What a full-coverage Spanish health policy actually includes

Terms used

• Cobertura completa — The cobertura completa is a private health policy covering outpatient, specialist, hospital and emergency care, with limits and exclusions.
• Cuadro médico — The cuadro médico is the insurer's network of doctors and clinics you can use under your policy.
• Reembolso — Reembolso is a policy type that lets you see any doctor and then claims back part of the cost.
• Autorización previa — The autorización previa is the insurer's approval you must get before certain treatments or tests.
• Copago — The copago is a small fixed fee you pay each time you use a service, in return for a lower premium.

Key rules

• Full coverage: Full coverage still has exclusions and limits, so read the conditions before you pay.
• Planned treatment: Get the insurer's approval before planned admissions, surgery and high-tech scans, or you may pay the bill yourself.
• Limits: Physiotherapy, psychology and prostheses usually have caps, so compare the numbers.
• Cheaper plans: A lower premium often means a copago on every visit, test or stay.

What "full coverage" usually means

A full-coverage policy (cobertura completa) normally covers outpatient care, specialists, diagnostics, hospitalisation and emergencies. It does not mean everything is covered. Many services have limits, and many procedures need the insurer's approval first.

Typically included:

• Primary care and paediatrics.
• Specialist consultations.
• Diagnostic tests and imaging.
• Hospital care, both day and overnight, plus surgery and intensive care.
• Maternity and childbirth, often only after a waiting period.
• Emergency care and ambulance.
• Rehabilitation and physiotherapy, with limits.
• Preventive check-ups, on many plans.

What is usually excluded

Expect these to be left out or only partly covered:

• Cosmetic surgery.
• Conditions you had before joining and did not declare.
• Infertility and assisted reproduction, on many plans.
• Experimental treatments.
• Dental work beyond basic services.
• Optical treatments.
• Injuries from extreme sports or war.
• Long-term care.

Declare your health history honestly when you apply. An undeclared condition can be refused later.

Seeing a specialist

On most network-based plans (cuadro médico), you can book an in-network specialist directly, with no GP referral. You book through the insurer's app, website or phone line. Reimbursement plans (reembolso) let you see any doctor without a referral.

Some low-cost and copago plans work differently. Services such as advanced imaging, surgery, hospital admission and rehabilitation need a specialist's prescription, and often the insurer's approval.

Prior authorisation

Many procedures need approval from the insurer before you go ahead (autorización previa). This commonly covers:

• Planned admissions, surgery and day-case procedures.
• MRI, CT, PET and nuclear medicine.
• Radiotherapy and chemotherapy.
• Rehabilitation and physiotherapy courses.
• Home oxygen therapy and dialysis.
• Genetic tests and prostheses.

If you have a planned admission without approval, the insurer can refuse to pay and you cover the bill. Emergencies can be admitted without approval. The insurer usually has to be told within 24 to 48 hours.

Sub-limits

A sub-limit caps a service by number of sessions, days or euros. Services that commonly have one:

• Physiotherapy and rehabilitation: for example 10 to 20 sessions a year.
• Psychology and psychotherapy: a fixed number of sessions or a capped annual amount.
• Prostheses and implants: a maximum amount in euros.
• Psychiatric hospital stays: a maximum number of days.
• Home care, transplants, dental, ophthalmology, ambulance and non-urgent transport, and assisted reproduction.

Limits vary widely, so compare the actual numbers between policies.

Copago

Many plans charge a copago, a small fixed fee each time you use a service. In exchange, the monthly premium is lower. Consultation fees are typically a few euros. In 2025 a specialist consultation copago was around 3 to 15 euros. Tests and hospital stays cost more, and many plans cap total copagos per year. Plans without copago cost more per month.

Before you sign

Use the checklist below to go through a quote line by line. The FAQ answers the most common questions on referrals, approvals, limits and copago. Ask the insurer for the full conditions in writing, because products differ.

Checklist

• Check that the policy lists primary care, specialist consultations, diagnostic tests, hospital care, surgery and emergency care as covered.

• Ask whether maternity cover starts only after a waiting period.

• Look at the exclusions for cosmetic surgery, infertility treatment, dental work, optical treatment and conditions you did not declare.

• Ask whether you can book in-network specialists directly or need a GP referral, and whether imaging, surgery or rehabilitation need a specialist's prescription.

• Ask which procedures need the insurer's prior authorisation before you go ahead, such as planned admissions, surgery, MRI or CT scans and chemotherapy.

• Check the limits on physiotherapy sessions, psychology sessions and prostheses, and note the number or euro amount for each.

• Find out whether the plan has a copago, what you pay per consultation, test and hospital stay, and whether there is an annual cap.

Frequently asked questions

Can I see a specialist without going to a GP first?

Yes, most network-based (cuadro médico) policies let you book an in-network specialist directly, but some low-cost or copago plans ask for a referral.

Which tests and treatments need the insurer's approval first?

Planned hospital admissions, surgery and day-case procedures need the insurer's prior authorisation (autorización previa). So do MRI, CT and PET scans, radiotherapy, chemotherapy, dialysis, genetic tests, prostheses and courses of rehabilitation or physiotherapy.

Which services usually have a limit on sessions or euros?

Physiotherapy, psychology, prostheses and implants, home care, psychiatric hospital stays, dental care, ophthalmology and ambulance transport commonly have limits. Physiotherapy is often 10 to 20 sessions per year, and psychotherapy often has a fixed number of sessions or a capped annual amount.

How much does a copago usually cost per consultation?

A typical specialist consultation copago in 2025 was around 3 to 15 euros. Diagnostic tests and hospital stays usually cost more, and many plans cap what you pay in copagos each year. In return, the monthly premium is lower than on a plan without copago.