yourgeneral conditions orradbo - sanitas expat · 2018-02-22 · your general conditions ......

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YOUR GENERALCONDITIONS

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Sanitas S.A.

Entity domiciled in Spain and entered in the MadridCompanies Register at page 4,530, volume 1,241, book721, section 3, entry 1.

Entered on 10 February 1958 in the Register of theDirectorate General for Insurance.

Registered offices at Calle Ribera del Loira, 52, Madrid28042.

Tax ID Code A-28037042

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INDEX

Your general conditions

Preliminary clause........................................................................................................ 6

Glossary of terms..........................................................................................................7

Clause I: Purpose of the Insurance...........................................................................11

Clause II: Benefits.......................................................................................................11

PRINCIPAL BENEFITS......................................................................................................................................11

1. Primary care.................................................................................................................................................11

1.1. General Medicine....................................................................................................................................... 11

1.2. Pediatrics and Childcare.............................................................................................................................11

1.3. Nurse Care Service....................................................................................................................................11

2. Emergencies................................................................................................................................................11

Sanitas 24 Hours...............................................................................................................................................11

3. Medical specialities.....................................................................................................................................11

3.1. Allergology..................................................................................................................................................11

3.2. Clinical Analysis..........................................................................................................................................11

3.3. Anatomic Pathology....................................................................................................................................11

3.4. Anesthesiology...........................................................................................................................................12

3.5. Angiology and Vascular Surgery................................................................................................................12

3.6. Digestive System........................................................................................................................................12

3.7. Cardiology...................................................................................................................................................12

3.8. Cardiovascular Surgery..............................................................................................................................12

3.9. General and Gastrointestinal Surgery........................................................................................................12

3.10. Maxillofacial Surgery.................................................................................................................................12

3.11. Traumatology and Orthopedic Surgery.....................................................................................................12

3.12. Pediatrics Surgery....................................................................................................................................12

3.13. Reconstructive Surgery............................................................................................................................12

3.14. Chest Surgery...........................................................................................................................................12

3.15. Dermatology.............................................................................................................................................12

3.16. Endocrinology and Nutrition..................................................................................................................... 12

3.17. Geriatrics..................................................................................................................................................12it

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3.18. Hematology and Hemotherapy.................................................................................................................12

3.19. Internal Medicine......................................................................................................................................12

3.20. Nuclear Medicine......................................................................................................................................12

3.21. Nephrology...............................................................................................................................................13

3.22. Pneumology..............................................................................................................................................13

3.23. Neurosurgery............................................................................................................................................13

3.24. Clinical Neurophysiology..........................................................................................................................13

3.25. Neurology.................................................................................................................................................13

3.26. Obstetrics and Gynecology.......................................................................................................................13

3.26.1. Neonatology Care.............................................................................................................................13

3.26.2. Newborn care....................................................................................................................................13

3.27. Ophthalmology......................................................................................................................................... 13

3.28. Medical Oncology.....................................................................................................................................13

3.29. Ear, Nose and Throat...............................................................................................................................14

3.30. Psychiatry.................................................................................................................................................14

3.31. Radio Diagnosis/Imaging Diagnosis.........................................................................................................14

3.32. Radiotherapy............................................................................................................................................14

3.33. Rehabilitation............................................................................................................................................14

3.34. Rheumatology.......................................................................................................................................... 14

3.35. Urology.....................................................................................................................................................14

4. Other care services.....................................................................................................................................14

4.1. Ambulance..................................................................................................................................................14

4.2. Special Care in the Home of the Insured....................................................................................................14

4.3. Obstetric-Gynaecological Nursing (Midwifery)............................................................................................15

4.4. Physiotherapy.............................................................................................................................................15

4.5. Speech and Language Therapy.................................................................................................................15

4.6. Podiatry (Chiropody exclusively).................................................................................................................15

4.7. Prostheses..................................................................................................................................................15

4.8. Maternal Infant Program.............................................................................................................................15

4.9. Psychology.................................................................................................................................................16

4.10. Home-based respiratory therapy..............................................................................................................16

5. Hospital admission........................................................................................................................................16

6. Early detection of disease............................................................................................................................16

ADITIONAL COVERAGES OF YOUR INSURANCE.........................................................................................17

Second medical opinion...................................................................................................................................18

Traffic and Occupational Accidents Cover.....................................................................................................18

Family Care Cover.............................................................................................................................................18

Sanitas Dental 21...............................................................................................................................................20

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Europe Assistance............................................................................................................................................24

Coverage rent.................................................................................................................................................... 27

COMPLEMENTARY COVERAGES OF YOUR INSURANCE...........................................................................34

Accidents Cover................................................................................................................................................35

Cover in the United States................................................................................................................................43

Sanitas Dental Cover.........................................................................................................................................44

Pharmacy Cover................................................................................................................................................48

Temporary Disability Cover..............................................................................................................................48

Alternative Medicine Cover...............................................................................................................................52

Vision Cover.......................................................................................................................................................53

Reimbursement of Expenses Cover................................................................................................................53

Reimbursement of Pediatric, Gynecological and Obstetric Consultations Cover......................................56

Repatriation cover.............................................................................................................................................56

Clause III: Exclusions from cover..............................................................................58

Clause IV: Qualification periods................................................................................61

Clause V: Form of service provision.........................................................................62

Clause VI: Other features of your insurance............................................................64

1. Basis and loss of rights of the policy........................................................................................................64

2. Duration of insurance................................................................................................................................. 65

3. Insurance premiums...................................................................................................................................65

4. Newborn children inclusions..................................................................................................................... 66

5. Provision of reports.................................................................................................................................... 67

6. Complaints...................................................................................................................................................67

7. Other important legal points...................................................................................................................... 68

8. Others...........................................................................................................................................................69

9. Jurisdiction..................................................................................................................................................69

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Preliminary clause

This Policy is governed, by Ley 50/1980,de 8 de octubre de Contrato de Seguro("the Insurance Contract Act’), by RoyalLegislative Decree 6/2004 of 29 October2004 enacting the consolidated text ofLey de Ordenación y Supervisión deSeguros Privados ("the PrivateInsurance Ordination and SupervisionAct’), the implementing Regulations ofthat Act (Royal Decree 2486/98 of20November 1998), by Law 22/2007 of11th of July, sobre comercialización adistancia de servicios financierosdestinados a los consumidores(“Distance Marketing of FinancialServices destined to Consumers”), byLey 26/2006, de 17 de julio, demediación de seguros y reasegurosprivados (“the private insurance andreinsurance mediation Act) and theseGeneral Terms and Conditions and theParticular Terms and Conditions.

Clauses restricting the rights ofInsured shall be applicable whenhighlighted in bold letters andspecifically accepted.

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Glossary of terms

For the purposes of this document of the Profesionales insurance product, the followingdefinitions apply:

INSURANCE TERMS

ACCIDENTBodily injury suffered while the Policy is inforce, stemming from an external, sudden,violent cause beyond the Insured's control.

STANDING MEMBERSHIPThis involves recognition by the Insured ofcertain rights due to standing membership inSANITAS, which will be specified in theParticular Terms and Conditions.

INSUREDEach person included in the policy andspecified in the Particular Conditions, entitledto receive insurance benefits and who may ormay not be the same as the Policyholder.

BENEFICIARYPerson to whom the insurance Policyholderacknowledges the right to receive thecompensation or benefit arising from thiscontract, to the corresponding sum

CO-PAYMENTParticipation of the Insured in the sum of thecost of the medical action or series of actions,according to the medical service required,received from professionals or the centersproviding it and to be paid directly toSANITAS.

HEALTH QUESTIONNAIREDeclaration made and signed by thePolicyholder or Insured before formalization ofthe policy, which is used by SANITAS toassess the risk subject to insurance.

FRAUDULENT INTENTAction or omission committed fraudulently ordeceivingly with the intention of producingdamage or obtaining a benefit that affects theinterests of a third party.

INSURER OR INSURANCE COMPANYSanitas, Sociedad Anónima de Seguros, thelegal person taking on the risk as agreedunder this Agreement.

DEDUCTIBLESum of medical and/or hospital expensesincluded in the insurance cover that,according to the corresponding cover, ispayable by the Policyholder or the Insured tothe care provider.

PARTICIPATION IN COSTSPrior to access to certain cover, the Insuredmust pay a single payment to SANITAS,which is specified according to the degree ofdifficulty of the cover.

QUALIFICATION PERIODSPeriod of time (calculated by months elapsedfrom the effective date of the insurance)during which some of the covers included donot enter into force.

POLICYWritten document that contains the Termsand Conditions governing the insurance. ThePolicy comprises: the insurance application,health questionnaire, general, particular andspecial terms and conditions and thesupplements or appendices that are added toit either to complete or amend it.

PRE-EXISTING CONDITIONSState or condition of health (illness, injury ordefect), not necessarily pathological, sufferedby the Insured prior to the date of hisinclusion in the policy.

BENEFITImplementation by SANITAS of the coverguaranteed in the policy.

PREMIUMThe premium is the price of the insurance, i.e.the amount that the Policyholder or Insured

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must pay the Insurer. The premium invoiceshall also contain any legally applicablesurcharges, duties and taxes.

LOSSEvery occurrence of consequences which arepartly or wholly covered by the Policy. The setof services arising from the same cause isconsidered to constitute a single claim.

POLICYHOLDERThe physical or legal person who, togetherwith SANITAS, signs this contract and whomay be the same as or different to theInsured and to whom the obligations arisingthere from correspond, particularly thepayment of the premium, except those that,due to their nature, are the obligation of theInsured

HEALTH TERMS

HEALTHCAREAct of assisting or caring for the health of aperson.

HOSPITAL HEALTHCARE /H E A L T H C A R E W I T HHOSPITALISATIONThis is the care provided when admitted to ahospital, with a record of admission and theInsured remaining there as a patient for aminimum of 24 hours for medical treatment,diagnosis, surgery or therapy.

H E A L T H C A R E W I T H O U THOSPITALISATION / OUTPATIENTHEALTHCAREThis is medical care, diagnosis, surgery ortherapy provided in doctors' offices and/or inhospital that does not involve hospitalization.

SOCIAL CAREAll care that is not necessary, according tousual practical and compliant with goodmedical practice, for the treatment of dulydiagnosed pathologies.

CONSULTATIONAssistance and examination of a patient by adoctor, performing the necessaryexaminations and medical tests to obtain a

diagnosis or prognosis and prescribetreatment.

DIAGNOSISMedical opinion on the nature of a patient'sdisease or injury, based on assessment ofhis/her signs and symptoms and on theperformance of additional diagnostic tests.

REGISTERED NURSE (‘ATS’, ‘DUE’)Registered nurse or Technical HealthcareAssistant legally qualified and authorized toperform nursing.

ILLNESSAny alteration of the state of health of anindividual who suffers the action of apathology that is not the result of an accident,which is diagnosed and confirmed by a legallyrecognised doctor or dentist and whichrequires professional medical care.

CONGENITAL DISEASEA disease that exists at the time of birth as aresult of hereditary factors or disordersacquired during pregnancy up to the time ofbirth. A congenital disorder may becomemanifest and be recognised immediately afterbirth, or be discovered later, at any time of theindividual’s life.

USER GUIDE TO DOCTORS ANDSERVICESHealthcare professionals and centersbelonging to the medical network of this policyand recommended by SANITAS for theprovision of the services included in theinsurance. The Guide may undergomodifications during the validity period of thepolicy. There is a full, up-to-date list of thedoctors and centers forming the medicalnetwork of this policy available to the insuredin the SANITAS offices.

CONVENTIONAL ROOMSingle-unit room equipped with the necessaryhealth care systems. Suites or roomsprovided with an anteroom are not consideredconventional

HOSPITALAny legally authorised public or privateestablishment for the care of diseases or

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bodily injuries, provided with the means forperforming diagnoses, medical treatmentsand surgical operations, and able to admitin-patients.

For the purposes of the Policy, hotels, resthomes, spas, facilities intended primarily forthe treatment of chronic diseases and similarinstitutions are not regarded as hospitals

SURGERYAny operation for diagnostic or therapeuticpurposes, performed by means of incision orany other path of internal approach by anappropriate medical specialist at anauthorised centre (inpatient or outpatient),which normally requires the use of anoperating theatre comprising aspecial-purpose room and equipped with thenecessary systems

INJURYAny pathological change that takes place in atissue or in a healthy organ and which entailsanatomic or physiological damage, i.e., adisturbance of physical integrity or functionalbalance.

OSTEOSYNTHESIS MATERIALPieces or elements of metal or of any otherkind used for joining the ends of a fracturedbone or for welding joint ends.

ORTHOPAEDIC MATERIALAnatomic pieces or elements of any kindused to prevent or correct body deformities.

PHYSICIANDoctor or Bachelor in Medicine legally trainedand authorised for medical or surgicaltreatment of the disease or injury that givesrise to a cover contained in the Policy.

CHILDBIRTHThe expulsion of one or more newbornchildren and the related placentas from theinterior of the uterine cavity to the exterior.Normal or ‘at term’ childbirth occurs betweenweek 37 and week 42 after the date of the lastmenstruation. Childbirth occurring earlier than37 weeks qualifies as premature; childbirthoccurring after 42 weeks qualifies aspost-term.

ORGAN DISEASEStructural injury to tissue or organs of thehuman body.

PROSTHESESAny element of any kind that temporarily orpermanently replaces the absence of anorgan, tissue, organic fluid, member or part ofany of these. By way of example, thisdefinition encompasses mechanical (jointsubstitutes) or biological elements (heartvalve replacement, ligaments), intraocularlenses, medication reservoirs, etc.

PSYCHOLOGYPsychology is the science of practicalapplication of knowledge, skills andtechniques to diagnose, prevent and resolveindividual or social problems, especially asregards the individual’s interaction with his/herphysical and social environment

NEWBORNThe distinct stage of life comprising the firstfour weeks after birth.

HOME SERVICESVisit at the home appearing in the Policy atthe Insured's request, by a generalpractitioner, paediatrician, or registered nurse,in those cases in which the Insured is not in acondition to attend the doctor's or registerednurse's surgery because of his/her disease.

EMERGENCY HOME SERVICESCare provided at the Insured’s addressappearing in the Policy in cases ofemergency, provided by a general practitionerand/or registered nurse.

TREATMENTAll means (hygienic, pharmacological,surgical or physical) primarily directed to cureor relieve a disease after it has beendiagnosed.

EMERGENCYAn “Emergency” is a clinic situation that doesnot suppose a vital commitment or irreparabledamage to the physical integrity of the patient,that requires immediate medical care

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VITAL EMERGENCYAn emergency is a situation that requiresimmediate medical care as a delay couldprove life-threatening or lead to irreparableharm to the patient's physical integrity.

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Clause I: Purpose of theInsurance

Within the limits and conditions stipulated inthe Policy and following payment by thePolicyholder of the corresponding premium,co-payments and deductibles that maycorrespond, SANITAS provides its insuredwith a wide range of professionals, clinics andhospitals for medical, surgical and hospitalcare, according to normal medical practice, inthe specialties and modalities included in thecover of this Policy, their cost being assumedthrough direct payment to the professionals orcenters providing the insured provision.

Any diagnostic and therapeutic advancesarising in medical science after the effectivedate of this contract may become part of thecover of this policy provided that they aresafe, effective and universalized andconsolidated. Whenever this policy isrenewed, SANITAS shall inform of thetechniques or treatments to be included in thecover of the policy for the following period.

Clause II: Benefits

PRINCIPAL BENEFITS

In general, with the limitations andexclusions highlighted in the terms andconditions ofthis policy, the healthcarebenefits covered correspond to thefollowing specialties:

1. Primary care

1.1. General Medicine

This includes medical care in a healthcarecenter, indication andprescription of basicdiagnosis tests and procedures (analysis andgeneral radiology) during thedays and timesestablished for this purpose by the doctor. Itincludes also home services when, forreasons attributable only to the Insurer’sillness, he/she is prevented to attend theconsultancy.

In emergencies the Insured shall go to thepermanent emergency services or elsecontact the SANITAS telephone service.

1.2. Pediatrics and Childcare

This includes the care of children until theyare 15 years old in consultancy and at home,the indication and prescription of tests andbasic diagnosis procedures (analysis andgeneral radiology), being applicable all otherregulations mentioned for the benefit ofGeneral Medicine.

1.3. Nurse Care Service

Includes healthcare at the healthcare centerand at home.

2. Emergencies

These include emergency healthcareprovided in permanent emergency centers.

In justified circumstances, the service shall beprovided at the home of the Insured, by thepermanent services on call, only in thosetowns in which SANITAS has contractedthe performance of such service.

Sanitas 24 Hours

Telephonic service that comprises theinformative attention performed by a medicalteam, who shall advice the Insured abouthis/her questions of medical character,treatments, medication, analysisinterpretation, etc., 24 hours a day, 365 daysa year.

3. Medical specialities

3.1. Allergology

3.2. Clinical Analysis

3.2.1. Genetic Studies

Comprises only those necessary for diagnosisand/or prescription oftreatment of affectedand symptomatic patients.

3.3. Anatomic Pathology

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Includes the performance of therapeutictargets prior to the administration of certainpharmaceutical products, provided that thetechnical summary ofcharacteristicsof theproduct as established by the SpanishAgency of Medicinal Products and MedicalDevices requires that such targets bedetermined.

3.4. Anesthesiology

3.5. Angiology and Vascular Surgery

Varicose vein treatments with foam ormicrofoam are excluded.

3.6. Digestive System

3.7. Cardiology

3.8. Cardiovascular Surgery

The cryoablation technique andpercutaneous techniques forthereplacement of heart valves are excluded.

3.9. General and Gastrointestinal Surgery

Includes laparoscopic surgery.

3.10. Maxillofacial Surgery

Includes the diagnosis and surgical treatmentof diseases andtrauma involving only thejawbone, maxilla and facial bones.

Dentistry treatments are excluded, as arecosmetic treatments and/or treatmentstargeting functional issues of the patient'smouth or teeth, such as orthognatic,pre-implant and pre-prosthesis surgery.

3.11. Traumatology and OrthopedicSurgery

Includes arthroscopic surgery.

3.12. Pediatrics Surgery

In the same terms and conditions as thosementioned for adult surgery.

3.13. Reconstructive Surgery

3.14. Chest Surgery

3.15. Dermatology

3.16. Endocrinology and Nutrition

3.17. Geriatrics

3.18. Hematology and Hemotherapy

Comprises autologous bone marrow andparentperipheral blood cell transplants solelyfor treatment of hematological tumors.

3.19. Internal Medicine

3.20. Nuclear Medicine

Contrast agents are paid for by SANITAS.

PET and PET/CT are covered only forindications authorized by the SpanishAgency forMedicinal Products and MedicalDevices (AEMPS) on the technical datasheet using thedrug 18-fludeoxyglucose(18 FDG). Such indications are precisely thefollowing:

A)Oncology Diagnosis:

• Characterization of the sole lung nodule.• Detection of the unknown origin tumor

evidenced, for example by cervical glandillness, liver or bone metastasis.

• Characterization of a pancreatic mass.

B) Staging:

• Head and neck tumors, including assistedguided biopsy.

• Primary lung cancer.• Breast cancer locally advanced• Esophagus cancer• Pancreas carcinoid• Colorectal cancer, especially in recurrent

cases• Malignant lymphoma• Malignant melanoma, with Breslow higher

than 1,5 mm or metastasis in lymph nodesin the initial diagnosis.

C)Monitoring of treatment response:

• Malignant lymphoma

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• Head and neck tumors

D) Detection in case of reasonablesuspicion of recurrence:

• Gliomas with high degree of malignity• Head and neck tumors• Thyroid cancer (non medullary): patients

with increase of the serum levels ofthyroglobulin and body tracking withnegative radioactive iodine.

• Primary lung cancer• Breast cancer• Pancreas carcinoid• Colorectal cancer• Ovary cancer• Malignant lymphoma• Malignant melanoma

E)Neurology:

• Location of epileptogenic foci in thepre-surgery assessment in the temporaryepilepsy.

3.21. Nephrology

Includes dialysis techniques only for thetreatment of acute processes. Chronictreatments of dialysis and hemodialysisare excluded.

3.22. Pneumology

3.23. Neurosurgery

Includes surgery with surgical navigationassistance and Intraoperat iveElectro-physiological Monitoring.

3.24. Clinical Neurophysiology

3.25. Neurology

3.26. Obstetrics and Gynecology

Includes laparoscopic gynecological surgeryand studyand basic diagnosis of infertility andsterility.

It also includes family planning, tubal ligation,IUD implantation (the IUD has to be paid bythe Insured) , and follow up of treatment withanovulatories.

The following genetic tests are included:karyotype, factor V Leiden andprothrombingenemutation 20210. Any othergenetic test other than those mentionedshall be excluded.

3.26.1.Neonatology Care

It comprises the medical check, vaccineadministration and performance of all thosetests that systematically are performed tonewborns during his/her first 48 hours of life,according to the care delivery protocolapplicable in each autonomous regions,excluding all medical service that is aconsequence of a pathology orcomplication appearing at the moment ofbirth.

3.26.2.Newborn care

It comprises the expenses derived from careperformed to newborns, providing he/she isenrolled as Insured in SANITAS and hascontracted the corresponding coverage.

3.27. Ophthalmology

Includes laser photocoagulation and corneatransplant surgery. Thetransplantable corneamust be paid for by the Insured.

3.28. Medical Oncology

Treatment must always be prescribed by theMedical Oncology consultant in charge of thepatient's care. The treatments shall be paidby SANITAS if they are conducted atahealthcare site, both as Oncologicday-patient treatment and as inpatienttreatment if such was necessary.

SANITAS, shall only pay for expensescorresponding to specifically cytostaticdrug products, the sale of which isauthorized in the Spanish market and onlyif these products are used according tothe instructions of the summary of productcharacteristics and administeredparenterally, in as many cycles asrequired.

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3.29. Ear, Nose and Throat

Includes laser surgery and radiofrequencysurgery.

3.30. Psychiatry

The admission as psychiatric in-patient onlyincludes the treatment of acute outbreaks.It is limited to a maximum period of 50days per Insured/year.

3.31. Radio Diagnosis/Imaging Diagnosis

Comprises standard diagnostic techniques.Contrast agents shall be paid for bySANITAS.

It also includes:

A) The colonography performed bycomputerized tomography (CT) in thefollowing indications:

• Screening of colon cancer and colonpolyposis in patients without a knownclinical history of colon cancer, polyposis orinflammatory intestinal illness, as long asthey present family background of thesepathologies or are candidates to screeningfor age reasons (from the age of 50).

• Screening of colon cancer and colonpolyposis in patients in which theconventional colonoscopy iscontraindicated due to their clinical situationor supposes a higher risk.

• As complement to conventionalcolonoscopy when this has not achievedthe complete length of the colon.

To access to the insured coverage of thisdiagnosis test the Insured must participatein the cost of the service in the amountexpressly indicated in the particularconditions of his/her policy.

B) Includes CT coronary angiography:covered only for patients with symptoms ofcoronarydisease with non-conclusiveischemia test results, valve replacementsurgery, post-operative coronary stenosis

bypass assessment and malformations ofthe coronary tree.

Assessment of the stenosis afterimplantation of a coronary stent and thecalcium score are excluded.

3.32. Radiotherapy

3.33. Rehabilitation

It comprises the consultations which have thepurpose of diagnosis, evaluation andprescription of the physiotherapy treatmentsincluded in the cover of Physiotherapy.

3.34. Rheumatology

3.35. Urology

Includes vasectomy, the study and basicdiagnosis of infertility and sterility andurinarytract lithotripsy.

Prostate interventions by any lasertechnique are excluded.

4. Other care services

4.1. Ambulance

This service shall be performed by land. Thepresent benefit only includes transfers fromthe place where the Insured is to the hospitalwhere the care covered by this policy will beprovided and from this hospital to theInsured’s home. It includes also intra-hospitaltransfers when the hospitals are located indifferent provinces when the care resources inthe province of residence of the Insured arenot enough to attend him/her.

This benefit does not include any transferrequired for physiotherapy treatments,forconducting diagnostic tests or foroutpatient attendance to consultancies.

4.2. Special Care in the Home of theInsured

This shall be performed by the care teamsdesignated by SANITAS, providing there is

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the possibility of contracting the service, whenthe conditionof the patient requires specialcare but does not require hospital admission.

4.3. Obstetric-Gynaecological Nursing(Midwifery)

Care provided by a midwife will be availableonly for hospital-based child delivery.

4.4. Physiotherapy

This covers musculoskeletal physiotherapy onan outpatient basis, exclusively forcomplaints originating in themusculoskeletal system providing it is not achronic or degenerative process, and isonlycovered until the patient has achieved thegreatest functional recovery possible in theopinion ofhis/her rehabilitating physician.

It also includes the musculoskeletalphysiotherapy as inpatient, secondary toorthopedic surgery and heart rehabilitationunder a hospital admission systemfollowing surgery withextra-corporealcirculation. Also includes lymphatic drainageafter a mastectomy arising from cancer.

Neurologic rehabilitation, pelvic floorrehabilitation and heart rehabilitation asout patient are excluded, as well as thosethat are performed with robotic equipment.

4.5. Speech and Language Therapy

It is included only when related with organicprocesses, to a maximum of 6 months ayear per Insured.

Language therapy in non organicprocesses is excluded.

4.6. Podiatry (Chiropody exclusively)

Limited to a maximum of 6 sessions perInsured and insurance annuity.

4.7. Prostheses

Only includes the internal prostheses andinternally implantable materials expresslyindicated below and up to the insuredcapital limits established, if such is the

case, in the Particular Conditions of thepolicy. In those cases that SANITAS requiresso, the Insured shall have to provide withreports and/or budgets.

1. Ophthalmology: monofocal intraocularlens for cataract surgery.

2. Traumatology and Orthopedic Surgery:Hip, knee and other joint prostheses;necessary material for backbone fixing;intervertebral disc; interbodyor interspinalintervertebral material; vertebroplasty/kyphoplasty material; biological bone ligamentmaterial obtained from tissuebanks in Spain;osteosynthesis material; bone substitutesexclusively for backbone surgeryand bonegrafts after tumor surgery.

3. Cardiovascular Area: The followingvascular prostheses: stent, peripheral orcoronary by-pass, medicalised ornon-medicalised, with exclusion of thoseused in aorta in any of its stages and theaortic valved ducts, heart valves withexclusion of aortic valved ducts and anyother that require implantation viapercutaneous or transapical; pacers withexclusion of any type of defibrillator andthe artificial heart; coils and/or embolizationmaterials.

4. Chemotherapy or Pain Treatment:reservoirs.

5. Other surgical materials: abdominalmeshes except those used as closing inlaparoscopic surgery; urological suspensionsystems; spinal tapsystems (hydrocephalus);breast implants and expanders, exclusivelyfor the breast affected by prior tumor surgery.

6. Bone fixing materials in cranial and/ormaxillofacial surgery

4.8. Maternal Infant Program

Includes theoretical and practice classes forchild delivery preparation, child healthexaminations, as well as telephonicassessment by nursing professionals duringthe first six months of life of the child.

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4.9. Psychology

Includes individual psychological careprescribed by Psychiatrists, GeneralPractitioners or MedicalOncologists. Alsoincludes simple psychological diagnosis andpsychometric tests, the forms of which shallbe paid for by the Insured.

It includes a maximum of 4 consultationsper month and with a limit of 15 sessionsper Insured and insurance annuity.

Cover excludes psychoanalysis,psychoanalytic therapy, hypnosis,narcolepsy andpsychosocial andneuropsychiatric rehabilitation services.

4.10. Home-based respiratory therapy

Exclusively comprises the followingtreatments:

a) O x y g e n t h e r a p y : l i q u i d ,concentrator-based and gaseous.Liquidoxygen therapy must be prescribed foradministration for at least 15 hours a daySANITAS shall only pay for one type ofoxygen therapy treatment.

b) Generation of positive airway pressure totreat sleep disorders.

c) Aerosol therapy and Ventilation therapy.

5. Hospital admission

Includes any type of hospitalization (medical,psychiatric, in ICU, surgery, obstetrical) in aclinic or hospital.

The patient shall occupy a conventional,individual room with a bed for relatives,except inpsychiatric hospitalization, in ICUand in incubator and SANITAS shall pay forany expensesarising from the performing ofthe diagnosis and therapeutic methods,surgical treatments(including surgery anddrug costs, except cytostatic drugs that arenot authorized for sale in Spain) andaccommodation with the upkeep of thepatient, included in the cover of the policy.

6. Early detection of disease

This includes the medical consultation,physical examination and basic diagnostictestsprescribed by the correspondingconsultant for the early diagnosis of thefollowing diseases:

6.1. Digestive System: early diagnosis ofcancer of the esophagus, stomach andcolon-rectum.

6.2. Cardiology : early diagnosis of heart risk.

6.3. Pneumology: early diagnosis of lungcancer.

6.4. Obstetrics and Gynecology: earlydiagnosis of breast cancer, cervical cancerand ovariancancer.

6.5. Urology : early diagnosis of prostate andbladder cancer.

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ADITIONALCOVERAGES OFYOUR INSURANCE

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Second medical opinion

This cover includes a second opinion onmedical diagnosis or treatment in the event ofseriouschronic diseases, requiring scheduledcare, which course requires exceptionaldiagnostic or therapeutic measures and/orwhereof the life prognosis is seriouslycompromised. Such a second opinion shall beissued by leading consultants, healthcarecenters,physicians oracademics in anycountry in the world, designated by SANITAS

To use this service, the Insured shall send theclinical dossier comprising writtenmedicalinformation, X-rays or other imagediagnoses performed, excluding dispatch ofany biological or syntheticmaterials. SANITASshall confidentially send this dossier to thecorresponding specialist or center,accordingto the disease in question.

When the process finishes, a report about thesecond medical opinion shall be sent to theInsured, including:

• Summary of his/her clinical history

• Opinion of the leading experts consulted

• Curriculum de of these leading experts.

All along this process, the Insured shall beaccompanied by a consultant physician,responsible for the management of the caseand for assessing the patient at all times.

Traffic and OccupationalAccidents Cover

Sanitas will cover, under the terms andconditions set down in the policy hereunder,healthcare required by the insured as a resultof traffic accidents, occupational accident oroccupational illness, considered as such bythe relevant Administrative Authorities.

Healthcare requiring treatment for illness,injury, malformation or defects derivedfrom sporting completions is excluded.

Family Care Cover

1. PURPOSE OF THE COVER

Family Care is a complementary cover to thehealthcare policy with guarantees that arecovered when the insured needs to behospitalised for more than 48 hours or isimmobilised at home for more than 5 days forconvalescence with medical leave or anequivalent certified document, or when theinsured dies as a result of an accident orillness.

2. TERRITORY COVERED

The Family Care guarantees will applythroughout Spain for insured parties domiciledin Spain, even if the accident or illness isproduced outside of Spain.

3. USE OF THE SERVICES

To use the services the insured must be up todate with his or her premium paymentobligations. The services will be provided viaa provider appointed by SANITAS. Theinsured must contact the provider by calling902 747 767 as soon as possible afterlearning of the hospitalisation, immobilisationor death.

4. GUARANTEES INCLUDED

Through the provider that SANITAS appoints,SANITAS will provide the followingguarantees:

1. Home help

The provider will send a person to theinsured's home to help with basic householdtasks (cleaning, washing, ironing, mealpreparation, etc.) for a maximum of 30 hoursat a ratio of 2 continuous hours per daystarting from the first day. These hours will bedistributed throughout a maximum period of 1month.

The number of hours of service provision willbe assigned on the basis of an objective

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assessment of the applicant's degree ofautonomy, considering aspects such as theeffective time of immobilisation or invalidity toperform basic tasks, the seriousness of theinsured's injuries and the number ofdependent family members.

The provider reserves the right to ask theinsured for the medical report and tests thathave been performed, which will be assessedby a medical team who will determine andevaluate the insured's degree of invalidity andsubsequently the hours ofhome help needed.

The home help guarantee cannot beaccumulated if various members of the samefamily are injured or immobilised in the home.

2. Transfer of a relative to care forchildren under 16 years of age ordisabled children

Transfer of a relative of the insured or theperson designated by the insured to theinsured's home to care for his or her children.The transfer will be aboard a scheduled airlineflight (economy class), train (1st class) or taxi.Return ticket included.

This guarantee excludes guarantees 3, 4 and8.

3. Home help to care for childrenunder 16 years of age or disabledchildren

A person will be sent to the insured's home tocare for children under 16 years of age ordisabled children and the number of hours willbe established on the basis of the effectivetime of immobilisation or the severity of theinsured's injuries, with a minimum of 2continuous hours a day from the first day andup to a total maximum of 30 hours distributedthroughout the maximum period of 1 month.

This guarantee excludes guarantees 2 and 4.

4. Transfer of children under 16 yearsof age or disabled children

Transfer of children under 16 years of age ina scheduled airline flight (economy class),

train (1st class) or taxi to the home of therelative appointed by the insured in Spain.


5. Escort transferring children under16 years of age or disabled children

A person will be appointed to escort underageor disabled children to the home of therelative appointed by the insured in Spain.The escort will be appointed by the provider,so long as there is no possibility of theinsured appointing an adult escort.

6. Escort to take children under 16years of age or disabled children toschool and back

An escort will be appointed by the provider fora maximum of two journeys a day for up to 5days, if no relative is available, and for amaximum period of 1 month.

7. Home help to care for elderlyparents

A person will be sent to the insured's home tocare for elderly parents who live in the samehome as the insured and who are dependentupon him or her, according to the laws inforce. Up to a maximum of 30 hours at a ratioof a minimum of 2 continuous hours per daystarting from the first day.

The number of hours of service provision willbe assigned on the basis of an objectiveassessment of the applicant's degree ofautonomy, considering aspects such as theeffective time of invalidity to perform basictasks, the seriousness of the insured's injuriesand the number of dependent familymembers.

The provider reserves the right to ask theinsured for the medical report and tests thathave been performed.


8. Transfer of a relative to care forelderly parents

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Transfer of the relative appointed by theinsured to the insured's home in a scheduledairline flight (economy class), train (1st class)or taxi to care for elderly parents who live inthe same home as the insured and who aredependent upon him or her, according to thelaws in force. Return ticket included.

This guarantee excludes guarantees 2, 7 and9.

9. Transfer of elderly parents

Transfer in a scheduled airline flight(economy class), train (1st class) or taxi to thehome of the relative appointed by the insuredin Spain of the elderly parents who live in thesame home as the insured and who aredependent upon him or her, according to thelaws in force.Return ticket included.


10. Care of pets (dogs and cats)

Transport and accommodation for pets (dogsand cats) from the first day and for amaximum of 1 month.

11. Dispatch of medication

Dispatch of medication to the place where theinsured is located in Spain, for a maximum of3 times in 1 month.

The cost of the medication is excluded andmust be paid for by the insured upon delivery.The provider takes no responsibility regardingdelays in delivery or state of medication forcauses not imputable to it.

5. GENERAL EXCLUSIONS

Damage, situations, expenses andconsequences deriving from the followingare excluded from the insured guarantees:

5.1. Wilful misconduct on the part of theinsured

5.2. Nuclear reactions or radiation orradioactive, chemical or biologicalcontamination, either directly or indirectly.

5.3. Events whose size or seriousnessqualify them as catastrophic.

5.4. Armed conflict, even if it hadn't beenpreceded by an official declaration of war.

5.5. Extraordinary risks, even when thedisaster has ended, as well asextraordinary situations such as naturalphenomena (flood, earthquake, volcaniceruption, atypical cyclone, falling astralbodies and meteorites).

6. GRACE PERIODS

For the provision of the guarantees describedabove, it will be necessary for two months tohave passed from the date of the presentsupplementary cover taking effect in relationto the insured who requests a service coveredherein.

All of the guarantees described above will beprovided to the Insured by the provider thatSanitas appoints from the date of the presentsupplementary cover taking effect in relationto the insured who requests a service coveredherein.

Sanitas Dental 21

1. Services included in yourpolicy

For this type of service the Insured does notneed to pay the dentist any amount.

The services covered shall only be providedby the medical professionals included in thelist of dentists in the medical networkcorresponding to this policy.

This care shall only be provided at thedentist’s surgery, specifically excluding careoutside of it.

The services and treatments listed below arecovered:

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GENERAL AND PREVENTIVEDENTISTRY• General dentistry consultation: examination

and diagnosis• Oral cleansing/tartar removal• Priority consultation in case of emergency

SURGICAL PROCEDURES• Simple extraction• Extraction of non-impacted third molars• Extraction of impacted third molar plus

dental cysts• Extraction of impacted tooth (not third

molar) plus dental cysts• Extraction of root remains• Extraction by odontosection• Postoperatory check-up (includes removal

of stitches)

COSMETIC DENTISTRY• Photoactivation whitening brace (for

treatments performed at the same clinic)

CHILDREN’S DENTISTRY (patientsaged under 15 years)• Consultation• Buccodental education• Intraoral X-rays• Oral cleansing/tartar removal• Extraction of deciduous teeth

PROSTHESIS• Occlusal analysis

PERIODONTICS• Periodontal X-ray series

ORTHODONTICS• Consultation• X-ray study for orthodontics• Extraction of deciduous teeth• Simple extraction• 1st replacement metal brackets• 1st replacement ceramic brackets• 1st replacement self-binding brackets• 1st replacement sapphire brackets• 1st replacement of cosmetic self-binding

brackets• Orthodontics box (for treatments performed

at the same clinic)• Oral protector for orthodontics (for


I M A G I N G D I A G N O S I S :RADIOLOGY/OTHERS• Periapical/bite-wing/occlusal• Periodontal X-ray series• Lateral skull X-rays• Orthopantomogram (panoramic)• Cephalometry• Photographs or slides• Computed axial tomography (dental CT

scan)

TEMPOROMANDIBULAR JOINTPATHOLOGY• Occlusal analysis

EMERGENCIESIn case of emergency, the Insured must go tothe permanent emergency centres indicatedin the Practical Guide.

2. Services with a deductiblepayable by the Insured

The Insurer must agree to the relevantprescription and deductible given by thedentist, and the Insured shall pay directly thisdeductible to the dentist corresponding to thecost of the service requested.

The Insured shall bear the cost of services inaccordance with the scale of deductibleamounts in force at the time of serviceprovision.

If there is any change to the deductibles to bepaid by the Insured, Sanitas shall notify thenew amounts to the Insured two months inadvance of the date of effect. Payment of thepremium shall imply acceptance of suchchanges.

The deductible amounts of these services areindicated in the Particular Conditions of thePolicy, such deductible amounts shall becharged to the Insured. These services are:

GENERAL AND PREVENTIVEDENTISTRY• Topical fluoride treatments• Treatment for dental sensitivity• Fissure sealer

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SURGICAL PROCEDURESMinor surgery• Frenectomy (upper or lower)• Removal of epulis/small mucosal cysts• Drainage of gingival/parodontal abscesses• Apicoectomiy• Dental cystPreprosthetic surgery• Vestibuloplasty (per quadrant)• Alveolar regularization (per quadrant)• Removal of torus (per quadrant)Orthodontic surgery• Orthodontic fenestration (per tooth)

CONSERVATIVE DENTISTRY• Fillings / obturation• Reconstruction• Direct pulp coating• Indirect pulp coating• Provisional obturation

ENDODONTICS• Consultation for symptom treatment

(opening, instrumentation and drainage)• Root-end filling material (MTA)• Fiberglass or carbon post• Monoradicular endodontics• Biradicular endodontics• Polyradicular endodontics• Monoradicular re-endodontics• Biradicular re-endodontics• Polyradicular re-endodontics

COSMETIC DENTISTRYWhitening• Custom tray tooth whitening (per treatment)• Dental bleaching by photoactivation (per

treatment)• Dental bleaching by photoactivation (per

tooth and session)• Combined dental bleaching photoactivation

plus brace)Dental reconstruction• Reconstruction of aesthetic composite front

(per tooth)• Intraoral repair of porcelain (per tooth)• Porcelain facing• Injected facing• Zirconia facing• Composite facing• Cosmetic bridge crown or unit over tooth

CHILDREN’S DENTISTRY (patientsaged under 15 years)• Topical fluoride treatments• Fissure sealer• Obturation of deciduous teeth• Pulpotomy without reconstruction• Pulpectomy without reconstruction• Preformed metallic crown• Apical formation (full treatment)• Fixed space maintainer• Removable space maintainer• Bridge/crown/space maintainer removal,

(per tooth)• Guided occlusion or occlusal pad (per

tooth)• Oral screen• Tooth reimplantation

PROSTHESIS• Assembly and study of semi-adjustable

articulator• Selective carving• Diagnostic polishing (per tooth)Fixed prosthesis• Bridge/crown/space maintainer removal

(per tooth)• Recementation• Inlay• Provisional resin crown• Bridge crown or unit on tooth• Cosmetic bridge crown or unit over tooth• Supplement for precious metal• Monoradicular cast stump• Multiradicular cast stump• Maryland support (unit)• AttachesRemovable prosthesis• Removable acrylic (1 to 3 teeth)• Removable acrylic (4 to 6 teeth)• Removable acrylic (more than 6 teeth)• Hypoallergenic resin supplement (per arch)• Repair• Repair (rebase)(per appliance)• Repair (addition of retainer)• Metal reinforcement• Repair (add piece to acrylic removable)• Provisional complete (one arch, upper or

lower)• Definitive complete with metal

reinforcement• Skeletal (per tooth)• Skeletal (base structure)• Flexible removable (from 1 to 3 teeth)

(Flexite, Valplast, others)

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• Flexible removable (from 4 to 6 teeth)(Flexite, Valplast, others)

• Flexible removable (more than 6 teeth)(Flexite, Valplast, others)

• Ceramic shoulder or neck (per tooth)

PERIODONTICSNon-surgical treatmens• Periodontal examination (periodontal

X-rays) (per arch)• Periodontal maintenance• Radicular scraping and smoothing (per

quadrant) (curettage)• Periodontal bracing (per tooth)• Radicular scraping and smoothing (per

tooth) (curettage)Surgical Treatmens• Gingivectomy (per quadrant)• Flap surgery (per tooth)• Regeneration with biomaterials (lyophilised

bone, etc.)(per unit 0.5g)• Membrane (unit)• Crown lengthening• Apical replacement flap (per quadrant)• Graft free gum• Mucogingival surgery

ORTHODONTICSSupplementary treatments• Study and diagnosis for orthodontics• Retention appliance with brace (end of

treatment)(per arch)• Retention appliance with lingual bar (end of

treatment)(per arch)• Revisions (in latency or resting periods)• Renewal mobile device, replacement or

loss• Appliance repairs (due to appliance

breakage)• Orthodontic microscrews (per unit)• 2nd replacement metal brackets (unit)• 2nd replacement ceramic brackets (unit)• 2nd replacement self-binding brackets (unit)• 2nd replacement sapphire brackets (unit)• 2nd replacement of cosmetic self-binding

brackets (unit)

Treatment with fixed appliances with metalbrackets• Start of one arch; upper or lower (including

first appliance)• Start of both arches (including first

appliances)

Treatment with fixed appliances with ceramicbrackets• Start of one arch; upper or lower (including


appliances)

Treatment with fixed appliances with sapphirebrackets• Start of one arch; upper or lower (including


appliances)

Treatment with fixed appliances withself-binding brackets• Start of one arch; upper or lower (including


appliances)

Treatment with fixed appliances with aestheticself-binding brackets• Start of one arch; upper or lower (including


appliances)

Treatment with fixed appliances with invisibletechnique• Start treatment under 12 months of age• Start treatment over 12 months of age

Interceptive treatment with fixed appliances• Start of one arch; upper or lower (including

first appliance - quad helix)• Start of both arches (including first

appliances)

Interceptive treatment with removableappliances• Start of one arch; upper or lower (including


appliances)

Mixed treatments: orthopaedic force with fixedappliances• Start of one arch; upper or lower (including


appliances)

Mixed treatments: orthopaedic force withremovable appliances

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• Start of one arch; upper or lower (includingfirst appliance)

• Start of both arches (including firstappliances)

DENTAL IMPLANTS• Implantology study• Implantology maintenanceDental implant surgery• Osteointegrated implant (unit)• Closed maxillary sinus lift• Open maxillary sinus lift• Regeneration with biomaterials (lyophilised

bone, etc.)(per unit 0.5g)• Biomaterial regeneration (block bone)• Membrane (unit)Guided surgery• Study guided implantological surgery• Supplement per implant in guided surgery

(unit)• Radiological guide• Surgical brace (for guided surgery)Prosthesis over implants• Crown over implant• Cosmetic crown over implant• Provisional crown over implant• Provisional crown for immediate charge• Titanium stump (per tooth)• Zirconia stump over implant (per tooth)• Overdenture on implants (per appliance)• Hybrid prosthesis (per arch)• Metal termination: supra or mesostructure

(unit)• Supplement for precious metal in implants• Prosthetic additament (intermediate pieces)• Prosthetic additament for immediate charge• Locator (unit)• Micromilled Bar (on 5 implants or fewer)• Micromilled Bar (on 6 implants or more)• Ackerman-type clip (per implant)• Attachment over implant (includes riders)

TEMPOROMANDIBULAR JOINTPATHOLOGY• Assembly and study of semi-adjustable

articulator• Revisions, brace adjustments• Selective carving• Neuromyorelaxation brace (Michigan type)• Stabilisation splint (single)

Europe Assistance

What is this?

This is an additional supplement to yourpolicy covering emergency illness or accidentabroad.

Wich services am I entitled to?

1. Medical Costs

By virtue of the contract signed with EUROPASSISTANCE, the company Sanitas, S.A. deSeguros guarantees the insured parties andall other beneficiaries of the policy, for theperiod of its validity, healthcare abroad undertheir responsibility to a limit of 12.000€ perperson and year for medical expenses(physicians, surgeons and hospitals/clinics)originating outside Spanish territory, whetherprovided by its own physician or physiciansauthorised by the Company, even whenprovided by physicians and hospitals outsidethe company.

What does it cover?

Expenses from doctors, surgeons, hospitalsand/or clinics outside Spain as a result ofmedical attention received abroad, derivedfrom an illness or accident occurring abroad.

• doctors' fees• drugs prescribed by a doctor or surgeon• emergency dentistry fees, excluding

endodontics, aesthetic reconstructionsfrom earlier treatments, oral cleaning,prothesis, crowns and implants, theseare covered by the previous amount up to amaximum of €241 per Insured.

• hospitalisation costs• costs for ambulance services requested by

a doctor for a local journey

What is not covered?

• doctors' fees abroad under €3• costs arising from the diagnosis or

treatment of a physiological condition(e.g. pregnancy) or an illness that wasknown about before the trip began,

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unless it is a clear or unforeseeablecomplication; treatments arranged inSpain; pregnancy costs incurred afterthe first 150 days

• costs of glasses, contact lenses,crutches and protheses in general

• direct or indirect consequences of thenucleo transmutation of the atom, andradiation caused by the artificialacceleration of atomic particles

• consequences arising from war,insurrections, uprisings, earthquakes,floods or volcanic eruptions

• assistance or aid due to participation inany kind of competitive motor event(race or rally)

Limits

12.000€ per person and year.

2. Extended hotel stay for anaccompanying person due tohospitalisation of the Insured

When the Insured has to be admitted tohospital on a doctor's orders and inaccordance with the EUROP ASSISTANCEmedical service, EUROP ASSISTANCE shallreimburse the costs arising from a requiredextended hotel stay for the accompanyingperson - also insured - to a maximum of €60per day for a total of 10 days

3. Transport of ill or injured persons

What does it cover?

If the Insured becomes ill or is accidentallyinjured during the term of the Agreement,EUROP ASSISTANCE shall take charge oftransporting the insured under medicalsupervision, by the following means,according to the severity of the illness orinjury:

• air ambulance (aircraft)• air ambulance (helicopter)• scheduled flight• first-class sleeper train• ambulance – or sledge if injured on a ski

slope

The choice of means of transport and of thehospital to which the member shall beadmitted shall be based solely on medicalgrounds in the discretion of the EUROPASSISTANCE medical team


• complaints or injuries that can betreated on site which do not prevent thetrip from continuing

• mental and chronic illnesses causingalterations in the Insured’s health

• relapses and convalescence forunhealed conditions or those beingtreated at the time the trip began

• pregnancies , although clear orunforeseeable complications in the first 150days are covered.

4. Family member's travel and stay toaccompany the Insured in hospital

If the Insured needs to be hospitalised on thetrip for more than five days and he/she has nodirect family member with him/her, EUROPASSISTANCE shall provide a family memberresident in Spain with a return economy-classair fare with a regular airline or first-class railticket. EUROP ASSISTANCE shall pay up to€60 euros per day for up to five day s inrespect of hotel accommodation and stayexpenses.

5. Transport in the event of death

In the event of death of the Insured, EUROPASSISTANCE shall arrange and take chargeof transfer of the coffin to the place of burial inhis or her place of residence, includingminimum mandatory expenses for coffin,embalming and administrative formalities.EUROP ASSISTANCE shall not pay thefuneral and burial costs. On applicationfrom the beneficiaries, EUROP ASSISTANCEshall bear the cost of cremation at the placeof death and transfer of the ashes to the placeof burial in his or her place of residence.EUROP ASSISTANCE shall not pay thefuneral and burial costs.

6. Early return of insured accompanyingrelatives

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If t Insured has been transported in theevent of death as specified in the guarantee"Transport in the event of death", and thiscircumstance prevents the insuredaccompanying family members from returninghome by the means originally arranged,EUROP ASSISTANCE shall bear the costscorresponding to the transportation of sameto their place of residence in Spain.Maximum of two adults and accompaniedunder 14s.

7. Accompanying children

If, during the term of the contract, Insuredpersons travelling with disabled persons orchildren under 14 years of age cannot lookafter them due to sudden illness or accidentcovered by the Policy, EUROP ASSISTANCEshall arrange and cover the costs of outboundand inbound travel of a person residing inSpain named by the Insured or his/her family,or an EUROP ASSISTANCE stewardess toaccompany children on their return to theirhabitual residence in Spain as fast aspossible.

8. Search and retrieval of luggage andpersonal belongings

If the Insured has his/her luggage delayed orlost, EUROP ASSISTANCE shall help in itssearch and retrieval, advising on how to filethe corresponding formal complaint. If theluggage is retrieved, EUROP ASSISTANCEshall send it to the Insured’s habitualresidence in Spain, providing the presence ofthe owner is not required for its recovery.

9. Dispatch of documents and personalbelongings overseas

EUROP ASSISTANCE shall organise and paythe postage of essential items for the journeywhich have been left at home (contact lenses,prosthetics, spectacles, credit cards, drivinglicence, ID card and passport). This serviceextends to posting the same items home ifthey have been left behind on the journey orrecovered after theft.

EUROP ASSISTANCE shall only organisethe dispatch and postage for parcelsweighing no more than 10 kilogrammes.

10. Advance of funds

EUROP ASSISTANCE shall advance funds ofup to €1,500 to the Insured, when required.EUROP ASSISTANCE shall require somekind of special guarantee ensuring theInsured’s repayment of the advance. In anyevent, the amounts advanced shall bereturned to EUROP ASSISTANCE within amaximum period of 30 days.

11. Legal advice

If the Insured is incarcerated or prosecuted asa result of a traffic accident, EUROPASSISTANCE shall pay up to €1,500 forlawyer and attorney fees incurred from legalassistance provided. If this service iscovered by the Motor Insurance Policy, itshall be considered an advance andEUROP ASSISTANCE shall reserve theright to request a special guarantee fromthe Insured to ensure payment of theadvance.

12. Advance of the amount for baildemanded abroad

If the Insured is prosecuted or incarcerated inthe country in which it arises, EUROPASSISTANCE shall issue an advance equalto the amount of bail demanded by the localauthorities to a maximum of €10,000.

Europ Assistance reserves the right torequest a special guarantee from the Insuredto ensure repayment of the advance. In anyevent, the amounts advanced shall be repaidto EUROP ASSISTANCE within a maximumperiod of two months.

13. Dispatch of medication

What does it cover?

If the Insured needs a drug prescribed tohim/her by a physician and unavailable athis/her present location, EUROPASSISTANCE shall locate and send themedication by the fastest available means,subject to local laws and regulations.


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This cover excludes events ofdiscontinued manufacture of themedication or unavailability from normaldistribution channels in Spain. TheInsured shall reimburse EUROPASSISTANCE for the price of themedication against presentation of invoice

14. Transmission of urgent messages(relating to covers)

EUROP ASSISTANCE shall use a 24-hourservice to accept and transmit urgentmessages from the Insured if they have noother means to send such messages andprovided the messages are consequent on acover under the Agreement.

15. Time frame

This supplement covers travel up to 90consecutive days only.

16. Use of services

This supplement is an addition to the InsuredParty’s Healthcare Assistance InsurancePolicy and is not valid if not accompanied bythe latter. The General Terms and Conditionsof the Healthcare Assistance Policy areapplicable to all the guarantees and servicesincluded in this supplement.

To be eligible to use all the services includedin this additional supplement to the TravelAssistance Policy, the Insured Party must beup to date with all their obligations to theInsurance Provider. The services shall berendered through the means granted byEurop Assistance; therefore, the InsuredParty must contact said entity at the phonenumber indicated on the back of his/her cardso that the matter can be managed by theInsured Party at no cost to him/her to theextent that it is covered by the insurancepolicy. In the event of a life-threateningemergency, the Insured Party shall report tothe nearest clinic or hospital and report theevent to Europ Assistance within a period of 7days of the date of admission.

Coverage rent

1. OBJECT OF THE INSURANCE OFTHE COMPLEMENTARY COVERAGERENT

Within the limits and conditions established inthe Policy, and following payment by thepolicyholder of the corresponding Premium,SANITAS assumes the payment of anindemnification for each day of internment ofthe Insured in hospital or clinic if as aconsequence of an acquired illness oraccident suffered during the validity of thisbenefit and covered by it, the Insured had tobe necessarily interned in a hospital forhis/her due medical or chirurgic treatment, aminimum of 24 hours, due to:

a) Illness of the Insured that needs hospitalcare.

b) Chirurgic intervention of the Insured

c) Accident of the Insured.

The daily indemnification shall be asestablished in the particular conditions andshall be earned from the first day of hospitalinternment and during all the time that theInsured is registered as interned in ahhospital or clinic until his/her documentedhospital discharge and with a maximum of365 days. If within the period of the twelvemonths following a hospitalization of theInsured, due to which he/she has earned anindemnification, the Insured hat to behospitalized again for the same or aconsequent or related cause, the newinternment shall be considered as aprolongation of the previous, to the effect ofthe calculation of the above established limitof 365 days.

For the cases in which the Insured sufferedseveral illnesses at the same time, or a newillness ensued the daily indemnification to bepaid by SANITAS shall be that indicated inthe corresponding Particular Conditions.

In this last case, SANITAS shall be informedin writing of this circumstance. If this new

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illness had no relation with the previousprocess, a new term shall start to count fromthe date that the new illness has started.

2. EXCLUDED RISKS

The following risks shall be excluded fromthe present coverage:

2.1. The direct provision by SANITAS ofmedical, hospital or surgery services.

2.2. The indemnification for hospitalizationdue to problems of social type.Also theindemnification for hospital internment isexcluded when a consequence of:

2.3. All types of preexisting and/orcongenital illnesses, defects ordeformities occurred before the date ofenrollment of each Insured in the Policy,as well as those that can derive fromthose, providing they were known bySANITAS or Insured and not declared.

The Policyholder, in his/her name and inthe name of the beneficiaries and/or eachof them, is obliged to manifest in themoment of subscription of the insuranceproposal/application, if they suffer or havesuffered any type of injuries or illnesses,especially those of a recurrent character,congenital or that need or have neededstudies, diagnosis tests or any type oftreatments; or if at the time of subscriptionof the policy they suffered symptoms orsigns that could be considered as thebeginning of any pathology.

Manifesting in such form, the conditionshall be considered as preexisting and/orcongenital and, as a consequence,excluded from the coverages agreed in theinsurance contract. If there werepreexisting and/or congenital illnesses,SANITAS preserves the right to accept orrefuse the enrollment of the applicant orapplicants, and in case of accepting, thecorresponding clause of exclusion shallbe included in the Particular Conditions ofthe Policy in what refers to theindemnification as a consequence of

preexisting and/or congenital illnesses,defects or deformities present before thedate of enrollment of each Insured in thePolicy; as well as those that can derive ofthose.

2.4. All illnesses or injuries produced as aconsequence of civil, international orcolonial wars, invasions, insurrections,rebellions, acts of a terrorist character inany of its forms (chemical, biological,nuclear, etc.), revolutions, mutinies,uprisings, repressions and militarymaneuvers, even in time of peace, andofficially declared epidemics.

2.5. Illnesses, accidents, injuries,malformations or defects that have adirector indirect elation with nuclearradiation or radioactive contamination, aswell as those arising from cataclysmssuch as earth quakes, floods, volcaniceruptions and other sysmic ormeteorological phenomena.

2.6. The illnesses, injuries, malformationsor defects derived from working,professional and sport competitionaccidents, those derived from the use ofmotor vehicles covered by the CompulsorySubscription of Automobile Insurance.

2.7. The illnesses or injuries derived fromchronic alcoholism, drug addiction,intoxication due to alcohol, psychotropics,narcotics or hallucinogens abuse, suicideattempt and self injuries, as well as Healthcare due to illnesses or accidents suffereddue to dolo of the Insured.

2.8. The illnesses or injuries derived of theinfection of the Human ImmunodeficiencyVirus, AIDS, and the illnesses related withthis.

2.9 The illnesses or injuries producedpracticing as amateur risky sports, suchas aerial activities, speed or endurancetests with motor vehicles, bobsleigh, waterdiving, climbing, boxing, bull fighting,

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martial arts, rugby or any other activitywith a similar risk.

2.10. Illnesses or processes of a chroniccharacter.

2.11. All those diagnostic, surgical ortherapeutic processes whose clinicsecurity and efficacy are not dulyscientifically contrasted or that are of newappearance, not expressly included in thepresent policy. Those procedures nonconsolidated in the habitual clinicalpractice and those that have manifestlybeen overcome by others available.Equally those procedures of anexperimental character or that theireffective contribution to the prevention,treatment or healing of illnesses is notsufficiently proved.

2.12. The indemnification for services ortechnics that consist in mere activities ofleisure, rest, comfort, or sport, as well astreatments in spas and rest cures.

2.13. The interventions, infiltrations andtreatments, as well as any otherintervention that has a purely cosmetic oresthetic character.Also, the treatment ofany type of pathology or complication thatmay arise at a later stage and that aredirectly and/or principally caused due tothe submission of the insured to anintervention, infiltration or treatment of theabove mentioned of a purely esthetic orcosmetic nature are excluded.

2.14. Treatments and interventionsdirected to solve the sterility or infertility inboth sexes (in vitro fertilization, artificialinsemination, etc.) and the voluntaryinterruption of pregnancy. The study,diagnosis and treatment of impotency isalso excluded.

2.15. Any process that requires for itstreatment the use of psychology,psychoanalysis, hypnosis, psychotherapy,narcolepsy, sleep cure and educativetherapy, such as speech education or

special education in sick persons withpsychic affectations.

2.16. The indemnif ication forhospitalization as a consequence ofchirurgic technics or therapeutictreatments that use laser, exceptphotocoagulation technics inOphtalmology.

2.17. General medical examinations of apreventive character.

2.18. Determinations of the genetic map,that have the finality of knowing thepredisposition of the Insured or of his/hercurrent of future offspring to suffer certainillnesses related with genetic alterations

2.19. The indemnification for hospitalinternment as a consequence ofpregnancy, child delivery and caesarean,together with their possible complications,unless otherwise agreement included inthe Particular Conditions of the Policy.

3. WAITING PERIODS

All coverages shall enter into force once it hastaken effect on the date expressly indicated inthe corresponding Particular Conditions, andonce the following waiting periods haveelapsed:

4. LIMITATIONS DUE TO PATHOLOGY

The maximum indemnification for thefollowing cases shall be:

• Mental or nervous illnesses: anindemnification shall be paid to the Insuredcorresponding to the days he/she stays

• For the rent for illness that requires surgical intervention: 8 months

• For the rent for hospitalization without intervention: 8 months

• For the rent for the additional guarantee for child delivery: 8 months

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admitted in hospital, with a maximum of20 days per Insured and annuity .

• Disease of backbone: an indemnificationshall be paid to the Insured correspondingto the days he/she stays admitted inhospital, with a maximum of 30 days perInsured and annuity .

• Indemnification for child delivery orcaesarean: the Insured shall have the rightto the indemnification with a maximum of6 days per Insured and annuity , if shehad to stay admitted in hospital orsanatorium.

5. SPECIAL CASES

• Stay in I.V.U..or I.C.U.: In case that theInsured needs to be admitted in I.V.U. orI.C.U., he/she will receive double of thecontracted insured daily amount whilehe/she stays in one of these units..

• Admittance of the Insured in otherprovince: Fort he admittance of theInsured in a hospital facility situated in aprovince different from that of his/herhabitual address indicated in the policy,he/she shall receive fifty per cent (50%)more tan the contracted insured dailyamount while he/she stays admitted in suchfacility.

• Convalescence: Fort he admittance of theInsured due to a surgical interventionhe/she will receive fifty per cent (50%) moreof the contracted insured daily amountwhile he/she stays admitted in such facility.

• Whenever a hospital admittance isproduced, without Sanitas having to pay,under the insured guarantee of the Healthcare policy the expenses related with suchadmittance, the insured shall receivedouble of the contracted insured dailyamount expressly indicated in the particularconditions for this coverage.

6. TRANSACTION IN CASE OFSINISTER

For the transaction of a covered sinister thefollowing rules have to be fulfilled:

6.1. The Insured or any person in his/hername must communicate the hospitaladmittance, surgical intervention and ingeneral any insured medical service within themaximum term of seven (7) days since thedate of acknowledgement, unless a longerterm has been fixed.

In the case of surgical intervention orprogrammed hospital admittance, he/shemust communicate such circumstance to theInsurer from the moment that he/she has theknowledge of the date in which such surgicalintervention or hospital admittance will takeplace and in any case within the maximumterm of seven (7) days from which he/she hasknown it.

6.2. Together with the communication ofillness or accident, the Policyholder or theInsured shall send to SANITAS a medicalreport in which the diagnosis and nature ofthe illnesses shall be specified, as well as themedical center, date of admittance, probableduration of the hospitalization, being itindispensable that the part related with theillness is written and signed by the physicianthat treats the patient.

6.3. Once the hospitalization has finished, thePolicyholder or, in its case, the Insured, mustsubmit to SANITAS the followingdocumentation:

6.3.1. Application for indemnification form,duly completed and broken down, where thefollowing is shown:

a) The person to whom the hospital care hasbeen delivered.

b) The nature of the performed medical act oracts and their dates..

c) Identification of the individual or legalperson that has delivered the care (clinic,hospital, etc.), recording, if such is the case,

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the surname, name or company namecustomer, address, corporation number andtax identification number (N.I.F.).

If the mentioned form is not available, thenotice of the sinister can also be sent toSANITAS by written notice where the abovementioned data are recorded.

6.3.2 Original medical prescriptions of thehospital care delivered to the Insured.

6.3.3 Hospital discharge report where thedate of admittance and the date of dischargeare recorded, as well as information about theillness’s process and its evolution.

6.4. When care continuity is required, thePolicyholder or in its case, the Insured, mustsubmit to SANITAS, besides the form ofindemnification application and the medicalprescription, as it is described in the formerpoints of the present clause, a medical reportwhere the need for such care continuity isindicated.

6.5. The Insured must also follow faithfully allprescriptions of the physician in charge ofhis/her healing and must provide SANITASwith all types of information about thecircumstances or consequences of thesinister.

6.6. The Policyholder or the Insured or theirrelatives must allow that physiciansdesignated by SANITAS visit the Insured asmany times as SANITAS considers itnecessary, as well as any enquiry orascertainment about his/her state of healththat SANITAS considers necessary.

The nonfulfillment of the rules established inthe six previous points shall be considered asexpress waiver to the indemnificationcollection, unless it has not been possible tofulfill them for reasons not attributable to thePolicyholder’s, Insured’s or their relatives’wills.

If such is the case, the expenses attributableto the translation into Spanish of thecorresponding documents (invoices, reports,

etc.) written in other languages shall be on theaccount of the Insured.

7. FORM OF PAYMENT OF THESINISTERS

The amounts due by SANITAS by virtue ofthis coverage shall be made affective to theBeneficiary once all the requireddocumentation has been received and allappropriate ascertainments have been madeby SANITAS, to establish the existence of thesinister.

SANITAS shall make, on the next 40 daysfollowing the reception of the sinisterdeclaration, the payment of the minimumamount of those that SANITAS may oweaccording to the circumstances by it known(article 18 of the Insurance Contract Law).

SANITAS shall pay the indemnificationaccording to what is established in theprevious conditions.If in the term of threemonths since the occurrence of the sinisterSANITAS has not paid the amount due to anon justified cause of that was attributable toit, the indemnification shall be increased inthe money legal rate valid on the moment itwas earned, increased by 50 per 100. Theserates shall be considered as produced bydays, without the need of judicial claim.Nevertheless, once 2 years have elapsedsince the occurrence of the sinister, theannual rate cannot be less than 20 per 100(article 20 of the Insurance Contract Law).

In the case that due to delay of SANITAS inthe payment of the amount of theindemnification turned uncontestable, theInsured was forced to claim it judicially, thecorresponding indemnification shall beincreased by the rate established inparagraph above this, together with theexpenses of the process, according to article38, paragraph 9 of the Insurance ContractLaw.

After the communication of each sinister,causing or not the payment of anindemnification, the parts can terminatethe agreement, The part deciding thetermination, must notify the other in

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writing within the term of 30 days since thedate of communication of the sinister, ifthere was no cause for theindemnification, or since the settlement, ifthere was cause to it, being it compulsoryto make the notification at least with aminimum of 15 days’ notice to the date ofeffectiveness of the termination.

If the decision of terminating the contract istaken by the Policyholder, SANITAS will keepthe premiums corresponding to the period incourse, and if it was taken by SANITAS, itmust reimburse to the Policyholder the part ofPremium corresponding to the time betweenthe date of effect of the termination and thedate of expiration of the period of insurancecovered by the paid Premium.

8. DURATION

8.1. Only persons that, on the date ofenrollment have an age comprised between 0and 75 years, can be included as Insured inthe present coverage.

8.2. The contracted coverages shall not beeffective until the first Premium receipthas been paid.

Geographical scope

The coverages of the present guarantee shallbe effective WORLDWIDE, providing theInsured has his/her habitual addressestablished in Spain, not with standing theprevious, the indemnifications shall be madeeffective in Spain and in euros.

Accidents or illnesses acquired in countriesand/or unexplored regions shall be excluded.

9. CONTROVERSIES

9.1. In case of disagreement about the natureof an illness and/or the amount of theindemnification, each party shall appoint anexpert, whose acceptance must be expressedin writing. If one of the parties has not madeits designation, it is obliged to make it in thenext eight days following the date on which ithas been required by the party that has madeits designation, and if it does not make it in

this last term, it is understood that it acceptsthe opinion issued by the other party’s expert,being bound by it.

9.2. In case the Experts come to anagreement, it shall be recorded in a joint act,in which the causes of the sinister, theassessment of the damages and othercircumstances that affect the determination ofthe amount of the sinister shall be recorded.

9.3. When there is no agreement between theexperts, both parties shall jointly appoint athird expert and, if there is no agreement, thedesignation shall be made by the FirstInstance Judge, in voluntary jurisdiction actand following the procedure established forthe choice of Expert of the Civil ProsecutionLaw. In this case, the expert report shall beissued in the term established by the partiesor, in its defect, in the term of thirty dayscounted from the acceptance of itsdesignation by the third Expert.

9.4. The opinion of the experts, by unanimityor by majority, shall be notified to the partiesimmediately and in undoubtedly form, being itbinding for them, unless it is judiciallycontested by any of the parties within the termof thirty days, in case of SANITAS and of onehundred and eighty days in case of theInsured, counted both from the date of itsnotification,.If the corresponding contestationwas not made in such terms the opinion shallbecome uncontestable.

9.5. If the opinion of the Experts was notcontested, SANITAS must pay the amount ofthe indemnification indicated by the Experts inthe term of five days.

9.6. In the case that due to delay of SANITASin the payment of the amount of theindemnification that has becomeuncontestable the Insured was forced to claimit judicially, the corresponding indemnificationshall be increased with the annual rate legallyestablished that in this case shall start toaccrue since the opinion turned uncontestablefor SANITAS and, in any case, with theamount of the expenses caused to theInsured by the process to whichindemnification shall make express

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condemnation the sentence of any judicialprocedure that was applicable.

Each party shall pay the fees of its expert.The fees of the third expert and rest of theexpenses caused by the expert assessmentshall be borne by half by the Insured and bySANITAS.

Nevertheless, if any of the parties had madethe assessment necessary by maintaining anassessment manifestly disproportionate, itshall be the only responsible of suchexpenses.

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COMPLEMENTARYCOVERAGES OF YOURINSURANCE

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Accidents Cover

1.PURPOSE OF THE INSURANCE

Within the limits and conditions established inthe policy and following payment by thePolicyholder of the corresponding Premium,SANITAS covers the payment of theindemnifications that are mentioned in thispolicy, as a compensation for bodily injuriescaused by accidents that can occur to theinsured in the performance of the professionor occupation that is indicated in this policyorin the performance of any other activity ofhis/her ordinary life that does not have aprofessional character. Accident is defined asthe bodily injury stemming from an external,sudden, violent cause, external and beyondthe Insured’s intention that produces death orpermanent disability and that causes thepayment of the Policy’s benefits. Accidentsalso include the injuries caused while theInsured is practicing any sport as amateur,except those expressly excluded from thispolicy.

SANITAS guarantees the payment of thecorresponding capital, whenever suchComplementary Guarantee has beencontracted and this is recorded expressly inthe Particular Conditions of the policy.

2.COVERED RISKS

a) Death due to Accident of the Insured:

Death due to accident of the Insured isdefined as that produced by any bodily injurystemming from thhe direct action of anexternal, sudden violent cause, beyond theInsured will that is covered by the Policy andthat causes his/her death within the next twoyears counted from the date he/she sufferedthe accident, providing the death occursduring the validity of the present policy andthe Beneficiary proves to SANITAS that thedeath of the Insured is a direct consequenceof the accident he/she suffered.

b) Permanent Disability :

If as a consequence of an accident coveredby the policy the disability of the Insured wascaused, immediately or within the period ofone year since the date of its occurrence,SANITAS shall pay the Insured theindemnification specified in the presentconditions, according to the coefficient ofsuch disability.

It is expressly recorded that the permanentdisability coefficients that are included in theguarantees are those indicated below:

• Total permanent disability, being that, thesituation due to which the Insured remainscompletely disabled to perform anyremunerated profession or occupation, as aconsequence of an accident.

• Partial permanent disability, when thedisability, although being permanent, doesnot reach the level of total for anyprofession or occupation, shall turn into apartial permanent disability and in this casethe company shall pay the percentagesindicated in the scale established in theclause indicated after Guarantees andInsured Capital.

This complementary cover will not beavailable to be contracted separately from theprincipal illness insurance.

3. EXCLUDED RISKS

Together with the risks excluded from theGeneral Conditions of the policy, the followingaccidents are also excluded from the cover ofthe present Complementary Guarantee:

3.1. Those occurred in doings notoriouslydangerous or criminal committed by theInsured, including the attempted,frustrated or consummated suicide, aswell as his/her participation in bets,challenges or quarrels, except in provencases of legitimate self-defense andattempt to save persons or goods.

3.2. Those occurred as a consequence ofcivil, international or colonial wars,invasions, insurrections, rebellions, actswith a terrorist character in any of theirforms (chemical, biological, nuclear, etc.) it

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revolutions, mutiny, uprisings,repressions and military maneuvers, evenin time of peace and officially declaredepidemics.

3.3. Those occurred whilst practicingboxing, rugby, bull fighting and bullrunning, martial arts, in endurance orspeed contests with motor vehicles,including training, fencing, othernotoriously dangerous sports and thosesuffered whilst practicing any sport as aprofessional.

3.4. Those occurred in state ofsomnambulism, manifested intoxication(alcoholic or toxic) mental alienation ordrugaddiction. The state of intoxicationshall be determined according to the Lawof Road Safety in force.

3.5. Those ensued as a consequence ofpregnancy or child delivery.

3.6. Those occurred due to sunstroke,freezing, burnings and other effects of theatmospheric temperature, unless they arethe consequence of an accident.

3.7. Those suffered as member of aerialcrew, or as passenger of helicopters orplanes of less than two engines.

3.8. Those occurred in unexplored regionsand/or travels that have the character of anexploration.

3.9. Those caused intentionally by theInsured, as well as any self-harm.

3.10. The intoxications, poisoning andhipersensitivity reactions due to theingestion of foodstuff or medicaments,and infections of a general character, suchas malaria, exanthematic typhus, sleepdisease, yellow fever and similar.

3.11. Diseases of any kind or nature, aswell as injuries and other sequels due tosurgical interventions or medicaltreatments not originated by an accidentcovered by the Policy.

3.12. Bodily injuries or complicationsrelated with an illness or morbid state(syncope, loss of conscience or similar)and hernias of any kind or nature as wellas their exacerbations, be them or not of atraumatic origin.

3.13. The rescue of persons in mountains,see or desert. In no case, SANITAS shallsubstitute the emergency aid organisms orpay for the costs of these services.

3.14. Those whose cover corresponds tothe Insurance Compensation Corporationas it is detailed in the Extraordinary RisksClause. Unless the contrary is expresslyestablished in the Particular conditionscorresponding to this guarantee and thecorresponding over Premium is paid, thefollowing shall not be covered:

a) Intervention in high tensión electriccurrents.

b) The practice as amateur of:

• Motocycles or moped driving.• Sailing or motor boats driving in high

seas.• Equestrian, polo, sky, alpinism and

caving.• Big gamehunting.• Under water diving.

4.DESIGNATION OF BENEFICIARY

The Policyholder can designate beneficiary ormodify the designation previously made,without SANITAS’ consent.

The designation of beneficiary can be madein the Policy, in a later written declarationcommunicated to SANITAS or in a will.

In case of death, the lack of expressdesignation by the Insured by writtencommunication sent to SANITAS, shall meanthat the beneficiaries of this guarantee inpreferred and exclusion order are thefollowing persons:

• Spouse and children of the Insured in equalparts.it

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• Parents of the Insured in equal parts.

• Brethren of the Insured in equal parts.

• Legal heirs.

In case of disability the insured sum shall bepaid to the Insured his/herself.

5. NON INSURABLE PERSONS

Persons under 14 years of age will not beable to appear as insured, according to whatis established in article 83 of the InsuranceContract Act. Also, this guarantee shall not beavailable for:

5.1. Persons over 65 years of age.

5.2. Persons affected by dementia, mentalalienation, blindness or strong myopia (morethan 10 diopters in one eye), deafness,paralysis, sequels of neurologic injuries,epilepsy, diabetes, alcoholism, drug addition,SIDA and/or positive HIV, spinal bone marrowillnesses, sleeping sickness and, in general,by any injury, illness or physical orpsychological disability that according toSANITAS’ criteria, diminishes their capacity incomparison with a person physically wholeand with normal health.

If any of these illnesses arise, the presentguarantee shall be considered asextinguished from that moment, reimbursingSANITAS the part of the Premium not earnedfrom the date SANITAS receives thenotification of such state.

6. GUARANTEES AND INSUREDCAPITAL

6.1. Death:

The amount of the indemnification shall bethe insured capital established in theParticular Conditions.

The payments that SANITAS may have madeunder the concept of permanent disability asa consequence of the accident that causesthe death of the Insured, shall be deducted ofthe indemnification due in case of death.

6.2. Total permanent disability:

The amount of the indemnification shall bethe insured capital established in theParticular Conditions for these cases:

• Loss or disablement of both arms or bothhands; of an arm and a leg; of an arm anda foot; of both legs or both feet

• Incurable mental alienation that disables forthe performance of a remunerated job

• Complete and permanent paralysis(tetraplegia)

• Absoluteblindness, incurable andpermanent

6.3 Partial permanent disability:

The amount of the indemnification shall bethe result of applying, on the Insured Capitalestablished in the Particular Conditions, thefollowing percentages:

Right Left

Removal of thelower jaw

30% 30%

Shortening of alower limb by atleast 5 cm

15% 15%

Amputation of 4fingers on onehand

10% 10%

Partial amputationof a foot and all itstoes

40% 40%

Unhealed fractureof a leg or a foot

25% 25%

Unhealed fractureof lower jaw

16,66% 16,66%

Unhealed fractureof a kneecap

20% 20%

Completefunctionalimpairment of aknee

16,66% 16,66%

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Completefunctionalimpairment of theelbow

16,66% 16,66%

Completefunctionalimpairment of theinstep of the footand ankle

16,66% 16,66%

Complete loss ofmovement of theshoulder joints

25% 20%

Total loss of wristmovement

20% 15%

Loss of a leg or afoot

50% 50%

Loss of indexfinger and othernonthumb finger ofhand

25% 20%

Loss of the middlefinger, ring or littlefinger of hand

10% 8%

Loss of the middlefinger, ring or littlefinger (two fingers)of hand

15% 12%

Loss of thumb andanother than theindex of hand

30% 25%

Total loss of arm orhand

60% 50%

Total loss of thumb 22% 18%

Total loss of indexfinger

15% 12%

Total loss of thethumb and indexfinger of hand

30% 25%

Total loss of threedigits includingthumb or indexfinger of hand

30% 25%

Total loss of threedigits that are notthumb or indexinfer of hand

25% 20%

If the Insured is left-handed, that must beconveniently declared in the InsuranceApplication, the percentage established forthe right upper limb shall be applied to the leftupper limb and inversely.

Forthe injuries not established, the coefficientof disability shall be established by analogywith the indicated coefficients, according tothe medical reports with respect to the strictphysical injury, without any consideration ofpersonal or professional type.

The disability coefficient to consider when thesame accident causes several anatomic orfunctional losses is calculated by adding thepercentages corresponding to each of themnot being possible that such coefficient canexceed of 100%. The sum of indemnificationpercentages, for several types of partialdisability, in the same limb or organ, cannotbe higher than the percentage established forthe total loss of such limb or organ.

If an organ or limb affected by an accidentalready suffered, before such accident, aphysic or functional defect since the sinister’s

Total loss ofanother toe of afoot

5% 5%

Total loss of aneye or sightreduced by half

30% 30%

Total loss ofmovement of a hipor knee

20% 20%

Total loss ofmovement of theright elbow

20% 15%

Complete rigidity ofthe spinal column

40% 40%

Completedeafness in bothears

60% 60%

Completedeafness in oneear

15% 15%

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occurrence, the coefficient of disability shallbe determined by the difference between thepreexisting and the defect resulting after theaccident.

The complete and irreversible loss of thefunctionality of one limb or one organ or theabsolute functional impotence of it, shall beinterpreted, regarding the effect of theinsurance, as equivalent to the anatomic lossof such limbor organ.

7. PROCEDURE TO FOLLOW IN CASEOF SINISTER

7.1.Death:

In case of accident, the Beneficiary has thefollowing duties and obligations:

7.1.1. Communicate SANITAS theoccurrence of the accident in themaximum term of 7 days and thecircumstances and consequences of it. Thecommunication shall be formulated in the fileof declaration of the sinister established for it,together with the following documents,common for all guarantees contracted thatare the object of these conditions:

a) Certificate of the physician that hasassisted the Insured in which thecircumstances and causes of the death shallbe detailed.

b) “Literal” certificate of the death registrationin the Civil Register.

c) Autopsy report where the results of thetoxicological report shall be recorded.

d) Documents that credit the personality andin case the condition of Beneficiary (unlessexpressly indicated in the particular conditionsof the policy).

e) Letter of exemption of the Inheritance Taxof the settlement if corresponding, dulycompleted by the Taxes Authorities.

The nonfulfillment of this obligation shallcause that SANITAS may claim any damagesoccasioned unless dolo or serious fault in

which case the right of indemnification shallbe lost according to the point Contract nullityand loss of rights.

7.1.2.Once the documents are received andconfirmed by SANITAS, the insured capitalmust be paid in the maximum term of 40 daysor, at least, the minimum amount thatSANITAS can owe according to thecircumstances known to SANITAS.

7.1.3. Not with standing the above mentioned,SANITAS remains authorized to retain thepart of insured capital in which, according tothe known circumstances, the tax debtresulting from the settlement of theInheritance Tax can be estimated.

7.1.4. If in the term of three months from theoccurrence of the sinister, SANITAS has notreimbursed its amount without a justifiedcause or a cause attributable to it, the amountSANITAS may owe shall be increased in thelegal rate of money valid n the date ofearning, increased in 50%. This interest shallbe produced on a daily basis, without theneed of a court claim. Nevertheless, once 2years have elapsed since the sinister’soccurrence, the yearly interest will not belower than 20 per 100 (article 20 of theInsurance Contract Act).

7.2. Permanent disability due to accident:

The determination of the coefficient ofdisability shall be made, according to thearticle 104 of the Insurance Contract Act, afterthe submission by the Insured, of the officialmedical report in which the sequels object ofevaluation are diagnosed, according to whatis established in the policy. SANITAS, if itconsiders it convenient, shall require theInsured in writing to be submitted to thecheckup of a physician designated bySANITAS, and after such checkup isperformed, and in the term of 15 days, shallnotify in writing to the Insured the amount ofthe indemnification that to SANITAS’ criteriacorresponds to him/her. If the Insured doesnot accept SANITAS’s proposal the partsshall submit to the expert opinion procedureestablished in the point Determination of theindemnification in case of disconformitybetween the parts.

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To receive the indemnification the Insuredmust communicate SANITAS theoccurrence of the accident in the maximumterm of 7 days, handing in all types ofinformation about its circumstances. Thecommunication shall be accompanied by thefollowing documentation:

a) Documentation of the social security wherethe coefficient of disability is specified.

b) Official medical report where thecircumstances and causes of the disabilityshall be detailed.

c) Documents that credit the personality and,in such case, the condition of Beneficiary.

d) Date of determination of the disability, thatshall be that indicated by the commission ofassessment of Disabling.

As a complement to the benefitscorresponding for permanent disability,SANITAS shall bear the cost of the firstorthopedic prosthesis that the Insured needsto be performed as a result of the guaranteedaccident not exceeding the amount of 10% ofthe base Insured capital for the case ofpermanent disability and up to the maximumamount of 601,01 euros.If in the coverage ofhis/her healthcare policy were there aneconomic limit less restrictive for suchprosthesis, the limit established in thisComplementary Guarantee shall not beapplicable.

8. GEOGRAPHICAL SCOPE

The covers included in this guarantee arevalid worldwide. The present guarantee will beextinguished if the Insured transfers his/herresidence abroad orif he/she does not live aminimum of six months per year in Spain.

9. CONCLUSION AND EFFECTS OFTHE GUARANTEE OF ACCIDENTS

9.1.This guarantee is concluded by theconsent, manifested by the subscription of thecorresponding Particular Conditions or of thetemporary document of coverage by thecontracting parties. The contracted coverage

and its modifications or additions shall not beeffective until the first premium receipt hasbeen paid, unless the contrary is agreed inthe Particular Conditions.

9.2. In case of delay in the fulfilment of any ofthese two requirements, SANITAS dutiesshall begin at 24 hours of the date in whichthey have been completed.

9.3. The guarantees object of these GeneralConditions enter into force at the time anddate established in the correspondingParticular Conditions.

10. DURATION OF THE INSURANCE

10.1. The duration of the presentcomplementary Guarantee of accidents shallcoincide with the policy of which it is a part.

10.2. Notwithstanding the above, thoseInsured that come to 70 years of age, will beexcluded from this guarantee on the date ofexpiry of the annuity in which they have cometo such age.

11. CANCELLATION IN CASE OFSINISTER

11.1. After the communication of eachsinister, causing it or not the payment ofan indemnification, the parties shall beable to cancel the present guarantee. Theparty that decides the cancellation, shallnotify the other party in writing in the termof 30 days counted from the date ofnotification of the sinister, if there was noindemnification to be paid or counted fromthe settlement if there was anindemnification to be paid, being itcompulsory to make the notification with aminimum of 15 days’ notice to the date inwhich the cancellation has to be effective.

SANITAS, once it knows the existence of asinister, shall check the causes and form ofoccurrence of it.

If the parties agree on the amount and form ofindemnification, SANITAS shall pay theagreed amount in the term established in thet

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point Procedure to follow in case of sinister ofthese conditions.

If the decision to cancel the presentguarantee is taken by the Policyholder,SANITAS shall keep the premiums of thecurrent period and if the decision was takenby SANITAS, it must reimburse thePolicyholder the part of the Premiumcorresponding to the period between the dateof effect of the cancellation and the date ofexpiry of the period of insurance covered bythe paid premium.

12. NULLITY AND LOSS OF RIGHTS

The guarantees object of these conditionsshall be null except in the cases establishedby the law, if at the moment of theirconclusion, there was no risk or the sinisterhad already occurred. The right forindemnification is lost:

12.1. In case of nondisclosure orinexactness when completing thequestionnaire, if there was dolo or seriousfault.

12.2. In case of aggravation of the risk, ifthe Policyholder or the Insured do notcommunicate to SANITAS or haveproceeded with bad faith.

12.3. If the sinister occurs before the firstPremium has been paid, unless otherwiseagreed

12.4. If the Policyholder or the Insured donot hand in to SANITAS the informationabout the circumstances andconsequences of the sinister and dolo orserious fault have occurred.

12.5. Of the Policyholder or the Insured donot fulfill their duty to lessen theconsequences of the sinister and they doson with the clear intention of damagingor deceiving SANITAS.

12.6 When the sinister has been causeddue to bad faith of the Insured.

13. COVERAGE OF EXTRAORDINARYRISKS

Indemnification by the InsuranceCompensation Corporation clause of thelosses caused by extraordinary events inpersonal insurances.

According to what is established in theconsolidated text of the legal Statute of theInsurance Compensation Corporation,approved by the Real Decreto Legislativo7/2004, of 29 of October and modified by theLey 12/2006, of 16of May, the policyholder ofthose that must compulsory include thesurcharge in favour of the mentioned publicenterprise entity has the faculty to agree thecoverage of extraordinary risks with anyinsurance company that meets therequirements established by the regulations inforce.

The indemnifications caused by sinistersproduced by extraordinary events occurred inSpain and that affect risks there located, andalso occurred abroad when the insured hashis/her habitual residence in Spain, shall bepaid by the Insurance CompensationCorporation when the policyholder has paidthe corresponding surcharges on its favor andany of the following circumstances occur:

a) That the extraordinary risk covered by theInsurance Compensation Corporation is notcovered by the insurance policy contractedwith the insurance entity.

b) That, being covered by such insurancepolicy, the obligations of the insurance entitycan not be fulfilled because the entity hasbeen declared judicially in bankruptcy orbecause it is submitted to a settlementprocedure intervened or assumed by theInsurance Compensation Corporation

The Insurance Compensation Corporationshall adapt its proceedings to what isestablished in the mentioned Legal Statute, inLaw 50/1980,of 8 of October, of InsuranceContract, in the Regulation of extraordinaryrisks insurance, approved by Real

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Decreto300/2004, of 20 of February, and incomplementary regulations.

SUMMARY OF LEGAL REGULATIONS

1. Covered extraordinary events

a) The following nature phenomena:earthquakes and seaquakes, extraordinaryfloods (including sea attacks), volcaniceruptions, atypical cyclonic storm (includingextraordinary winds of gusts higher than120km/h, and tornados) and meteorites.

b) Those violently caused as a consequenceof terrorism, rebellion, sedition, mutiny andpopular tumult.

c) Events or proceedings of the Army or of theSecurity Forces in times of peace.

2. Excluded risks

a) Those that do not produce the right toan indemnification according to the Law ofInsurance Contract.

b)Those caused in goods insured in aninsurance contract different than those inwhich the surcharge in favor of theInsurance Compensation Corporation iscompulsory.

c) Those due to vice or own defect of theinsured object or to its manifest lack ofmaintenance.

d)Those produced by armed conflicts,even if the official war declaration doesnot precede.

e) Those produced by nuclear energy,notwithstanding what is established inLaw 25/1964, of 29 of April, about nuclearenergy.Notwithstanding the abovementioned, direct damages caused in aninsured nuclear facility are included whenthey are consequence of an extraordinaryevent that affects the facility.

f) Those produced by the mere lapse oftime and, in case of goods totally orpartially submerged permanently, those

attributable to the mere action of surf orordinary currents.

g)Those produced in nature phenomenadifferent from those indicated in article 1of the Regulation of extraordinary riskinsurance and in particular, thoseproduced by the elevation of the phreaticlevel, slope movement, land glissade orsettlement, rock detachment and similarphenomena, unless those were causedmanifestly by the action of rain water that,on its turn, had caused in its zone asituation of extraordinary flood and wereproduced simultaneously to such flood.

h)Those caused by tumultuous actionsproduced in the course of meetings anddemonstrations performed according towhat is established in Organic Law 9/1983,of 15of July, regulating the right to meet aswell as during the course of legal strikesunless such actions could be qualified asextraordinary events according to article 1of the extraordinary risks insuranceRegulation.

i) Those caused by bad faith of theInsured.

j) Those derivative of sinisters whichoccurrence has taken place during thewaiting period established in article 8 ofthe extraordinary risk insuranceRegulation.

k) Those corresponding to sinistersproduced before the payment of the firstPremium or when, according to what isestablished in the Insurance Contract Act,the coverage of the InsuranceCompensation Corporation is suspendedor the insurance becomes extinguisheddue to lack of Premium payment.

l) Indirect risks or losses derivative ofdirect or indirect damages, different frombenefit loss established in theextraordinary risks insurance Regulation.Particularly, this coverage does notinclude damages or losses suffered as aconsequence of cut or alteration in the

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external supply of electric energy,combustible gases, fuel-oil, gasoil or otherfluids, or any other indirect damages orlosses different of those mentioned inparagraph above this, even if thesesalterations derive from a cause included inthe coverage of extraordinary risks.

m) Sinisters that due to their magnitudeor seriousness are qualified by theNation’s Governement as a “nationalcatastrophe or calamity”.

3. Deductible:

In case of direct damages (exceptautomobiles and dwellings and theircommunities), the deductible on the accountof the Insured shall be of a 7 per cent of theamount of the compensable damagesproduced by the sinister. In case of thecoverage of loss of benefits, the deductible onthe account of the Insured shall be thatestablished in the policy for the loss ofbenefits in ordinary sinisters.

4. Extension of coverage

The coverage of extraordinary risks shallreach the same persons and insured sum thathave been established in the policy regardingthe ordinary risks. Nevertheless the policiesthat cover own damages in motor vehicles,the Corporation guarantees the total insuredrate even if the policy only guarantees a partof it.

PROCEDURE TO FOLLOW IN CASEOF COMPENSABLE SINISTER BY THEINSURANCE COMPENSATIONCORPORATION

In case of sinister, the Insured, policyholder,beneficiary or their respective legalrepresentative, directly through the insurancecompany or the insurance mediator, shallcommunicate, withn the term of seven dayscounted from the date of acknowledgement,the occurrence of the sinister, in thecorresponding regional office of theCorporation, depending on the place wherethe sinister took place.The communicationshall be made in the form established, which

is available in the web page of theCorporation (www.consorseguros.es), or in itsoffices or in the insurance company’s offices,to which the documents that, according to thenature of the injuries, is required, must beenclosed.

Also, rests and vestiges of the sinistermust be preserved for the expertexaminations and, in case of absoluteimpossibility, submit the probationdocuments of the damages, such asphotographs, notary affidavits, videos orofficial certificates. Equally, the invoicescorresponding to the wrecked goodswhose destruction cannot be delayed shallbe preserved.

All necessary measures to lessen thedamages shall be adopted.

The assessment of the losses derivatedfrom the extraordinary events shall bemade by the Insurance CompensationCorporation, not being this Corporationbound by the assessment made, if suchwas the case, by the Insurance Companycovering the ordinary risks.

To clarify any doubt that may arise about theprocedure to follow, the InsuranceCompensation Corporation has madeavailable the following number of insuredattention:902 222 665.

Cover in the United States

The covers under this Policy can be providedto the Insured in the United States viahealthcare facilities with agreements in placewith UHC, provided such services arepreviously approved by SANITAS, which willmanage and process the covered services.

Coverage in the United States extends to onehundred percent of medical expenses up tothe insurance limits per Insured and annualperiod indicated below:

• Total limit in the United States:30.000€.

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• Hospital care up to 24.000€, with a sub.limitfor childbirth of 1.500€.

• Outpatient care up to 6.000€.

This cover is provided under a partnershipagreement with UnitedHealthCare (UHC), andwill be without effect if that agreementterminates.

1. QUALIFYING PERIODS


• Psychology: 6 Months

• High complexity diagnosis tests: 6 Months

• Outpatient surgical operations: 3 Months

• Hospitalization and surgical operations different from outpatient care and those performed as inpatient, vasectomy and tubular ligation included: 10 Months

• The following Complex Therapeutical Methods: interventional cardiology/ hemodynamics; interventional radiology, radiotherapy and chemotherapy; and lithotripsy: 10 Months

• Child delivery or caesarean: 8 Months

Sanitas Dental Cover

1. Services included in yourpolicy:

In this type of services the Policyholder doesnot need to pay any amount to theodontologist.

The medical care covered will be onlyprovided by the doctors included in the list of

odontologists of the medical staffcorresponding to this policy.

This medical care will be provided only at theclinic of the odontologist, excluding expresslycare out of it.

The services and acts listed below are objectof coverage:

GENERAL AND PREVENTIVEODONTOLOGY• General dentistry consultation: examination

and diagnosis• Topical fluoride treatments• Oral cleansing/tartar removal• Treatment for dental sensitivity• Fissure sealer• Priority consultation in case of emergency

SURGICAL PROCEDURESExtractions• Simple extraction• Extraction of non-impacted third molars• Extraction of impacted third molar plus

dental cysts• Extraction of impacted tooth (not third

molar) plus dental cysts• Extraction of root remains• Extraction by odontosection• Postoperatory check-up (includes removal

of stitches)Minor surgery• Removal of epulis/small mucosal cysts• Drainage of gingival/paradontal abscesses• Apicoectomy• Dental cystOrthodontic surgery• Orthodontic fenestration (per tooth)

CONSERVATIVE DENTISTRY• Provisional obturation

COSMETIC DENTISTRYWhitening• Photoactivation whitening brace (for


CHILDREN’S DENTISTRY (patientsaged under 15 years)• Consultation• Buccodental education• Intraoral X-rays

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• Topical fluoride treatments• Fissure sealer• Oral cleansing/tartar removal• Extraction of deciduous teeth

PROSTHESIS• Occlusal analysis• Selective carvingFixed prosthesis• Recementation

PERIODONTICSNon-surgical treatments• Periodontal examination (periodontal

X-rays) (per arch)• Periodontal X-ray seriesSurgical treatments• Gingivectomy (per quadrant)

ORTHODONTICSSupplementary treatments• Consultation• X-ray study for orthodontics• Extraction of deciduous teeth• Simple extraction• Revisions (in latency or resting periods)• 1st replacement metal brackets• 1st replacement ceramic brackets• 1st replacement self-binding brackets• 1st repositioning sapphire brackets• 1st replacement of cosmetic self-binding

brackets• Orthodontics box (for treatments performed

at the same clinic)• Oral protector for orthodontics (for


DENTAL IMPLANTS• Implantology study• Implantology maintenance for treatments

covered under Milenium

I M A G I N G D I A G N O S I S :RADIOLOGY/OTHERS• Periapical/bite-wing/occlusal• Periodontal X-ray series• Lateral skull X-ray• Orthopantomography (panoramic)• Cephalometry• Photographs or slides• Computed axial tomography (dental CT

scan)

TEMPOROMANDIBULAR JOINTPATHOLOGY• Occlusal analysis• Selective carving

EMERGENCIESIn emergency cases, the policyholder shouldgo to the permanent emergency centres setout in the Practical Guide.

2. Services with a deductiblepayable by the Insured

a) The Insurer should accept the prescriptionand the relevant premium provided by theodontologist, and the policyholder shall paydirectly to the odontologist this premium forthe cost of the service requested.

b) The Policyholder will assume the cost ofthe appropriate services in compliance withthe schedule for premiums applicable at thetime provided.

c ) In case any change is made in the amountof the premiums supported by thePolicyholder, Sanitas shall notify the newpremiums to it two months in advance to theeffective date, and payment of the premiumshall involve accepting these changes.

d) The premiums of these services are set outin the Particular Conditions of the policy, andthese premiums will be supported by thePolicyholder. These services re as follows:

SURGICAL PROCEDURESMinor surgery• Frenectomy (upper or lower)Preprosthetic surgery• Vestibuloplasty (per quadrant)• Alveolar regularization (per quadrant)• Removal of torus (per quadrant)

CONSERVATIVE DENTISTRY• Filling / obturation• Reconstruction• Direct pulp coating• Indirect pulp coating

ENDODONTICS• Consultation for symptom treatment

(opening, instrumentation, and drainage)

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• Root-end filling material (MTA)• Fibreglass or carbon post• Monoradicular endodontics• Biradicular endodontics• Polyradicular endodontics• Monoradicular re-endodontics• Biradicular re-endodontics• Polyradicular re-endodontics

COSMETIC DENTISTRYWhitening• Custom tray tooth whitening (per treatment)• Dental bleaching by photoactivation (per

treatment)• Dental bleaching by photoactivation (per

tooth and session)• Combined dental bleaching photoactivation

plus brace)Dental reconstruction• Reconstruction of aesthetic composite front

(per tooth)• Intraoral repair of porcelain (per tooth)• Porcelain facing• Injected facing• Zirconia facing• Composite facing• Cosmetic bridge crown or unit over tooth

CHILDREN’S DENTISTRY (patientsaged under 15 years)• Obturation of deciduous teeth• Pulpotomy without reconstruction• Pulpectomy without reconstruction• Preformed metallic crown• Apical formation (full treatment)• Fixed space maintainer• Removable space maintainer• Bridge/crown/space maintainer removal

(per tooth)• Guided occlusion or occlusal pad (per

tooth)• Oral screen• Tooth reimplantation

PROSTHESIS• Assembly and study of

semi-adjustable articulator• Diagnostic polishing (per tooth)Fixed prothesis• Bridge/crown/space maintainer removal

(per tooth)• Inlay• Provisional resin crown• Bridge crown or unit on tooth

• Cosmetic bridge crown or unit over tooth• Precious metal supplement• Monoradicular cast stump• Multiradicular cast stump• Maryland support (unit)• AttachesRemovable prothesis• Removable acrylic (1 to 3 teeth)• Removable acrylic (4 to 6 teeth)• Removable acrylic (more than 6 teeth)• Hypoallergenic resin supplement (per arch)• Repair• Repair (rebase) (per appliance)• Repair (addition of retainer)• Metal reinforcement• Repair (add piece to acrylic removable)• Provisional complete (one arch, upper or

lower)• Definitive complete with metal

reinforcement• Skeletal (per tooth)• Skeletal (base structure)• Flexible removable (from 1 to 3

teeth)(Flexite, Valplast, others)• Flexible removable (from 4 to 6 teeth)

(Flexite, Valplast, others)• Flexible removable (more than 6

teeth) (Flexite, Valplast, others)• Ceramic shoulder or neck (per tooth)

PERIODONTICSNon-surgical treatments• Periodontal maintenance• Radicular scraping and smoothing

(perquadrant) (curettage)• Periodontal bracing (per tooth)• Radicular scraping and smoothing (per

tooth) (curettage)• Mucogingival surgerySurgical treatments• Flap surgery (per tooth)• Regeneration with biomaterials

(lyophilised bone, etc.) (per unit 0.5g)• Membrane (unit)• Crown lengthening• Apical replacement flap (per quadrant)• Graft free gum

ORTHODONTICSSupplementary treatments• Study and diagnosis for orthodontics• Retention appliance with brace (end of

treatment)(per arch)

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• Retention appliance with lingual bar (end oftreatment)(per arch)

• Renewal mobile device, replacement orloss

• Appliance repairs (due to appliancebreakage)

• Orthodontic microscrews (per unit)• 2nd replacement metal brackets (unit)• 2nd replacement ceramic brackets (unit)• 2nd replacement self-binding brackets

(unit)• 2nd replacement sapphire brackets (unit)• 2nd replacement of cosmetic self-binding

brackets (unit)

Treatment with fixed appliances with metalbrackets• Start of one arch; upper or lower (includes

first device)• Start of both arches (includes first devices)

Treatment with fixed appliances with ceramicbrackets• Start of one arch; upper or lower (includes


Treatment with fixed appliances with sapphirebrackets• Start of one arch; upper or lower (includes


Treatment using fixed appliances withself-binding brackets• Start of one arch; upper or lower (includes


Treatment with fixed appliances with aestheticself-binding brackets• Start of one arch; upper or lower (includes


Treatment with fixed appliances with invisibletechnique• Start of treatment under 12 months of age• Start of treatment over 12 months of age

Interceptive treatment with fixed appliances• Start of one arch; upper or lower (includes

irst device - quad helix)• Start of both arches (includes first devices)

Interceptive treatment with removableappliances• Start of one arch; upper or lower (includes


Mixed treatments: orthopaedic force with fixedappliances• Start of one arch; upper or lower (includes


Mixed treatments: orthopaedic force withremovable appliances• Start of one arch; upper or lower (includes


DENTAL IMPLANTSDental Implant surgery• Osteointegrated implant (unit)• Closed maxillary sinus lift• Open maxillary sinus lift• Regeneration with biomaterials

(lyophilized bone, etc.)(per unit 0.5g)• Biomaterial regeneration (block bone)• Membrane (unit)Guided surgery• Study for guided implantological surgery• Supplement per implant in guided

surgery(unit)• Radiological guide• Surgical brace (for guided surgery)Prosthesis over implants• Crown over implant• Cosmetic crown over implant• Provisional crown over implant• Provisional crown for immediate charge• Titanium stump (per tooth)• Zirconia stump over implant (per tooth)• Overdenture on implants (per appliance)• Hybrid prosthesis (per arch)• Metal termination: supra or mesostructure

(unit)• Supplement for precious metal in implants• Prosthetic additament (intermediate pieces)• Prosthetic additament for immediate charge• Locator (unit)• Micromilled Bar (on 5 implants or fewer)• Micromilled Bar (on 6 implants or more)• Ackerman-type clip• Attachment over implant (includes riders)

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TEMPOROMANDIBULAR JOINTPATHOLOGY• Assembly and study in semi-adjustable

articulator• Revisions, brace adjustments• Neuromyorelaxation brace (Michigan type)• Stabilisation splint (single)

Pharmacy Cover

This consists of reimbursing the amount fordrugs whose marketing is authorized by therelevant public body, provided that they arerequired for the treatment of conditionssuffered by the insured and which arecovered by the policy hereunder.

The reimbursement of this amount shall beperformed in the percentage set in theParticular Terms and Conditions and up to thelimit of the capital insured as specified in theabove Terms and Conditions, once theinsured submits the invoice in proof ofpayment of the drug and the doctor’sprescription.



• Reimbursement application for theabove mentioned medicaments : 4Months

Temporary Disability Cover

THE POLICYHOLDER OF THISINSURANCE IS:

SANITAS, S.A. DE SEGUROS with legaladdress in 28042 MADRID, Ribera del Loira,52, con CIF A-28037042.

THE INSURER COMPANY IS:

LA PREVISIÓN MALLORQUINA DESEGUROS, S.A., with legal address in 08036BARCELONA, Aribau, 168-170, entresuelo1ª, with CIF A08169013.

INSURED AN BENEFICIARIES:

The Policyholders, individuals, that, appearingin the list of Insured in the present collectivepolicy, are holders of insurance policiescommercially named as Profesionales, if theirage is between 16 and 65 years at themoment of contracting as such policyholderProfesionales, and providing they are enrolledin the Social Security, Mutuality or analogueInstitution that the applicable regulationsdetermine.

In any case, the Insured shall cease to beinsured on the date of expiry of the annuity ofinsurance in which he/she becomes 70 yearsof age.

INSURED AMOUNT:

Those indicated in the particular conditions ofthis policy .

COVERED RISKS

The Insurer is committed to guarantee theearning of the daily subsidy indicated in theParticular Conditions of this policy for a termextending from the 7º to the 365º daymaximum, according to what is regulated inthe present coverage, when the Insured isaffected by an alteration of his/her state ofHealth attributable EXCLUSIVELY to anillness (no accident, risk not object ofcoverage) that is not excluded in thiscoverage and that supposes the TOTALinterruption of his/her working or professionalactivity temporarily.

The definition and scope of the claim tothe effects of this contract is alien anddoes not follow the same definition andqualification criteria than the publicsystem and, therefore, the qualification ofthis is defined by the contents of thepresent insurance contract.

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APPLICABLE RULES FOR THEEARNING OF THE DAILY SUBSIDY.

a) In all illnesses or accidents, the Insuredmust receive consultant Health care andfollow in a continuous manner the medicaltreatment necessary for the process’ healing.

b) The illness must prevent temporarily theInsured, in a clinical explicable manner, theperformance of his/her working orprofessional activity in a TOTAL manner. Theright to earn the subsidy will cease on themoment on which the Insured can restarthis/her habitual professional or workingactivities, EVEN IN A PARTIAL MANNER,and even if he/she has not reached totalhealing.

Also, the earning of the daily subsidies shallcease from the moment in which it can bemedically diagnosed that the illness that hascaused the claim suffered by the Insured hasturned into a permanent disability for theperformance of the working or professionalactivity indicated in the policy.

c) The sum of days in which the daily subsidyfor illnesses of the Insured had been earned,that for any cause affect and/or are originatedby the same process, cannot be higher thanthe maximum term of 361 days, once thecontracted deductible of 7 days has beenapplied.

In the case that the Insured has notconsumed the maximum period of coverage,in a consecutive way or in different periodswith health intervals, and a new claim startedfor the same process or related causes, it willbe considered, to all effects, as an extensionof the previous claim. In these cases, the sumof all consumed periods cannot be higherthan the maximum term of coverage. Theabove mentioned shall not be applicable if 12months have elapsed between the dischargedate of the last claim and the leave of theconsecutive.

d) The daily subsidy to be paid by the Insurershall be of the amount indicated in theinsurance certificate, even in the case that theInsured suffered several illnesses at the sametime or a new illness overcame as a

consequence of the clinical course of that orthose initially declared.

In this last case, the Policyholder, Insured orBeneficiary are obliged to provide the Insurerwith a medical report informing of suchcircumstance. If the new overcome illnesshad as cause a different process to that orthose declared previously, a new term shallstart to count since the date in which the lastillness or accident has occurred.

QUALIFYING PERIODS

The contracted guarantees have a waitingperiod of 38 months without prejudice of thewaiting period established hereunder for thecase of pregnancy.

SPECIAL CASES WITH LIMITEDCOVERAGE PERIODS WITHRESPECT TO THE MAXIMUM TERMDESCRIBED IN THE PARAGRAPH“COVERED RISKS”

a) When the primary cause or causes ofthe illness suffered by the Insured arepregnancy, the maximum term of coveragethat the Insurer guarantees is LIMITED to45 days for the same annuity of contract,once the contracted deductible days areapplied if such is the case.In any case, theright to earn the subsidy shall cease onthe same date on which the delivery orcesarean of one or several newbornsoccurs, even if the Insured has notreached her total healing.Such subsidyshall have a waiting or lack of coverageperiod of 12 months counted from the dateof inclusion of the Insured in the policy.

b) The mental and behavioral illnessesand/or disorders that force the Insured tostay in an interrupted manner admitted ina psychiatric hospitalization area inhospitals and/or care residences, themaximum term of coverage that theInsurer guarantees is LIMITED to 90 daysfor the same annuity of contract, applyingif such is the case, the contracteddeductible days.

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EXCLUDED RISKS

The following risks are not object ofcoverage in the present contract:

a) The direct performance by the Insurer ofthe medical, surgical services and thepayment of the expenses of the medicaland pharmaceutical care, or any otheralteration of Health attributable directly orindirectly to an accident.

b) All alterations of a state of Health,chronic or not, injuries or defects with anorigin previous to the date of inclusion ofthe Insured in this policy.

c) All alterations of the state of Healthwhich cause is originated by civil orinternational war, those derived of nuclearor atomic energy unless it is a sequel or amedical treatment, the officially declaredepidemics and all risks officially declaredas catastrophic.

d) The illnesses produced in any case ofsport practiced with a professionalcharacter.

e) The illnesses which cause wasoriginated by the ingestion of alcoholicdrinks, drug addiction and suicide intents.As well as all alterations of the state ofhealth produced by medical acts ortreatments which the Insured hasundergone voluntarily and which primarycause or causes are not an illness or anaccident.

f) The abortion and child delivery.

g) The Immunodeficiency Syndrome (IDAS)and/or illnesses caused by the HumanImmunodeficiency Virus (HIV). Thefibromyalgia and the Chronic FatigueSyndrome.

h) Mental and behavioral illnesses and/ordisorders that do not force the Insured tostay in an uninterrupted manner admittedin a psychiatric hospitalization area of ahospital and /or care residence. All

illnesses and/or disorders caused ortriggered by stress are also excluded.

Also, all exacerbations, sequels,consequences and/or complications andtheir specific treatments related to alldescribed excluded risks, shall be alsoconsidered as EXCLUDED RISKS.

AGE LIMIT

The coverage of the present collective policyshall be applied exclusively to personswith an age below 70 years.

INSTRUCIONS IN CASE OF CLAIM

In order to have the right to earn thecontracted daily subsidies, the Insured must,within the term of 7 days counted from thedate of the claim, provide the Insurer, dulycompleted, with the following documents:Sinister Declaration, form that shall beprovided upon his/her application by theInsurer and that has to be completed in all itsparts, being it indispensable that the partrelated with the illness is extended and signedby the physician in charge of the patient. If thementioned form is not available, the notice ofthe claim can be provided to the Insurer inwritting where the following must be stated:

1. Number of policy2. Name of Policyholder3. Name, surname, age and address of theInsured.

To the mentioned writing notice, a reportissued by the physician assisting the patientmust be enclosed, indicating the illness, itscauses, if he/she must keep absolute homerepose or relative repose, if he/she hassuffered the illness before and on what date,if his/her illness prevents him/her fromperforming his/her working or professionalactivities in a total or partial manner, probabledate of initiation of the process, date on whichhe/she started to perform the assistance,prognosis in what refers to the illness’sduration and, last of all, date on which thereport is issued.

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Once the Sinister Declaration is received, TheInsurer can dispose the inspection visits thatit considers convenient to check the Insured’sstate of Health, whenever none of theconsultants that assist the patient oppose tothese, remaining the Insured with theobligation to provide the Insurer with themedical reports required by the latter for thecorrect assessment of the claim.

The date on which the Insured isdischarged shall not earn any dailysubsidy.

APPLICABLE REGULATIONS ANDCONTROL AUTHORITY

The collective policy subscribed betweenSANITAS, S.A. DESEGUROS, asPolicyholder, and LA PREVISIÓNMALLORQUINA DE SEGUROS, S.A.,asInsurance Company, shall be regulated byLaw 50/1980, of 8th of October, of theInsurance Contract, Real Decreto Legislativo6/2004, of 29 of October, by which theconsolidated text of the Law de Ordenación ySupervisión de Seguros Privados, and itsReglamento de Desarrollo (Real Decretonº2486/98 de 20 de noviembre) and by whatis agreed in the Collective Policy subscribedbetween the Policyholder and the InsuranceCompany. The Dirección General de Segurosy Fondos de Pensiones is the organdependant of the Ministerio de Economíathat, with headquarters in Madrid(Spain)performs the control of the activity of theInsurance Company.

GRIEVANCE AND COMPLAINTSSTAGES

Grievances and complaints can be addressedto the Customer Attention Service of LAPREVISIÓN MALLORQUINA DE SEGUROS,S.A. with headquarters in the legal address ofthe Insurer. If the resolution of these was notfavourable to the customer, he/she canreproduce it by written means addressed tothe Commisioner for the Defense of theInsured in 28046 MADRID, Paseo de laCastellana, nº 44. In any case, the concernedperson can use the judicial way. The contractis submitted to the Spanish jurisdiction and,within it, the competent judge for the

acknowledgement of the actions derived fromit shall be that corresponding to the Insured’saddress, to which effect he/she shall appointan address in Spain if his/hers was abroad.

VALIDITY OF THE INSURANCE

The present coverage will remain validwhile the conditions of the collectivepolicy subscribed between Sanitas asPolicyholder and Previsión Mallorquina asInsurer Company are valid and the Insuredis a Policyholder of the present policy.

Also, the condition of Insured shall beextinguished retroactively at the samemoment in which the following eventsoccur, even if there is no previouscommunication to the Insurer:

a) When the Insured ceases in all habitualprofessional activity or turns into thesituation of unemployment or retirement.

b) Since the date on which it can bemedically diagnosed that the illness thathas caused the sinister suffered by theInsured has turned into a permanentdisability for the performance of his/herworkingor professional activity indicatedin the policy.

TREATMENT OF PERSONALCHARACTER DATA

The enrollment as Insured in the collectivepolicy that causes this informative extractrequires for its development, fulfillment,control and execution by LA PREVISIONMALLORQUINA DE SEGUROS, S.A. theinclusión in files and the treatment of data ofthe Insured, including their Health data, aswell as the communication of those data thatare adequate, pertinent and non excessive forthe fulfillment ofthe indicated finality betweenthe services performed and the insurancecompany.

The application for any insured benefit thathe/she needs on the basis of the insurancecontract, supposes the express conformity ofthe Insured to the fact that LA PREVISIONMALLORQUINA DE SEGUROS, S.A.

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To be able to benefit from the coverinsured by this supplementary cover, theinsured must reside in Spain at least sixmonths in each contractual annuity.

This supplementary cover is notapplicable in the United States of America.

A)Insured capital limits

1. Hospital health care

With the same extent of insured coverage asthat mentioned under the modality ofcontracted medical network, SANITAS shallpay up to the limits and sublimits of insuredcapital established in the ParticularConditions of the policy, the expenses causedby inpatient treatment, surgical operations,child delivery or cesarean, surgeons’ and theirassistants’ fees, midwifes, anesthetists,operating theaters use, materials andmedicaments, ICU care, as well as inpatientexpenses that include upkeep andconventional room whit companion bed.

Surgical operations performed to the sameInsured on the same day, by the sameprofessional, shall be considered a soleoperation in what refers to the application ofthe corresponding limit of insured capital.

The amounts indicated in the invoices for theuse of specific surgical technics (robotic,laser, etc.) shall be included in the limitcorresponding to surgeons’ and assistants’fees.

The Insured shall be able to usesimultaneously the modalities of medicalnetwork and reimbursement in relation to thesame inpatient treatment, being committed tofulfill in any case with the regulationsapplicable to each of those care modalitiesand providing that Sanitas has authorizedpreviously such simultaneous use.

2. Outpatient care

With the same extent of insured coverage asthat mentioned under the modality ofcontracted medical network, SANITAS shallpay up to the limits and sublimits of insuredcapital established in the Particular

Conditions of the policy, the expensescorresponding to:

• Consultations.• Emergency Home Services.• Diagnosis Tests.• Therapeutic Methods.• Outpatient or Daypatient surgery.• Land ambulance service.

B)Reimbursement percentage

As a general rule, Sanitas will only reimbursethe percentage indicated in the ParticularConditions of the policy, of the amount ofmedical and/or hospital expenses in which theInsured really incurs as a consequence of thecare received for the contracted benefitsincluded in the coverage of this policy, beingthe rest of the percentage difference on theaccount of the Insured.

In case the Insured uses the contractedmedical network in Spain or the worldwidenetwork of participating centers with the priorauthorization, the Policyholder or Insured willnot have to attend the payments for suchservices, being all medical and hospitalexpenses on the account of Sanitas. TheInsured shall have to proceed as establishedin this clause.

C)Procedure for the reimbursement ofexpenses.

For the management of reimbursement ofexpenses included in the insured coverage ofthis policy, the following must be compliedwith:

C.1. The Insured or any person in his/hername, must communicate the inpatienttreatment, surgical operation and in generalany medical service insured in the maximumterm of seven (7) days since he/she knew it,unless a larger term has been agreed.

In case of surgical operation or programmedinpatient treatment, he/she mustcommunicate such circumstance to Sanitassince the moment in which he/she hasknowledge of the date in which such surgicaloperation or inpatient treatment is going totake place and, in any case, within the

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3. ARRANGING REIMBURSEMENT

To arrange reimbursement the insured needsto present the following documentation withina period not exceeding 7 days:

a) A duly completed reimbursementapplication form.

b) Original invoices broken down by date,amount and item.These documents must be originals.

Once all the necessary documentation hasbeen received and verified, the correspondingamount will be reimbursed within ten workingdays.

4. DISCLAIMER

The insured may freely choose whichprofessional provides the services coveredhereunder. Sanitas will not intervene in anyway in this choice, nor shall it participate in orsupervise how these services are provided.This means Sanitas is exempt from the direct,joint and several, and secondary liability of theacts of these providers.

• For the reimbursement of acupuncture consultations and acupuncture materials: 6 months

• For the reimbursement of homeopathy consultations and homeopathic products: 6 months

Vision Cover

This supplement exclusively includesreimbursement for the following opticalmaterials: prescription contact lenses andprescription eyeglass lenses, provided theyare prescribed by an ophthalmologistpertaining to the network of the policycontracted, unless said policy includes areimbursement modality, in which case theophthalmologist would not necessarily have topertain to said network of physicians. Limitone invoice per year.

The reimbursement of this amount shall beperformed in the percentage set in theParticular Terms and Conditions and up to thelimit of the capital insured as specified inthose Terms and Conditions, once theinsured party submits the invoice in proof ofpayment of the covered optical materialstogether with the ophthalmologist’sprescription.

1. QUALIFICATION PERIODS


• Request for the reimbursement ofoptical material : 6 months

R e i m b u r s e m e n t o fExpenses Cover

The medical benefits object of coverage bythis policy under the modality ofcontracted medical network in Spain andthe network of participating centers andwithin the same limits and exclusions canalso be covered under the modality ofreimbursement of expenses. Thereimbursement by SANITAS of theexpenses corresponding to the insuredmedical benefits already mentioned, willbe performed according to thereimbursement percentages and specificinsured capital limits for each contractedbenefit, according to which is specified inthe Particular Conditions of this policy andfol lowing the regulations forreimbursement management establishedin this General Conditions.

In case of using the modality ofreimbursement of expenses, it will not benecessary that the prescription andperformance of care services is made by aprofessional belonging to the medical networkcontracted by Sanitas.

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To able to benefit from the coverinsured by this supplementary cover, theinsured must reside in Spain at least sixmonths in each contractual annuity.

This supplementary cover is notapplicable in the United States of America.

A)Insured capital limits

1. Hospital health care

With the same extent of insured coverage asthat mentioned under the modality ofcontracted medical network, SANITAS shallpay up to the limits and sublimits of insuredcapital established in the ParticularConditions of the policy, the expenses causedby inpatient treatment, surgical operations,child delivery or cesarean, surgeons’ and theirassistants’ fees, midwifes, anesthetists,operating theaters use, materials andmedicaments, ICU care, as well as inpatientexpenses that include upkeep andconventional room whit companion bed.

Surgical operations performed to the sameInsured on the same day, by the sameprofessional, shall be considered a soleoperation in what refers to the application ofthe corresponding limit of insured capital.

The amounts indicated in the invoices for theuse of specific surgical technics (robotic,laser, etc.) shall be included in the limitcorresponding to surgeons’ and assistants’fees.

The Insured shall be able to usesimultaneously the modalities of medicalnetwork and reimbursement in relation to thesame inpatient treatment, being committed tofulfill in any case with the regulationsapplicable to each of those care modalitiesand providing that Sanitas has authorizedpreviously such simultaneous use.

2. Outpatient care

With the same extent of insured coverage asthat mentioned under the modality ofcontracted medical network, SANITAS shallpay up to the limits and sublimits of insuredcapital established in the Particular

Conditions of the policy, the expensescorresponding to:

• Consultations.• Emergency Home Services.• Diagnosis Tests.• Therapeutic Methods.• Outpatient or Daypatient surgery.• Land ambulance service.

B)Reimbursement percentage

As a general rule, Sanitas will only reimbursethe percentage indicated in the ParticularConditions of the policy, of the amount ofmedical and/or hospital expenses in which theInsured really incurs as a consequence of thecare received for the contracted benefitsincluded in the coverage of this policy, beingthe rest of the percentage difference on theaccount of the Insured.

In case the Insured uses the contractedmedical network in Spain or the worldwidenetwork of participating centers with the priorauthorization, the Policyholder or Insured willnot have to attend the payments for suchservices, being all medical and hospitalexpenses on the account of Sanitas. TheInsured shall have to proceed as establishedin this clause.

C)Procedure for the reimbursement ofexpenses.

For the management of reimbursement ofexpenses included in the insured coverage ofthis policy, the following must be compliedwith:

C.1. The Insured or any person in his/hername, must communicate the inpatienttreatment, surgical operation and in generalany medical service insured in the maximumterm of seven (7) days since he/she knew it,unless a larger term has been agreed.

In case of surgical operation or programmedinpatient treatment, he/she mustcommunicate such circumstance to Sanitassince the moment in which he/she hasknowledge of the date in which such surgicaloperation or inpatient treatment is going totake place and, in any case, within the

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maximum term of seven (7) days countedfrom the date from which he/she knew this.

C.2. In case of surgical operations, inpatienttreatment, child deliver or cesarean, diagnosistests and therapeutic methods, together withthe communication of the illness or accident,the Policyholder or Insured shall send toSanitas the medical report in which it isspecified the diagnosis and nature of theillness, as well as, if such is the case, thecare center, date of entry, probable durationand type of treatment.

C.3. The Insured shall also faithfully follow allprescriptions of the doctor in charge of his/hertreatment and shall give SANITAS all type ofinformations about the circumstances andconsequences of the claim.

C.4. The Policyholder or the Insured or theirrelatives must allow that professionalsdesignated by Sanitas visit the Insured asmany times as SANITAS considers itnecessary, as well as any enquiry or checkSANITAS may deem necessary about his/herstate of health.

C.5. In case of inpatient treatment, once it isfinished, the Policyholder or the Insured shallcommunicate such circumstance toSANITAS, indicating the duration of thetreatment.

C.6. The Policyholder or the Insured shallhand in to Sanitas the following documents:

• Application of reimbursement, dulycompleted.

• Documents or invoices of the expensesreally incurred in by the Insured, dulybroken down in any of the conceptsincluded in the invoices where it is showed:

a) The person receiving the medical and/orhospital care.

b) The nature of the medical servicesperformed (consultation, diagnosis tests,therapeutic methods, surgical operations,etc.), their dates and amounts.

c) Identification of the individual or legalperson that has performed the care(physician, registered nurse, clinic orhospital, etc.), indicating expressly thesurname, name or legal denomination,address, corporation number and taxidentification number.

• Documents accrediting the payment of theinvoice made by the Insured.

• Medical prescription of the medical and/orhospital services received by the Insured,except in the case of consultations andpodiatry in respect of which it will not benecessary to submit such prescriptions.

• Medical report specifying medical and/orhospital services received by the Insured,the illness’ process and its evolution, aswell as the medical or hospital discharge,with indication, if such is the case, of thenecessity of continuous care.

The unfulfilment of the regulations establishedin the five previous points will be consideredas express waiver to receive thereimbursement amount, unless suchfulfillment is impossible due to force majeurecauses.

The Policyholder or Insured will keep theoriginals of the documents mentioned in thispoint during the term of five years countedfrom the date of payment by Sanitas of theapplied for reimbursement and will makethem available to Sanitas upon Sanitas’request with the purpose of fulfilling Sanitas’obligations.

D)Payment of the amounts due to bereimbursed.

The Policyholder or the Insured must applyfor the reimbursement of the medical and/orhospital expenses to which they are entitledaccording to the present policy in the term of90 days counted from the date on which theyhave received the corresponding care.

Once all the required documents are receivedand all corresponding checks are made, to

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establish the existence of a claim, Sanitas willreimburse or consign the guaranteed amount.

In case the medical and/or hospital care isperformed abroad, the assessment of theexpenses or of the amount to be reimbursedby Sanitas will be made in euros according tothe buyer’s official foreign exchange rate that,on the day of payment made by thePolicyholder or the Insured of the invoice ofthe medical and/or hospital care expensesbeing reimbursed, the foreign currency has inwhich the Policyholder or Insured have madethe payment for the received assistance. Theexpenses corresponding to the translation toSpanish language of the correspondingdocuments (invoices, reports, etc.) written inother languages, shall be on account of theInsured.



• Vasectomy and tubular ligation: 10 month

• Psychology: 6 month

• High complexity diagnosis tests: 6 month

• The following Complex Therapeutical Methods: interventional cardiology/ hemodynamics; interventional radiology, radiotherapy and chemotherapy; and lithotripsy: 10 month

• Outpatient surgical operations: 3 month

• Child delivery or caesarean: 8 month

• Hospitalization and surgical operations different from outpatient care and those performed as inpatient: 10 month

Reimbursement of Pediatric,Gynecological and ObstetricConsultations Cover

In the event that the Insured arranges thisspecific cover, the Insurer assumes, underthe terms set down in the correspondingsupplement to the policy hereunder, thereimbursement of 60% of reasonable andnormal costs incurred by the Insured derivedfrom medical consultations, exclusively in thespecialities of Paediatrics and of Gynaecologyand Obstetrics, that the Insured has had as aresult of an illness or accident covered by thepolicy. For this method of costreimbursement, the limits of capital insuredper consultation and per insured and annuityshall be those set down in the ParticularTerms and Conditions of the policyhereunder. To process the reimbursements,the Policyholder or, as applicable, theInsured, should submit to SANITAS thereimbursement request form duly completed,original receipt or invoice of the costs actuallyincurred by the Insured, which specify theperson who received the medical care and thefull identification of the physical or legalperson that provided the medical care, andoriginal receipt or accreditation of thepayment of the invoices by the Insured.

1.TERM OF THE INSURANCE

For the speciality of Paediatrics, the insuredin this supplementary cover shall cancel itupon expiry of the annuity in which they turn15 years’ old.

Repatriation cover

Transfer to the country of origin of theinsured and an escort in the event of theinsured's death

If the insured dies in Spain, SANITAS will, viathe provider it appoints, organise and takecharge of the transfer of the coffin or ashes, inthe case of cremation, from the place of deathto the international airport closest to the placeof interment in the deceased's country of

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origin expressly designated in the particularconditions, when the insured's beneficiariesreport on the undertaker's that will takecharge of the mortal remains at the airport.

SANITAS will furthermore assume the costsof the transfer from the international airport tothe place of interment in the deceased'scountry of origin, with a $1,000 limit andalways so long as the burial is more than 30km from the international airport.

In the event of the insured's death, theprovider appointed by SANITAS will also takecharge of the transfer from the place of theinsured's death in Spain to the internationalairport closest to the place of interment in thedeceased's country of origin of a direct familymember of the deceased whose habitualplace of residence is in Spain (hereafter theescort).

SANITAS will also assume the cost oftransferring the escort from the internationalairport to the place of interment in thedeceased's country of origin with a $1,000limit so long as the burial is more than 30 kmfrom the international airport.

The policy also covers the escort's return tripfrom the place of interment to his or her placeof habitual residence in Spain (first-classtrain, economy-class scheduled airline or anyother suitable form of transport). Thisguarantee will be provided so long as thereturn trip takes place within a maximum offifteen days from the date of death.

TERRITORIAL SPHERE

The services apply in Spain.

USE OF THE SERVICES

To use the services under this supplementarycover, the insured must be up to date withhis/her obligations, especially with regardspremium payment, and the information mustbe included in a file which will be supplied tothe provider at the start of the cover.

The Sanitas card clearly indicates a hotlinenumber to make reverse-charge calls if

needed, pursuant to the conditions of thepresent supplementary cover, and if anyadditional information is needed.

RISKS EXCLUDED

• Interment and ceremonial expenses areexcluded from this cover.

• Transfers not previously communicatedto the provider and for which thecorresponding prior authorisation hasnot been obtained are generallyexcluded. The service provision will notproceed if this communication is notproduced under the indicated terms. Thetransportation of organs, tissue, cellsand by-products, embryos and fetuses isexpressly excluded.

• Transfer is excluded if the insured'sdeath occurs in a state of war,insurrection or similar conflict of anytype or nature, even when not officiallydeclared; and those cases where thetransfer is to a country under the sameconditions.

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Clause III: Exclusions fromcover

Healthcare arising from the risks indicatedbelow is excluded from the cover of thispolicy, regardless of any other exclusion dulyhighlighted in the terms and conditions of thispolicy:

A. All types of disease, injury, pain,constitutional or congenital defect,deformity, medical condition or situation(such as pregnancy or gestation) existingprior to the registration date of eachInsured party in the policy and/or those asa result of accidents or diseases and theirconsequences arising prior to the date ofinclusion of each insured party in thepolicy.

The Policyholder, on his/her behalf or thatof the insured, must include any type ofinjury, congenital condition, disease,diagnostic test, treatment and symptomsthat may be considered the start of acondition in the health questionnaireincluded in the request for insurance.Where not indicated, any insured coverdirectly or indirectly relating to thedeclaration not made shall be excluded.SANITAS shall assess the informationprovided by the Policyholder as a basis toaccept or reject the request for insured orto accept it excluding certain insuredcover.

B. Healthcare relating to diseases,accidents, injuries, deformities or defects:

• Arising as a result of civil wars,international wars, terrorist action in anyform (chemical, biological, nuclear, etc.),revolutions and military manoeuvres,even during peacetime, and officiallydeclared epidemics.

• Directly or indirectly related to nuclearradiation or radioactive contaminationand those resulting from naturalphenomena such as earthquakes,

flooding, volcanic eruptions and otherseismic or meteorological phenomena.

• Arising from working or professionalaccidents.

• Arising from the use of motor vehiclesthat are the purpose of the AutomobileCompulsory Subscription Insurance.

• Arising while the Insured is involved, asan amateur, in sports of risk, such asflying activities, speed trials in a motorvehicle, scuba diving, climbing, boxing,bull fighting, martial arts, rugby or anyother similar activity of risk, as well asthose resulting from sportingcompetitions.

C. Healthcare provided at Social Securityclinics or services or those integrated inthe National Health System. Cross-borderhealthcare is also excluded.

D. Hospitalisation for problems of a socialnature.

E. Health care and/or inpatient treatmentprovided to the Insured by persons thatare related with the Policyholder or withthe Insured by conjugal relationship orkinship until the fourth grade ofconsanguinity or affinity, inclusive.

F. Healthcare derived from chronicalcoholism, drug addiction, intoxicationdue to the abuse of alcohol, psychotropicdrugs, narcotics or hallucinogens,attempted suicide and self-harm, diseasesor accidents due to negligence or grossnegligence of the Insured, infection byHuman Immunodeficiency Virus, AIDSand related diseases.

G. All diagnostic, surgical or therapeuticprocedures for which their clinical safety andeffectiveness are not duly provenscientifically or that are new to appear afterthis policy has been signed;non-universal procedures and those notconsolidated in normal clinical practice,those proven to have been overtaken byother available procedures and experimental

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procedures or those not sufficientlyproven for their effective contributiontowards the prevention, treatment or cure ofdisease.

For the purposes of this policy, a diagnostic,surgical or therapeutic procedure isconsidered safe and effective when it isapproved by the European Drug Agencyand/or the Spanish Agency for MedicinalProducts and Medical Devices. A procedureis also considered universal and consolidatedwhen it is performed in normal clinicalpractice in at least nine AutonomousCommunities of Spain in a generalizedmanner in their public hospitals, not only inFlagship Hospitals.

H. Any type of service relating to:

• Conditions or treatments not covered,as well as any complications arising fromthem.

• Specific diagnosis and treatments,including surgery, aimed at remedyingsterility or infertility in either sex (in vitrofertilization), artificial insemination, etc. orinvolving impotence and erectiledysfunction, including sex-changesurgery.

• Voluntary interruption of pregnancy.

• Organ, tissues, cells or cellscomponents, except autologoustransplant of both bone marrow andprogenitor cells of peripheral blood dueto hematologic lineage tumors and corneatransplant. In this latter case, SANITASdoes not pay for the economic cost of thecornea to be transplanted.

• Any surgical procedure on unbornbabies.

• Any surgical technique using roboticsurgery equipment.

• Genetic map determinations toascertain the predisposition of theInsured or his ancestors or present or

future offspring to certain diseasesrelated to genetic disorders. Geneticmapping o f tumors andpharmacogenetics are also expresslyexcluded.

• Prosthesis and implantable materialsexcept those mentioned in thecorresponding paragraph of the presentGeneral Conditions. Among others, anyexternal prosthesis, any orthopaedicmaterial, external fixing materials,synthetic or biological materials, grafts,aortic endoprosthesis, valved ducts,implantable pumps for the infusion ofmedicaments, medullary stimulatingelectrodes, defibrillators and the artificialheart.

• Operations, infiltrations and treatments,as well as any other action that is purelyfor questions of appearance or of acosmetic nature. Breast surgery is onlycovered in the case of tumours. Surgicalinterventions of a prophylactic nature orfor breast hypertrophy or breast reductionin men are expressly excluded. Any kindof disorder or complication which mayoccur subsequently and which is directlyand/or mainly caused by the Insured’sundergoing an operation, infiltration ortreatment of a purely aesthetic orcosmetic nature are also expresslyexcluded.

• Treatment with platelet- orgrowth-factor-rich plasma.

• Educational therapy in all its forms,such as language education in processesunrelated to organic disease or specialeducation in patients with mental illness.

• General medical examinations forpreventive purposes, except the covermentioned in these General Terms andConditions.

• Alternative medicine, naturopathy,homeopathy, acupuncture, mesotherapy,hydrotherapy, magnetotherapy,pressotherapy, ozone therapy, etc.

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• Services or techniques that merelyconsist of leisure, rest, comfort orsporting activities, similarly treatments atspas and health farms.

I. All surgical techniques or therapeuticprocedures using laser, except:

• Ophthalmic photocoagulation.

• Haemorrhoid treatments.

• Clinical (not cosmetic) peripheralvascular surgery.

• Ear, nose and throat.

• In musculoskeletal physiotherapy.

J. Travelling expenses except thoseincluded in the ambulance section ofthese General Terms and Conditions.

K. The following pharmaceuticalproducts:

• Those administered to the patientoutside hospitalization or in day carehospital, except chemotherapyadministered parenterally by a healthcareprofessional in partner centers.Vaccinations and autovaccinations of alltypes; drugs in ventilation therapy andaerosol therapy and parapharmacyproducts.

• Medicinal products not on the market inSpain.

• Advanced therapies (human medicinalparts based on genes, cells and celltherapy and including autologous,allogenic or xenogenic products).

L. Water birth, homebirth and alternativechildbirth techniques are expresslyexcluded.

M. Bariatric surgery in morbid obesity isexcluded .

N. Radiosurgery is excluded

Ñ Parkinson surgery is excluded

O Epilepsy surgery is excluded

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Clause IV: Qualificationperiods

All benefits which under this Policy areassumed by the Insurer, on the basis of theapproved medical network, will be providedfrom the time this contract becomes effective.

However, the foregoing general principledoes not apply to medical, surgical and/orhospital healthcare in the events detailedbelow, to which shall apply the specifiedqualification periods:

The above qualification periods do not applyto accidents or illnesses that arelife-threatening, unexpected and diagnosedafter the date the corresponding cover takeseffect, provided the care is covered by theinsurance policy. Including cases ofpremature childbirth (before 37 weeks).

Qualitification Periods for the modality ofContracted Medical Network:

• Vasectomy and tubular ligation: 10 Months

• Psychology: 6 Months

• High complexity diagnosis tests: 6 Months

• The following Complex Therapeutical Methods: interventional cardiology/ hemodynamics; interventional radiology, radiotherapy and chemotherapy; and lithotripsy: 10 Months

• Outpatient surgical operations: 3 Months

• Child delivery or caesarean: 8 Months

• Hospitalization and surgical operations different from outpatient care and those performed as inpatient: 10 Months

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Clause V: Form of serviceprovision

1. Through the contractedmedical network

Care shall be provided according tohealthcare regulations applicable, byprofessionals with sufficient qualifications foreach specific service and belonging to thecontracted medical network corresponding tothis insurance product. Where one of theservices included in the cover of this policydoes not exist in the town where the Insuredis located, it shall be provided in anotherregion through the healthcare provider thatthe Insured choses in each case.

On receiving applicable services, the Insuredmust present his/her SANITAS card. Also deInsured must show his/her Identity NationalDocument, if such was required. Each timethe Insured receives a service covered by thispolicy, he/she must pay, in the concept ofparticipation in the cost of such service, theamount that is established in the ParticularConditions.

SANITAS must provide insured cover underthe terms established in the policy and is notbound by the decisions that professionalsmay make, whether or not they belong to itsmedical network or are included in thisinsured cover.

The care may be provided in different ways,depending on the service to be given:

1.1. Free access.

The Insured shall be able to attend freely inSpain to the consultancies of consultants,general physicians and pediatrics, as well asthe emergency centers that belong to thecontracted medical network by Sanitas for thisproduct. Please check your User Guide toDoctors and Services for those consultantsf o r wh i c h y o u w i l l n e e dprescription/authorization.

1.2. Prior prescription for theperformance of the service

Diagnosis tests, therapeutic methods, andcertain care services will require, for theirperformance, written prescription by aphysician belonging to SANITAS medicalnetwork.

Particularly, Psychology consultations mustbe prescribed by a Psychiatrist, GeneralPractitioner, Oncologist or Pediatric.

1.3. Prior prescription and authorizationfor the performance of the service.

As a general rule, for surgical operations,inpatient treatment and counselorprofessionals, prior express authorization bySanitas shall be needed, after the writtenprescription of the professionals belonging toSanitas network. Such authorization shall bealso needed for certain therapeutic methods,diagnosis tests and other care services,whenever such is said in the generalconditions of the policy. The authorizationvoucher shall not be valid if at the moment ofreceiving the service, the Insured is notfulfilling all the requirements established inthe General Conditions of his/her policy toaccess to the full insured coverage relating tothe service indicated in such authorizationvoucher (i.e. no being current on payments ofthe premium, preexisting condition notdeclared, etc.).

1.4. Prior authorization for the service tobe performed by expressly accreditedprofessionals

Any laparoscopic or arthroscopic surgicalprocedures and those involvingradiofrequency or laser techniques must beperformed by professionals specificallyarranged and accredited by SANITAS toperform this type of specific surgicaltechnique.

1.5. Prior authorization and expressdesignation of the physician

More particularly, for surgical procedures ofgreat complexity, as indicated below:neurosurgery, heart surgery, bariatric surgeryand backbone surgery, surgery requiringrobotic equipment, assisted navigationequipment or any other restricted

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implementation technology, that are coveredby this policy, SANITAS shall appoint thehealthcare center and the professionals toperform the surgery in each individual caseand prior to the specific surgical procedure.

1.6. Home Services.

Sanitas is bound to perform home services inthose cities where SANITAS has contractedthe performance of these services and only inthe address that is established in thepolicy. Any change of such address mustbe reliably communicated with a minimumnotice of eight days prior to the requirement ofany service.

The services performed at home are thoserelated with the specialties of GeneralPractitioner, Pediatrics, Emergencies, NurseCare, Special Care at Home, Ambulance andhome-based respiratory therapies. All of themrequire prescription by a physician exceptGeneral Practitioner and Pediatrics. Sanitaskeeps the right to not perform such servicewhen, following medical criteria, does notconsider it necessary.

Particularly, treatments involving home-basedrespiratory therapies, must be prescribed by apneumologist belonging to SANITAS network.In all chronic treatments, the Insured has torenew the pneumologist’s prescription and theservice authorization by SANITAS eachmonth.

1.7. Care in case of temporarydisplacement to Cantabria and Navarra.

In case of temporary displacement of theInsured to the mentioned AutonomousRegions the service included in the coverageshall be performed through the medicalnetwork of the Entities expressly contractedby Sanitas for such performance. The Insuredmust present his/her Sanitas card in theOffices of the contracted Entities, acceptingthe administrative steps of these Entities.

1.8. Emergencies

As specified in article 103 of the InsuranceContract Act, SANITAS assumes thenecessary care of an emergency nature in

accordance with the Policy Terms andConditions and that in all cases shall beprovided through the resources designated bySANITAS, expressly indicated in the UserGuide to Doctors and Services for thisproduct.

In cases of vital emergency, wherever theInsured must be admitted to a center notincluded in the medical network, SANITASmust be reliably informed of this admissionas soon as possible so that it can transfer theinsured to a partner center, provided his/hermedical condition allows as such.

1.9. Care in providers not recognized bySANITAS.

Notwithstanding what is mentioned in theabove paragraph for cases of vitalemergency, SANITAS shall not pay for thefees of professionals not belonging to itsmedical network, nor for the expenses ofinternment or services that suchprofessionals could order. Also, SANITASshall not pay, under the contractedmedical network modality that is the objectof insurance of this policy, for theexpenses originated in private or publiccenters not contracted for this product, nomatter who the prescribing or performingprofessional is.

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Clause VI: Other features ofyour insurance

1. Basis and loss of rights of thepolicy

1.1. The present agreement has beenclosed on the basis of the declarations madeby the Policyholder and the Insured in thehealth questionnaire included in theinsurance application, where questionsare made referring to the state of health oftheir health, profession, Insured’s sportpractices and in general those habits oflife that can be of relevance for a correctassessment of the risk that is the object ofthe insurance by this policy being itessential that the Policyholder/Insuredprovides with complete truthful about thequestions posed since these constitutethe basis for the acceptance of the risk ofthe present agreement, being the mentionedInsurance Application a constituent part of it.

1.2. The Policyholder's duty, before theconclusion of the contract, to declareSANITAS, according to the questionnaire itwill submit all the circumstances known tohim that might affect the valuation of risk. Heis relieved of this obligation if SANITAS didnot submit questionnaire or when, evensometiéndoselo, there are circumstances thatmay influence the risk assessment and thatare not included in it.

SANITAS may terminate the contract bydeclaration addressed to the Policyholderwithin a month, as of knowledge or inaccuracyof the policyholder. They correspond toSANITAS except willful misconduct or grossnegligence on its part, the premiums for thecurrent period to the time to make thisstatement.

If the incident occurs before SANITAS makethe statement to which the precedingparagraph, the provision will be reducedproportionally to the difference between theagreed premium and it has been applied tothe true risk they met . If he mediated maliceor gross negligence of the policyholder will

SANITAS released from payment of thebenefit (Art. 10 of the Insurance Contract Act).

1.3. Notwithstanding the foregoing, theInsured also loses the right to theguaranteed benefit:

a) In accordance with the provisions ofclause rights and duties of the generalconditions in the event of an increase inrisk if the Policyholder or the Insured notcommunicate SANITAS and have acted inbad faith (Art. 12 of the Insurance ContractAct).

b) If the incident occurs before thepremium has been paid (or, if singlepremium) unless otherwise agreed (Art. 15of the Insurance Contract Act).

1.4. The Policyholder can terminate theagreement when the medical network ischanged, providing the change affects to50% of the consultants that are part of thenational medical network of Sanitas, who willhave available for the Insured, at all times, inSanitas Offices, the complete and updated listof such consultants, for the Insured’sinformation.

1.5. In the event of the Insured not statinghis/her correct date of birth, SANITAS mayonly contest the policy if the Insured's trueage exceeds the established limits for thiswhen the policy comes into force.

1.6. Remote subscription of Insurance: Asspecified in Article 10 of the DistanceMarketing of Financial Services Act 22/2007of 11 July, the Policyholder shall have a termof fourteen calendar days to terminate theremote subscribed contract, without having toindicate any reasons and incurring in no typeof penalty.

The term for exercising the right totermination shall begin on the date theInsured Contract is formalized. However,where the Policyholder has not received theterms and conditions of the policy and theprior information note about the contracting ofthe Insurance policy, the term for exercisingthe right to terminate shall begin to count on

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the date on which said information note isreceived.

2. Duration of insurance

2.1. The Insurance Contract expiry date shallbe established in its particular terms andconditions and, at its expiry, in accordancewith Article 22 of the Insurance Contract Act,it shall be extended tacitly for periods of oneyear. Nevertheless, either of the parties mayrepudiate extension by giving the other partydue written notice not less than two (2)months before the date of expiration of thecurrent period.

2.2. If the insurance policy is terminatedunilaterally at the discretion of SANITAS, itmay not suspend the provision of coverwhile the Insured is undergoing hospitaltreatment, until discharge, unless the Insuredwaives to continue the treatment.

If the insurance policy is terminated by theInsured, the covers will cease to have effecton the expiry date specified in the ParticularTerms and Conditions of the policy, and theprovisions of the preceding paragraph will notapply. Therefore, if the Insured is receivingsome kind of insured benefit at the time thepolicy expires, the cover insured by SANITASshall cease on said expiration date and it willnot be obliged to pay for any cost as of saiddate, even those arising from a claimoccurring during Insurance validity.

2.3. With regards to each Insured person,the insurance lapses due

a) to death.

b) Transfer of residence abroad or notresiding a minimum of six (6) months innational territory. The premium shallcorrespond to SANITAS until de date in whichthe Insured communicates and credits suchcircumnstance.

2.4. Persons under 14 years of age can onlybe included in the insurance if the personsthat hold their custody or guardianship are

also insured, unless the parties agreeotherwise.

3. Insurance premiums

3.1. The Insurance Policyholder must paythe premium when the contract isaccepted. The arranged covers shall nottake effect until the first premium has beenpaid

3.2. The first premium shall be requestedonce the contract has been signed.Successive premiums shall be requestedon their respective due dates.

3.3. The Policyholder can apply for thedivision of the payment of the annualpremiums in biannual, quarterly or monthlyperiods.

In these cases, the correspondingsurcharge shall be applied. The division ofthe premium does not exempt thePolicyholder of his/her obligation to paythe complete annual premium.

3.4. If, due to the Policyholder’s fault, thefirst premium is not paid, SANITAS isentitled to terminate the contract or legallydemand payment based on the Policy. Wherepayment is not received before the claimarises, SANITAS shall be freed from itsobligation, except where otherwise agreedand duly indicated in the Particular Terms andConditions of the policy.

In the event of non-payment of the secondor successive premiums or their divisions,SANITAS’ coverage shall be suspendedone month after the due date of thepremium.

Where SANITAS does not claim paymentwithin the six months following said duedate, the contract shall be consideredterminated.

If the contract is not terminated ordischarged according to the abovementioned conditions, the cover shallonce again become effective twenty-fourhours following the day on which the

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Policyholder pays the premium or, whereapplicable, suitable part payments thereof.

The Policyholder shall lose any agreedright to pay part of the premium in thecase of non-payment of any receipt andshall, from that moment, be required topay the full premium agreed to for theremaining Insurance period.

For premiums paid in installments, in theevent of a claim, SANITAS may deduct fromthe amount payable or reimbursable to thePolicyholder or Insured any premiuminstallments for the current annual period notyet collected by SANITAS.

3.5. Where the parties stipulate theapplication of co-payments for certain benefitsinsured by this policy, the amountscorresponding to said co-payments shall bespecifically established in the ParticularTerms and Conditions of the policy. Theiramount shall be established each year bySANITAS. The provisions of this Clause in theevent of non-payment of the second orsuccessive premiums or part paymentsthereof shall apply in the case ofnon-payment of the amount of co-payment.

3.6. Except where otherwise specified in theParticular Terms and Conditions, the place ofpayment of the premium and co-payments,where applicable, shall be as indicated in thebank debit account order form.

To this end, the Policyholder shall provideSANITAS with the details of his/her bankaccount where the payment of the receipts forthis Insurance are to be debited and shallauthorize the bank to pay them.

3.7. SANITAS is only bound by the receiptsissued by the Management or by its legallyauthorized representatives.

3.8. The Insurer may modify the premium andthe amount of participation of the Insured inthe cost of services with each renewal of theContract. This review is based ontechnical-actuarial criteria made and basedon the variation in the cost of healthcareservices, the type, the frequency of use of thebenefits covered and the inclusion of

technological medical innovations that werenot covered on the initial effective date of thepolicy.The premiums to be paid by the Policyholderwill vary according to the age achieved byeach of the Insured, the geographical zonecorresponding to the place of performance ofthe services, the tariffs established by Sanitason the date of renewal of each policy beingapplicable. Such variation of premiums shallbe communicated in writing by Sanitas to thePolicyholder with at least two months’ noticewith respect to the renewal date.

3.9. After receiving communication fromSANITAS, when appropriate, relating to thevariation in the amount of the premiumsfor the next annual period, thePolicyholder may choose betweenextending the insurance policy andterminating it at the expiry of the currentinsurance period.

In the latter case, the Policyholder shall notifySANITAS in writing of his/her desire toterminate the contractual relationship at itsexpiration date.

3.10. Payment of the amount of the premiummade by the Policyholder to the insurancebroker shall not be considered as made toSANITAS, unless the broker provides thePolicyholder with the aforesaid Insurer'spremium receipt in return.

4. Newborn children inclusions

Newborn children can be included in thepolicy with all its rights since their date of birthif the care provided to the biological motherwhilst the child delivery has been provided bySANITAS within the coverage of the biologicalmother’s policy and if the inclusion of thebiological mother in the policy has taken placeat least 365 days prior to the child delivery.For this to be effective, the Policyholder mustcommunicate to SANITAS such circumstancewithin the 30 natural days following the dateof birth, by means of completing an InsuranceApplication. In any case, SANITAS will onlycover the Newborn’s healthcare when and ifhi/she is included as Insured in SANITAS.

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If the inclusion of the Newborn iscommunicated once the term mentionedabove has elapsed or without fulfilling all therequirements indicated in the paragraphabove this, SANITAS by virtue of theinformation provided by the Policyholder inthe Insurance Application can deny theinclusion of the Newborn as Insured member.

5. Provision of reports

The Policyholder and Insured must provideSANITAS, whenever expressly required so todo, medical reports and/or providers costestimates enabling the Insurer to determinewhether the requested care is covered by thepolicy. SANITAS is under no obligation tocover the requested care unless and until it issupplied with such reports and cost estimatesif the Insured is expressly required to supplythem.

6. Complaints

6.1. Complaints control and procedure

a) Supervision of the business activity ofSANITAS lies with the Spanish State and isexercised through the Directorate General forInsurance and Pension Funds of the Ministryof the Economy and Competitiveness.

b) In case of any type of complaint in relationto the insurance policy, for the settlementthereof the Policyholder, Insured, Beneficiary,Aggrieved Third Party or Successor of any ofthese should proceed to address:

1. The SANITAS Complaints ManagementDepartment - by means of a letter addressedto calle Ribera del Loira n° 52 (28042Madrid) or to fax no. 91 585 2468 - or to theemail address:[email protected], which willacknowledge receipt in writing and issue areasoned written decision, within thestatutory deadline of two (2) months fromthe date of filing of the complaint.

2. Once this internal process has beenexhausted or in the event of disagreementwith the decision of SANITAS, a complaintmay be lodged with the Insurance

Ombudsman designated by SANITAS in thefollowing cases:

a) In the case of complaints whose amountdoes not exceed €21,000 and whichconcern the interpretation of the Generaland Particular Terms and Conditions ofthe Policy. Claims concerning the personalor professional conduct of doctors,hospitals and medical services in generalwho give service to members shall not besubmitted to the Insurance Ombudsman.

b) When SANITAS so agrees, even thoughthe foregoing requirements are not met. Tofile a complaint with the InsuranceOmbudsman , the claimant shall remit awritten statement to post office box No.50.072 (28080 Madrid) setting forth thegrounds for his/her complaint. TheOmbudsman shall issue a writtenacknowledgement of receipt and declarewhether or not he/she is authorized toexamine the complaint. If the Ombudsmandeclares that he/she is authorized, he/sheshall examine the complaint and within thelegal deadline of two (2) months from the datethe claim was filed with SANITAS shall issuea reasoned decision, written notice of whichshall be served on the claimant andSANITAS, on whom the decision shall bebinding.

3. The administrative complaint proceduremay also be instituted before theComplaints Service of the DirectorateGeneral for Insurance and Pension Funds,Paseo de la Castellana, 44, 28046 Madrid.Accordingly, the claimant must prove thatthe established period for the settlementof the complaint by the InsuranceOmbudsman has expired or that thecomplaint has been rejected.

4. In any case, action may be broughtbefore the relevant Courts.

5. Legal actions originated in connectionto this Insurance Agreement shall besubject to a five-year time limit (Article 23of the Insurance Contract Act)

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7. Other important legal points

7.1. Subrogation

Once payment of the covered benefit hasbeen assumed, SANITAS may exercise therights and actions corresponding to theInsured due to the claim caused withregards to the persons responsible for it,up to the limit of compensation paid.

The Insured must sign the necessarydocuments for subrogation in favour ofSANITAS.

7.2. Notifications.

7.2.1. Notifications to SANITAS on the partof the Policyholder, the Insured or Beneficiaryshall be sent to the Insurer’s registeredoffice as stated in the Policy.

7.2.2. Notifications from SANITAS to thePolicyholder, the Insured or Beneficiary shallbe sent to the address of the Policyholder inSpain that is included in the policy, exceptwhere a change of address has been notifiedto SANITAS.

7.2.3. Reliable notifications sent to theinsurance agent who mediates or hasmediated in the contract shall take bevalid.

However, notifications sent by thePolicyholder or Insured to the Insurancebroker are not considered made toSANITAS until it has received them.

Notifications made by an Insurance broker toSANITAS on behalf of the Policyholder shallhave the same effect as if they were sent bythe Policyholder him/herself, except whereotherwise indicated by him/her.

On all accounts, the express agreement ofthe Policyholder shall be required to sign anew contract or to modify or terminate thecurrent insurance policy.

7.3. Protection of personal data

The Policyholder undertakes to ensure that allinformation provided to SANITAS in theinsurance application and throughout the termof this policy is accurate and he/she has notomitted any information on the health of eachof the Insured parties named in theapplication.

Nevertheless, he/she authorizes SANITAS toask physicians, clinics, hospitals, etc. andhe/she therefore authorizes such persons toprovide to SANITAS, any data on the healthof the persons included under the policy thatSANITAS may deem expedient for themanagement of the insurance, for offeringcomprehensive healthcare programs thatSANITAS may have available to improve itshealthcare process, for the proper appraisaland assessment of the risks to be covered, toprevent fraud, and to attend to the claims putforth by the insured parties.

Furthermore, and in accordance with Ley15/1999 de 13 de diciembre de Protección deDatos de carácter Personal (the Spanish DataProtection Act 1999) and Royal Decree1720/2007 of 21 December, approving theimplementing rules of the aforementionedAct, the Insurer informs the policyholder andthe insured parties and they consent to alltheir personal data being entered in files heldby the Insurer for the purpose of thecompany’s activities, the effectiveness ofcontractual relations, the provision ofintegrated care programs that will allow themto improve their health, the understanding ofreasons for cancelling the policy, fraudprevention and the sending, by any means, ofadvertising or other offers that might be ofinterest from the entity and third parties withwhich it collaborates, authorizing SANITAS touse their data to send them the informationthat best meets their particular needs. For thepurpose of preventing fraud, the insuredparties expressly consent to SANITASkeeping such data as are necessary, evenafter the contractual relationship has ended. Ifthe Policyholder/Insured withholds consent forhis/her data to be entered in such files andsubsequently processes, the insurancecontract cannot be arranged.

In addition, the insured parties and thepolicyholder expressly authorize assignment

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of those data to companies of the SanitasGroup identified at www.sanitas.es, relating tofinancial, insurance, social and healthcare,and/or health and welfare products andservices, and for the reason of co-insuranceand/or reinsurance of the risk and any otherperson with which SANITAS creates ties ofcooperation, for the effectiveness ofcontractual relations with the insured and forsending advertising from those companies.

The Policyholder accepts responsibility forinforming all insured parties under the Policyas to the inclusion of their data in the filesmentioned above and the processing of suchdata intended by the Insurer, so that they mayexercise as before SANITAS such rights asthey think fit. The Policyholder must informthose insured parties that the details of anymedical services covered for them under thepolicy will be disclosed to the Policyholder,unless the Policyholder gives the Insurer awritten release from its statutory duty to makesuch disclosure to the Policyholder, or any ofthe beneficiaries makes an application in thisrespect.

The Policyholder declares that he/she has theconsent of the insured parties to thePolicyholder’s disclosure of their personaldata to the Insurer and to the Insurerdisclosing to the Policyholder the details ofany medical services covered for the insuredparties under the policy.

He/she may exercise their statutory rights ofchallenge, access, rectification and erasure ofthese data at the Insurer’s head office at calleRibera delLoira 52, 28042 Madrid, CustomerRelations Department.

If the policyholder and/or insured parties donot wish to receive commercial informationfrom SANITAS or, as applicable, from othercompanies the Insurer collaborates with, orwho do not wish their data to be transferred toother companies except for the effectivenessof contractual relations, they must make thisknown in writing to the following emailaddress: [email protected].

In the event that no written communication isreceived within 45 days from the date onwhich the policyholder had knowledge of the

information contained in the foregoingparagraphs, it will be understood that theyagree to the sending of advertising being sentand the transfer of data to other companiesunder the terms described.

8. Others

The Policyholder and/or Insured grant theInsurer their authorization so that, ifconsidered necessary, it may record thetelephone conversations that take place inconnection with this Policy and use them in itsquality control processes and, whenapplicable, as a means of evidence for anyclaim that might arise between both parties,but preserving the confidentiality of theconversations held in all circumstances.

The Policyholder and/or the Insured may askSANITAS for a copy or written transcription ofthe contents of the conversations recordedbetween both.

9. Jurisdiction

The Court competent to hear actionsarising from the insurance contract shallbe the one corresponding to the Insured'saddress in Spain.

Made in duplicated in Madrid on 07 de May de 2015For the Insured / For SANITASPolicyholder