How policies and networks work

It is for anyone thinking about, planning or carrying out a move to Spain. When you finish, you should be able to look at a policy and tell what you would really get for your money.

Start with "Provider network (cuadro médico) or reimbursement (reembolso) policy: which type?" This choice shapes everything else, including which doctors and hospitals you can use. Then read "How provider networks and hospital access work" to check you can reach the care you want.

Prices, exclusions, waiting periods and travel insurance are covered elsewhere and are not part of this topic.

Key rules

• Reimbursement share: Reembolso policies typically repay about 80% to 90% of the eligible cost, up to the policy's tariff scale and annual limits.
• Cancelling at renewal: To cancel a health policy at renewal, you give at least one month's notice before the renewal date.
• Emergency admission: After an emergency admission without prior approval, the insurer usually has to be told within 24 to 48 hours.
• Upfront payment: With a closed network you pay nothing at the visit; with reembolso you pay first and claim back.
• Insurer-specific: Every insurer has its own network, and doctors may accept only some of its products.
• Province: Networks are published by province, so check the one for the town where you will live.

How policies and networks work: the whole process, step by step

• Choose the policy type: provider network (cuadro médico) or reimbursement (reembolso). Read "Provider network (cuadro médico) or reimbursement (reembolso) policy: which type?": before you buy

• Check the doctors and hospitals you want are reachable. Read "How provider networks and hospital access work": before you sign

• Read the conditions, limits and renewal terms. Read "How to read a Spanish health policy before you sign": before you sign

• Ask the insurer for prior authorisation for planned admissions, surgery, scans such as MRI or CT, and similar treatments: before the care, every time it applies

• If you have a reembolso policy, pay the provider in full and send the insurer the original itemised invoice, plus a medical report or prescription if asked: after each visit; repayment usually arrives by bank transfer within a few weeks

• After an emergency admission without approval, tell the insurer: within 24 to 48 hours

• If the network changes and your service gets worse, complain to the insurer's customer service, or plan to cancel at renewal: when you notice the change

• Decide at renewal whether to keep the policy, as the insurer can revise the premium and must tell you: give one month's notice before the renewal date to cancel

Documents you may need

The home and the lease

• Spanish contract — Getting English-speaking doctors and insurer service

Other documents

• Solicitud — How to read a Spanish health policy before you sign
• Cuestionario de salud — How to read a Spanish health policy before you sign
• Condiciones especiales or suplementos — How to read a Spanish health policy before you sign
• Full English policy documents from an international insurer or expat broker — Getting English-speaking doctors and insurer service

How policies and networks work: questions that cross several articles

Can I have both a network and reimbursement in one policy?

Yes, hybrid plans combine a network with a reimbursement option in one policy. In-network care is billed directly to the insurer, while care outside the network is paid upfront and partly repaid. Read "Provider network (cuadro médico) or reimbursement (reembolso) policy: which type?" to compare.

How much does a reembolso policy pay back?

Reembolso policies typically repay 80% to 90% of the eligible cost, up to the policy's tariff scale and annual limits. If your doctor charges more than the tariff scale (baremo), you pay the difference. Read "Provider network (cuadro médico) or reimbursement (reembolso) policy: which type?" and "How to read a Spanish health policy before you sign".

What happens if I go outside the network on a closed-network policy?

Non-emergency care outside the network is generally not covered, so you pay the full cost. See How provider networks and hospital access work.

What if my insurer changes its network during the year?

Insurers can add or remove providers mid-year, but changes to your premium or terms generally apply at renewal, with notice to you. If the service gets materially worse, you can complain to customer service or cancel at renewal.