How to read a Spanish health policy before you sign

Terms used

• Condiciones generales — The condiciones generales are the insurer's standard rules, limits and exclusions that apply to every policyholder.
• Condiciones particulares — The condiciones particulares are the details of your own policy: insured people, premium, start date and specific amounts.
• Cuadro médico — The cuadro médico is the list of doctors and clinics in the insurer's network.
• Carencia — The carencia is a waiting period after the policy starts, during which some cover cannot be used.
• Prima — The prima is the premium, the price you pay for the insurance.
• Copago — The copago is a fixed fee you pay each time you use a service.
• Franquicia — The franquicia is an amount you pay before the insurer starts to pay.

Key rules

• Cancel at renewal: Cancelling at renewal needs one month's notice from you, so diarise the date.
• Spanish text: The Spanish text generally prevails over an English translation unless the contract says otherwise.
• Limiting clauses: Clauses that limit your rights must be highlighted and accepted by you in writing.
• Before signing: The insurer must give you the general conditions, network list and main limits before you sign.
• Questionnaire: Answer the health questionnaire truthfully, or a claim can be refused.

Where the conditions and limits are

The condiciones generales hold the standard rules, and the condiciones particulares hold your own details. Read both before you sign. The general terms have the sections on cover, exclusions and definitions. The particular terms have the specific amounts, the insured people, the premium and the start date.

Look for these phrases. They mark where cover stops:

• Límite: a cap on the amount or the number of times you can use a service.
• Sublímite: a lower cap for one specific service.
• Ámbito territorial: where the cover applies. It is often Spain only, so check it if you travel.
• Exclusiones: risks the policy does not cover.
• Carencias: waiting periods before you can use some cover.
• Preexistencias: conditions you had before the policy started.
• Capital máximo: the most the insurer will pay.

Key terms in the price and the waiting time

A carencia is a waiting period after the policy starts. Typical examples are childbirth or surgery. The prima is the price you pay for the insurance. A copago is a fixed fee you pay each time you use a service. A franquicia is an amount you pay before the insurer pays. It is rare in health policies. The glossary below covers the other terms, such as tomador and asegurado.

What the contract is made of

The contract is more than one paper. It includes your application, your health questionnaire, the general terms, the particular terms and any special conditions or endorsements. The documents list below shows what to ask for.

Before you sign, the insurer must give you the general conditions, the cuadro médico and the main limits. If something is missing, ask for it first and do not sign until you have it.

Clauses that limit your rights

Clauses that limit your rights must be highlighted and accepted by you in writing. Read each one before you sign. Your signature on them is what makes them count.

Answer the health questionnaire truthfully. The insurer relies on your answers. Wrong answers can lead to the policy being cancelled or a claim being refused.

Does the English version count?

Treat the Spanish text as the one that counts. An English version is normally a courtesy translation, and the Spanish text generally prevails unless the contract says otherwise. If you both agree in writing that the English version governs, it can be binding. Look for a language clause in the contract and ask the insurer to confirm it in writing.

The contract must be written clearly, in a language you understand. If a clause is ambiguous, it is read against the insurer.

Renewal and price changes

Health policies are usually annual and renew by themselves. To cancel at renewal, you give at least one month's notice before the renewal date. The insurer must give at least two months' notice if it does not want to renew.

The insurer can change the premium at renewal, for example because of your age band or claims costs. It must tell you, and you can cancel before the new terms apply. The timeline below shows the steps.

Timeline and deadlines

• Policy renews automatically for another year unless someone gives notice: each year on the renewal date

• The insurer gives notice if it does not want to renew: at least two months before the renewal date

Documents you need

• Solicitud (application form): the form you sign to apply, issued by the insurer.

• Cuestionario de salud (health questionnaire): the insurer relies on your answers, so answer truthfully.

• Condiciones generales (general terms): the standard rules, limits and exclusions. The insurer must give you these before you sign.

• Condiciones particulares (policy-specific details): the insured people, premium and start date.

• Cuadro médico (list of network providers): the insurer must give you this, with the main limits, before you sign.

• Condiciones especiales or suplementos (special conditions or endorsements): only if your policy has any.

• English version of the policy, if you want one: normally a courtesy translation, and the Spanish text generally prevails unless the contract says otherwise.

What to watch out for

• Wrong answers on the health questionnaire: False answers can lead to the policy being cancelled or a claim being refused. Answer every question truthfully and keep a copy of what you signed.

• Limiting clauses you accept in writing: Clauses that limit your rights must be highlighted and specifically accepted in writing, so your signature on them counts. Read each highlighted clause, especially límite, sublímite, exclusiones, carencias and preexistencias, and ask the insurer to explain anything unclear before you sign.

• Cover limited to Spain: The ámbito territorial is often Spain only, so care abroad may not be covered. Find the ámbito territorial in the condiciones generales and ask about cover when you travel.

• Missing documents before signing: You may sign without having seen the general conditions, the network list or the main limits.

Glossary of Spanish health policy terms

• Carencia (waiting period): Look for the carencia in your contract. It is the waiting period after the policy starts, when some cover, such as childbirth or surgery, cannot be used yet.

• Prima (premium): Check the prima. It is the price you pay for the insurance.

• Tomador (policyholder): Confirm who the tomador is. It is the person who signs the contract and pays the premium.

• Asegurado (insured person): Check the name of each asegurado, the person whose health is covered.

• Beneficiario (beneficiary): Read who the beneficiario is. This is the person entitled to receive the benefit, usually the insured person in health insurance.

• Siniestro (insured event): Look for siniestro in the claims clauses. It is the illness or accident that triggers cover.

Frequently asked questions

Does the English version of my Spanish health policy count legally?

Usually no, because the Spanish text normally prevails and the English version is a courtesy translation. It can be binding if the contract says in writing that the English version governs. Look for the language clause before you sign.

What happens if I answer the health questionnaire wrongly?

False answers can lead to the policy being cancelled or a claim being refused, because the insurer relies on your answers when it accepts you. Answer every question truthfully and completely, including past conditions you might think are minor.

Where do I find the limits in my policy?

Limits appear mainly in the condiciones generales, in the sections on coverage, exclusions and definitions. Specific amounts are in the condiciones particulares. Look for the words límite, sublímite and ámbito territorial, which is the area where cover applies and is often Spain only.

Can the insurer raise my premium when the policy renews?

Yes, the insurer can revise the premium at renewal, for example because of your age band or claims costs, but it must tell you first.