GENERAL TERMS AND CONDITIONSsanitasinternationalstudents.com/docs/CG_Sanitas_International_Students_en.pdfThis is the care provided when admitted to a hospital, with a record of admission

GENERAL TERMS ANDCONDITIONS

Sanitas Sociedad Anónima de Seguros

Recorded on 10 February 1958 in the Register of theDirectorate General for Insurance and Pension Funds,code C-320.

Organisation domiciled in Spain, Ribera del Loira, 52 -28042 Madrid.

Companies Register of Madrid, sheet 4,530, volume1,241, book 721, section 3, Entry 1.

Tax ID Code A-28037042

3 - 34 Índice

CONTENTS

General terms and 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. Nursing Service..........................................................................................................................................11

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

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

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

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

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

3.2.1. Genetic Studies...................................................................................................................................11

3.3. Anatomic Pathology....................................................................................................................................12

3.4. Anaesthesiology.........................................................................................................................................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 Orthopaedic Surgery...................................................................................................12

3.12. Reconstructive Surgery............................................................................................................................12

3.13. Chest Surgery...........................................................................................................................................12

3.14. Dermatology.............................................................................................................................................12

3.15. Endocrinology and Nutrition..................................................................................................................... 12

3.16. Haematology and Haemotherapy.............................................................................................................12

3.17. Internal Medicine......................................................................................................................................13

4 - 34 Índice

3.18. Nuclear Medicine......................................................................................................................................13

3.19. Nephrology...............................................................................................................................................14

3.20. Pneumology..............................................................................................................................................14

3.21. Neurosurgery............................................................................................................................................14

3.22. Clinical Neurophysiology..........................................................................................................................14

3.23. Neurology.................................................................................................................................................14

3.24. Gynaecology.............................................................................................................................................14

3.24.1. Breast Surgery....................................................................................................................................14

3.25. Ophthalmology......................................................................................................................................... 14

3.26. Medical Oncology.....................................................................................................................................14

3.27. Ear, Nose and Throat...............................................................................................................................14

3.28. Psychiatry.................................................................................................................................................14

3.29. Radiodiagnosis/Imaging Diagnosis..........................................................................................................15

3.30. Radiotherapy............................................................................................................................................15

3.31. Rehabilitation............................................................................................................................................15

3.32. Rheumatology.......................................................................................................................................... 15

3.33. Urology.....................................................................................................................................................15

4. Other care services.....................................................................................................................................15

4.1. Ambulance..................................................................................................................................................15

4.2. Special Care in the Home of the Insured....................................................................................................16

4.3. Physiotherapy.............................................................................................................................................16

4.4. Speech and Language Therapy.................................................................................................................16

4.5. Podiatry (Chiropody exclusively).................................................................................................................16

4.6. Prostheses..................................................................................................................................................16

4.7. Home-based respiratory therapy................................................................................................................17

5. Hospital admission........................................................................................................................................17

6. Early detection of disease............................................................................................................................17

ADDITIONAL COVERAGES OF YOUR INSURANCE......................................................................................18

Overseas emergency healthcare cover...........................................................................................................19

Repatriation cover.............................................................................................................................................21

Second medical opinion cover.........................................................................................................................22

Sanitas Dental 21 Sup In C/C............................................................................................................................22

Clause III: Exclusions from cover..............................................................................23

Clause IV: Form of service provision........................................................................26

Clause V: Other features of the insurance................................................................29

1. Basis and loss of rights of the policy........................................................................................................29

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2. Duration of insurance................................................................................................................................. 29

3. Insurance premiums...................................................................................................................................30

4. Provision of reports.................................................................................................................................... 31

5. Complaints...................................................................................................................................................31

6. Other important legal points...................................................................................................................... 32

7. Others...........................................................................................................................................................33

8. Jurisdiction..................................................................................................................................................34

6 - 34 Condiciones Generales

Preliminary clause

The present contract is bound by thematters set out in Act 50/1980 of 8October on Insurance Contracts (OfficialState Bulletin of 17 October 1980), Act20/2015 of 14 July on the Management,Supervision and Solvency of Insurersand Reinsurers and its implementingregulation (Royal Decree 1060/2015 of20 November on the Management,Supervision and Solvency of Insurersand Reinsurers), Act 22/2007 of 11 Julyon the Distance Marketing of FinancialServices for Consumers Act 26/2006 of17 July on Private Insurance andReinsurance Brokerage and the mattersagreed upon in the General andParticular Terms and Conditions.

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


Glossary of terms

For the purposes of this document of the Sanitas International Students insurance product,the following definitions 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 to 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 Terms andConditions, entitled to receive insurancebenefits and who may or may not be thesame as the Policyholder.

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

HEALTH QUESTIONNAIREDeclaration made and signed by thePolicyholder or Insured before arranging thepolicy, which is used by SANITAS to assessthe 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.

INSURED'S HOMEThe place where the Insured lives and whichspecifically appears on the policy's ParticularTerms and Conditions.

INSURER OR INSURANCE COMPANYSANITAS, Sociedad Anónima de Seguros thebody corporate taking on the risk as agreedunder this Agreement.

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

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 andthe rights and duties of the parties and that isused as proof of existence thereof. The policycomprises: the insurance application, healthquestionnaire, General, Particular and SpecialTerms and Conditions and the supplementsor appendices that are added to it either tocomplete or amend it.

PRE-EXISTING PATHOLOGIESState 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 Insuredmust pay the Insurer. The premium invoiceshall also contain any legally applicablesurcharges, duties and taxes.

CLAIMEvery occurrence of consequences which arepartly or wholly covered by the policy andforming part of the Insurance. The set of


services arising from the same cause isconsidered to constitute a single claim.

EXTRA PREMIUMThis supplementary premium is establishedby way of express agreement shown in theParticular Terms and Conditions of the policy,in order to take on additional risk that wouldnot be the object of insured cover where suchagreement does not exist.

POLICYHOLDERThe physical person or body corporate that,together with SANITAS, signs this contractand who may be the same as or different tothe Insured and to whom the obligationsarising there 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 hospitalisation.

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 NURSERegistered nurse or Healthcare Assistantlegally qualified and authorised to performnursing.

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 centresbelonging 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 centres forming the medicalnetwork of this policy available to the insuredat 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


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

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.

C O M P L E X T H E R A P E U T I CPROCEDURESA high-tech therapeutic method is any methodrequiring technical equipment, a speciallydesignated area and specialised healthprofessionals in a healthcare or hospitalsetting.

The healthcare facility where it is performedmust have adequate personnel and resources

to deal with any complications that the patientmight experience as a direct or indirectconsequence of the method.

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.

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

EMERGENCY CARE SERVICESAssistance in justified circumstances both atthe Insured's home or anywhere else withinthe national territory where the Insured is,always so long as SANITAS has anarrangement for the provision of the service inthis place. The service will be provided by aGP and/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 clinical situation thatdoes not entail a life-threatening situation orirreparable damage to the physical integrity of


the patient, that requires immediate medicalcare.

LIFE-THREATENING EMERGENCYA life-threatening emergency is a situationthat requires immediate medical care as adelay could prove life-threatening or lead toirreparable harm to the patient's physicalintegrity.


Clause I: Purpose of theInsurance

Within the limits and conditions stipulated inthe policy and following payment by thePolicyholder of the corresponding premium,and deductibles that may correspond,SANITAS provides its insured with a widerange of professionals, clinics and hospitalsfor medical, surgical and hospital care,according to normal medical practice, in thespecialties and modalities included in thecover of this policy, their cost being assumedthrough direct payment to the professionals orcentres providing the insured provision.

Any diagnostic and therapeutic advancesarising in medical science after the effectivedate of this agreement may become part ofthe cover of this policy provided that they aresafe, effective and universal 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 of this policy, the healthcarebenefits covered correspond to thefollowing specialties:

1. Primary care

1.1. General Medicine

This includes medical care in a healthcarecentre, indication and prescription of basicdiagnosis tests and procedures (analysis andgeneral radiology) during the days and timesestablished for this purpose by the doctor. Itincludes also home services when, forreasons attributable only to the Insurer’sillness, he/she is prevented from attending theconsulting room.

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

1.2. Nursing Service

Includes healthcare at the healthcare centreand at home.

2. Emergencies

These include emergency healthcareprovided in permanent emergency centres.

In justified circumstances, the Insured will betreated at the place where he or she is by theround-the-clock emergency services, only inthose towns in which SANITAS hasengaged such service.

Sanitas 24 Hours

Telephone service that provides informationfrom a medical team, which will advise theInsured about his/her questions of medicalcharacter, 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 of treatment of affectedand symptomatic patients patients who alsohave high diagnostic yield.

Includes the study of genes BRCA1 andBRCA2 in the following indications:A) patient without personal history of breast orovarian cancer who meets the followingrequisites:• with 2 or more 1st or 2nd degree relatives

aged under 50 years old affected by breastcancer

• with 2 or more 1st or 2nd degree relativesaffected by ovarian cancer at any age


• with 2 or more 1st or 2nd degree relativesaged under 50 years old affected by breastcancer and ovarian cancer at any age

B) patient aged over 50 years old with ahistory of breast cancer• with 2 or more 1st or 2nd degree relatives

aged under 50 years old affected by breastcancer

• with 2 or more 1st or 2nd degree relativesaffected by ovarian cancer at any age

• with 2 or more 1st or 2nd degree relativesaged under 50 years old affected by breastcancer and ovarian cancer at any age

C) male patient with breast cancerD) patient aged under 50 years with breastcancerE) patient with ovarian cancer (+/-) breastcancer

The molecular study of the gene PCA3 andDNA HLA A/B/C/DQ/DR typing (the latterexcept for transplant in the affectedpatient) is excluded.

3.3. Anatomic Pathology

Includes the performance of therapeutictargets: BRAF, ALK, K-RAS, N-RAS,C-ERB2/HER2, EGFR, C-Kit prior to theadministration of certain pharmaceuticalproducts, provided that the summary ofproduct characteristics as established by theSpanish Agency of Medicinal Products andMedical Devices requires that such targets bedetermined. These criteria also apply to thespeciality of genetic testing.

3.4. Anaesthesiology

3.5. Angiology and Vascular Surgery

Varicose vein treatments with foam ormicrofoam are excluded.

3.6. Digestive System

The FibroScan diagnostic test is coveredannually by the Insured solely to evaluatethe progression in the degree of hepaticfibrosis in chronic liver diseases,

excluding conditions related toalcoholism.

The technique for submucous endoscopicdissection is only included for thetreatment of lesions of pre-malignant orincipient malignant colorectal/gastricmucosa in which conventionalpolypectomy has been ruled out andwhere surgical treatment is beingconsidered.

3.7. Cardiology

3.8. Cardiovascular Surgery

The cryoablation technique andpercutaneous techniques for thereplacement 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 and trauma 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 OrthopaedicSurgery

Includes arthroscopic surgery.

3.12. Reconstructive Surgery

3.13. Chest Surgery

3.14. Dermatology

3.15. Endocrinology and Nutrition

3.16. Haematology and Haemotherapy


Comprises autologous bone marrow andparentperipheral blood cell transplants solelyfor treatment of haematological tumours.

3.17. Internal Medicine

3.18. Nuclear Medicine

Contrast agents are paid for by SANITAS.

PET and PET/CT are covered only forindications authorised by the SpanishAgency for Medicinal Products andMedical Devices (AEMPS) on the technicaldata sheet using the drug18-fludeoxyglucose (18 FDG) . Suchindications are precisely the following:

A) Oncology Diagnosis:

Diagnosis:

• Characterisation of solitary pulmonarynodule.

• Detection of a tumour of unknown originevidenced, for example by cervical glandillness, liver or bone metastasis.

• Characterisation of a pancreatic mass.

Staging:

• Head and neck tumours, including assistedguided biopsy.

• Primary lung cancer.• Locally advanced breast cancer.• Cancer of the oesophagus.• Pancreas carcinoma.• 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.

Monitoring of treatment response:

• Malignant lymphoma.• Head and neck tumours.

Detection in case of reasonable suspicionof recurrence:

• Highly malignant gliomas (III) or (IV).

• Head and neck tumours.• Thyroid cancer (non medullary): patients

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

• Primary lung cancer.• Breast cancer.• Pancreas carcinoma.• Colorectal cancer.• Ovarian cancer.• Malignant lymphoma.• Malignant melanoma.

B) Cardiology

• Assessment of myocardial feasibility inpatients with severe dysfunction of the leftventricle who are candidates forrevascularization, only when conventionalimaging techniques are inconclusive.

C) Neurology

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

D) Infectious or inflammatory diseases

• Localisation of anomalous foci to guideetiological diagnosis in the case ofidiopathic fever.

Diagnosis of infection in the case of:

• Suspected chronic infection of the bones oradjacent structures: osteomyelitis,spondylitis, discitis or osteitis, even wherethere are metal implants.

• Diabetic patients with a foot indicatingCharcot neuroarthropathy, osteomyelitis oran infection of the soft tissues.

• Painful hip prosthesis.• Vascular prosthesis.• Detection of septic metastatic foci in the

case of bacteriemia or endocarditis.

Detection of the extension of inflammationin the case of:

• Sarcoidosis.• Inflammatory bowel disease.• Large-vessel vasculitis.


Treatment monitoring:

Unresectable alveolar echinococcosis, in thedetection of active foci of the parasite duringmedical treatment and once treatment hasdiscontinued.

3.19. Nephrology

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

3.20. Pneumology

3.21. Neurosurgery

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

3.22. Clinical Neurophysiology

3.23. Neurology

3.24. Gynaecology

Includes laparoscopic gynaecological surgeryand study and basic diagnosis of infertility andsterility.

The following genetic tests are includedfollowing medical assessment: factor VLeiden mutation, prothrombin gene mutation20210, and the study of genes BRCA1 andBRCA2 in the indications specified. MTHFRand Factor XII mutation tests are excluded.Any other genetic test other than thosementioned shall be excluded.

Exclusions:• Breast tomosynthesis.• Genomics platforms for prognosis of

breast cancer.• Determination of foetal DNA in maternal

blood.

3.24.1. Breast Surgery

Includes breast surgery in the followingsituations:

• Benign tumours. Excludes posterior breastreconstruction.

• Malignant tumours: includes surgery on theaffected breast and prophylactic surgery onthe contralateral breast if considered atherapeutic option after the results of theBRCA1 and BRCA2. Includes posteriorbreast reconstruction.

• Individuals not affected by breast cancer inwhich prophylactic breast surgery isconsidered a therapeutic option after theresult of BRCA1 and BRCA2. Includesposterior breast reconstruction.

3.25. Ophthalmology

Includes laser photocoagulation exclusivelyfor ischaemic retinopathies, macularoedema, glaucoma and peripheral retinallesions (holes or tears), kerataconustreatment and cornea transplant surgery .The transplantable cornea is paid for bySANITAS.

Any kind of refractive surgery (for myopia,hypermetropia and astigmatism) isexcluded.

3.26. Medical Oncology

The treatment prescription must always beperformed by the Medical Oncology specialistin charge of the patient's care. SANITAS mustpay for treatment if conducted at a healthcaresite, whether on the basis of an oncology dayunit or on an inpatient basis, if necessary.

SANITAS shall only pay for expensescorresponding to specifically cytostaticdrug products, the sale of which isauthorised 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.

3.27. Ear, Nose and Throat

Includes laser surgery and radiofrequencysurgery.

3.28. 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.

3.29. Radiodiagnosis/Imaging Diagnosis

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

It also includes:

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

• Screening of colon cancer and colonpolyposis in patients without a knownclinical history of colon cancer, polyposisorinflammatory 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 andcolonpolyposis in patients in which theconventional colonoscopy iscontraindicated due to their clinical situationor entails a higher risk.

• As a complement to conventionalcolonoscopy when this has been unable toreach the full length of the colon.

B) CAT coronography: included in theguarantee only for symptomatic patientspresenting a low or medium probability ofcoronary disease, in whom it is notpossible to perform an ischaemiadetection test or it is negative orinconclusive; asymptomatic patients butwith a positive or uncertain ischaemiadetection tests; for the coronary anomalystudy; suspected anomaly or identificationof the background of the diagnosedpatient; for evaluation of pulmonary veinsprior to atrial fibrillation ablation; forcoronary study prior to heart valve surgeryand for evaluation of stents or coronarygrafts.

Assessment of the calcium score isexcluded.

3.30. Radiotherapy

3.31. Rehabilitation

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

3.32. Rheumatology

3.33. Urology

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

Includes Multiparametric MagneticResonance of the prostate in the followingindications:

• Local, regional or remote staging.• Detection or guide for diagnostic biopsy

where clinical risk is suspected withnegative result in earlier biopsies.

• Therapeutic monitoring.

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 assist him/her.

This benefit does not include any transferrequired for physiotherapy treatments, forconducting diagnostic tests or for


outpatient attendance to consultingrooms.

4.2. Special Care in the Home of theInsured

It will be carried out by the health teamsdesignated by SANITAS, provided that theservice can be arranged when the patient'scondition requires special care short ofhospitalisation, and always subject to priormedical prescription. Does not comprise carefor problems of a social nature.

4.3. Physiotherapy

This covers musculoskeletal physiotherapy onan outpatient basis, exclusively forcomplaints originating in themusculoskeletal system providing it is nota chronic or degenerative process and isonly covered until the patient has achievedthe greatest functional recovery possible inthe opinion of his/her rehabilitating physician.

Includes shockwave therapy forosteotendinous injuries of the musculoskeletalsystem.

Also includes lymphatic drainage following acancer process. It also includes themusculoskeletal physiotherapy as inpatient,secondary to orthopaedic surgery andheart rehabilitation under a hospitaladmission system following surgery withextra-corporeal circulation.

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

4.4. Speech and Language Therapy

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

Rehabilitation therapy and speechrehabilitation are included for conditionscaused by stroke.

4.5. Podiatry (Chiropody exclusively)

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

4.6. Prostheses

Only covers internal prostheses andinternal implantable materials expresslylisted below.

The Insured must provide the reports and/orquotations if SANITAS so requires.

1. Ophthalmology: Monofocal intraocularlensfor cataract surgery.

2. Traumatology and Orthopaedic Surgery:Hip, knee and other joint prostheses;columnar fixation material; intervertebral disc;intersomatic or interspinal intervertebralmaterial; vertebroplasty/kyphoplasty material;biological bone ligament material obtainedfrom tissue banks in Spain; osteosynthesismaterial; bone substitutes - exclusively forcolumnar surgery and bone grafts aftertumour 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 ceilingsystems in laparoscopic surgery; urologicalsuspension systems; cerebrospinal(hydrocephalus) fluid shunts; breastprostheses and expanders, exclusively in thebreast affected by prior tumour surgery.

6. Bone fixing materials in cranialand/ormaxillofacial surgery


4.7. 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.

Liquid oxygen therapy must be prescribedfor administration for at least 15 hours aday. SANITAS shall only pay for one typeof oxygen therapy treatment.

b) Generation of positive airway pressure totreat sleep disorders.

c) Aerosol therapy and Ventilation therapy.

5. Hospital admission

Includes any type of hospitalisation (medical,psychiatric, in ICU, surgery) in a clinic orhospital.

The patient shall occupy a conventional,individual room with a bed for relatives,except in psychiatric hospitalisation, inICUand SANITAS shall pay for any expensesarising from the performing of the diagnosisand therapeutic methods, surgical treatments(including surgery and drug costs, exceptcytostatic drugs that are not authorised forsale in Spain) and accommodation with theupkeep of the patient, included in the cover ofthe policy.

6. Early detection of disease

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

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

6.2. Cardiology : early diagnosis of heart risk.

6.3. Pneumology: early diagnosis of lungcancer.

6.4. Gynaecology: early diagnosis of breastcancer, cervical cancer and ovarian cancer.

6.5. Urology : early diagnosis of prostate andbladder cancer.

ADDITIONALCOVERAGES OF YOURINSURANCE


Overseas emergencyhealthcare cover

What is this?

This is an additional cover to your policycovering emergency illness or accidentabroad.

The services covered will be those indicatedbelow, with their limits and exclusions andwithout prejudice to the limits and exclusionsestablished in the General Terms andConditions of this policy, which shall alsoapply to this additional cover.

Which services am I entitled to?

1. Medical Costs

SANITAS 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 toa maximum of €300 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 conditionor an illness that was known aboutbefore the trip began, unless it is aclear or unforeseeable complication;treatments arranged in Spain

• 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 SANITAS medicalservice, SANITAS shall reimburse the costsarising from a required extended hotel stayfor the accompanying person - also insured- to a maximum of €60 per day for a totalof 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,SANITAS shall take charge of transportingthe Insured under medical supervision, bythe following means, according to theseverity of the illness or injury:

• 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 at the discretion of SANITASmedical service.


• 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 .

4. Search and retrieval of luggage andpersonal belongings

If the Insured has his/her luggage delayed orlost, SANITAS shall help in its search andretrieval, advising on how to file thecorresponding formal complaint. If theluggage is retrieved, SANITAS shall send itto the Insured’s habitual residence in Spain,providing the presence of the owner is notrequired for its recovery.

5. Dispatch of documents and personalbelongings overseas

SANITAS shall organise and pay the postageof essential items for the journey which havebeen 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.

SANITAS shall only organise the dispatchand postage for parcels weighing no morethan 10 kilogrammes.

6. Advance of funds

SANITAS shall advance funds of up to€1,500 to the Insured, when required.SANITAS shall require some kind of specialguarantee ensuring the Insured’s repaymentof the advance. In any event, the amounts

advanced shall be returned to SANITASwithin a maximum period of 30 days.

7.Legal advice

If the Insured is incarcerated or prosecutedas a result of a traffic accident, SANITASshall pay up to €1,500 for lawyer andattorney fees incurred from legal assistanceprovided. If this service is covered by theMotor Insurance Policy, it shall be consideredan advance and SANITAS shall reserve theright to request a special guarantee from theInsured to ensure payment of the advance.

8. Advance of the amount for baildemanded abroad

If the Insured is prosecuted or incarcerated inthe country in which it arises, SANITAS shallissue an advance equal to the amount of baildemanded by the local authorities to amaximum of €10,000.

SANITAS reserves the right to request aspecial guarantee from the Insured to ensurerepayment of the advance. In any event, theamounts advanced shall be repaid toSANITAS within a maximum period of twomonths.

9. 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, SANITAS shalllocate and send the medication by the fastestavailable means, subject to local laws andregulations.


This cover excludes events ofdiscontinued manufacture of themedication or unavailability from normaldistribution channels in Spain. TheInsured shall reimburse SANITAS for theprice of the medication againstpresentation of invoice.

10. Transmission of urgent messages(relating to covers)


SANITAS shall use a 24-hour service toaccept and transmit urgent messages fromthe Insured if they have no other means tosend such messages and provided themessages are consequent on a cover underthe Agreement.

11. Time frame

This cover covers travel up to 90consecutive days only.

12. Use of services

This cover 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 cover.

To be eligible to use all the services includedin this additional cover 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 bySANITAS; therefore, the Insured Party mustcontact said entity at the phone numberindicated on the back of his/her card so thatthe matter can be managed by the InsuredParty at no cost to him/her to the extent thatit is covered by the insurance policy. In theevent of a life-threatening emergency, theInsured Party shall report to the nearest clinicor hospital and report the event to SANITASwithin a period of 7 days of the date ofadmission.

Repatriation cover

Transfer to the Insured member'scountry of origin

If the insured dies, SANITAS will, via theprovider it appoints, organise and takecharge of the transfer of the coffin or ashes,in the case of cremation, from the place ofdeath to the international airport closest tothe place of interment in the deceased'scountry of origin expressly designated in theparticular conditions, when the insured's

beneficiaries report on the undertaker's thatwill take charge of the mortal remains at theairport.

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.

TERRITORIAL SPHERE

The services are applicable in any country.

USE OF THE SERVICES

To use the services under thissupplementary cover, the insured must be upto date with his/her obligations, especiallywith regards premium payment, and theinformation must be included in a file whichwill be supplied to the provider at the start ofthe cover.

The SANITAS card clearly indicates a hotlinenumber to make reverse-charge calls ifneeded, 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.The transportation of organs, tissue,cells and by-products, embryos andfetuses is expressly 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 the


transfer is to a country under the sameconditions.

Second medical opinioncover

This cover includes a second opinion onmedical diagnosis or treatment in the eventof serious chronic diseases, requiringscheduled care, which course requiresexceptional diagnostic or therapeuticmeasures and/or whereof the life prognosisis seriously compromised. Such a secondopinion shall be issued by leadingconsultants, healthcare centres, physiciansor academics in any country in the world,designated by SANITAS.

To use this service, the Insured shall sendthe clinical dossier comprising writtenmedical information, X-rays or other imagediagnoses performed, excluding dispatch ofany biological or synthetic materials.SANITAS shall confidentially send thisdossier to the corresponding specialist orcentre, according to the disease in question.

When the process finishes, a report aboutthe second medical opinion shall be sent tothe Insured, including:

• Summary of his/her clinical history.

• Opinion of the leading experts consulted.

• Curriculum of these leading experts.

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

Sanitas Dental 21 Sup InC/C

The benefits insured by this policy arespecified in the document Insured DentalBenefits, attached to the Particular Termsand Conditions and forming an integral andinseparable part of them and of these

General Terms and Conditions. They areclassified as follows:

1. Without excess: The Insured does nothave to pay any amount to the dentist unlessthe policy provides for copayments, whichshall be specified in the Particular Terms andConditions.

2. With excess: The Insured must pay theexcess amount determined in the InsuredDental Benefits document, attached to theParticular Terms and Conditions of thispolicy, for the service performed.

If there is any change to the insured benefitsor the amount of excess, the Insurer shallnotify the Insured of the new amounts to paywith two months' notice of the date of effect.Payment of the premium implies acceptanceof such changes.


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 own behalfor that of the Insured parties, mustinclude any type of injury, congenitalcondition, disease, diagnostic test,treatment and symptoms that may beconsidered the onset of a condition in thehealth questionnaire included in theinsurance application. Where notindicated, any insured cover directly orindirectly relating to the declaration notmade shall be excluded. SANITAS shallassess the information provided by thePolicyholder as a basis to accept or rejectthe arrangement of the insurance or toaccept it excluding certain insured cover.

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

• Occur as a consequence of naturalphenomena: earthquakes, tsunamis,floods, volcanic eruptions or storms, aswell as any that are directly or indirectlyrelated to nuclear radiation orradioactive contamination.

• Those occurring as a consequence ofviolent acts, such as terrorism,revolutions or military uprisings, evenin peacetime, and officially declaredepidemics.

• Any other incident that is similar to theabove in which Sanitas cannot meet itscontractual obligations due to reasonsof force majeure or that are out of thereasonable control of the company.

• Arising from the use of motor vehiclesthat are covered by the CompulsoryVehicle Insurance;

• Those arising while the Insured isinvolved, as an amateur, in sports ofrisk, such as flying activities, speedtrials in a motor vehicle, scuba diving,climbing, boxing, bullfighting, martialarts, rugby or any other similar activityof risk, as well as those resulting fromsporting competitions.

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 safetyand effectiveness 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


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 Medicines 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 general manner intheir public hospitals, not only in FlagshipHospitals.

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.

• Transplants of organs, tissues, cells orcells components, except autologoustransplant of both bone marrow andprogenitor cells of peripheral blood dueto haematologic lineage tumours andcornea transplant.

• Any surgical technique using roboticsurgery equipment.

• Genetic map determinations toascertain the predisposition of theInsured or his/her progenitors or presentor future offspring to certain diseasesrelated to genetic disorders, exceptBCRA1 and BCRA2 under the termsdescribed in the section on genetictesting. Genetic mapping of tumours andpharmacogenetics are also expresslyexcluded.

• Prosthesis and implantable materialsexcept those mentioned in thecorresponding paragraph of the presentGeneral Terms and Conditions. Amongothers, any external prosthesis, anyorthopaedic material, external fixingmaterials, synthetic or biologicalmaterials, grafts, aortic endoprosthesis,valved ducts, implantable pumps for theinfusion of medicaments, medullarystimulating electrodes, defibrillators andthe artificial heart.

• 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 areexpressly excluded, except those whichmeet the criteria described in the sectionon breast surgery, breast hypertrophy orbreast reduction in men are expresslyexcluded. Any kind of disorder orcomplication which may occursubsequently and which is directly and/ormainly 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.

• Services or techniques that merelyconsist of leisure, rest, comfort or


sporting activities, similarly treatments atspas and health farms.

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

• Ophthalmic photocoagulat ionexclusively for ischaemic retinopathies,macular oedema, glaucoma andperipheral retinal lesions (holes or tears).

• Keratoconus treatment.

• Haemorrhoid treatments.

• Clinical (not cosmetic) peripheralvascular surgery.

• Ear, nose and throat CO2 laser .

• In musculoskeletal physiotherapy.

J. Travel expenses except those coveredin the ambulance section of these GeneralTerms and Conditions.

K. Any kind of refractive surgery (formyopia, hypermetropia and astigmatism)is excluded.

L. The following pharmaceuticalproducts:

• Those administered to the patientoutside hospitalisation or in a day carehospital, except chemotherapyadministered parenterally by a healthcareprofessional in partner centres.

• Vaccinations and autovaccinations ofall types; 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).

M. Bariatric surgery in morbid obesity isexcluded.

N Radiosurgery is excluded.

Ñ. Parkinson surgery is excluded .

O. Epilepsy surgery is excluded.

P. Any medical provision directly relatedto pregnancy, delivery or newborn care isexcluded.


Clause IV: 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 chooses in each case.

On receiving applicable services, the Insuredmust present his/her SANITAS card. Also theInsured must show his/her National IdentityDocument, 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 ParticularTerms and Conditions.

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 the consulting rooms of consultants,general physicians, as well as the emergencycentres that belong to the contracted medicalnetwork by SANITAS for this product. Pleasecheck your User Guide to Doctors andServices for those consultants for which youwill need prescription/authorisation.

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, or Oncologist.

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

As a general rule, for surgical operations,inpatient treatment and counselorprofessionals, prior express authorisation bySANITAS shall be needed, after the writtenprescription of the professionals belonging toSANITAS network. Such authorisation shallbe also needed for certain therapeuticmethods, diagnosis tests and other careservices, whenever such is said in theGeneral Terms and Conditions of the policy.The authorisation voucher shall not be valid ifat the moment of receiving the service, theInsured is not fulfilling all the requirementsestablished in the General Terms andConditions of his/her policy to access to thefull insured coverage relating to the serviceindicated in such authorisation voucher (i.e.no being current on payments of thepremium, preexisting condition not declared,etc.).

1.4. Prior authorisation 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 authorisation 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 navigation


equipment or any other restrictedimplementation technology, that are coveredby this policy, SANITAS shall appoint thehealthcare centre and the professionals toperform the surgery in each individual caseand prior to the specific surgical procedure.

1.6. Services at the Insured's home.

SANITAS undertakes to provide homeservices in those localities where it has anarrangement for the provision of this service.Any change of the Insured's home addressmust be reliably notified with a minimum ofeight days' notice before requiring anyservice.

Services provided in the Insured's home arethose relating to the specialties of FamilyMedicine, Emergency Care, Nursing, SpecialHome Care, Ambulance and RespiratoryTherapies. All of these require a doctor'sprescription except Family Medicine.SANITAS reserves the right not to provide theservice when in the doctor's opinion it is notnecessary.

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 authorisation 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. TheInsured must present his/her SANITAS cardin the Offices of the contracted Entities,accepting the administrative steps of theseEntities.

1.8. Emergencies

As specified in article 103 of the InsuranceContract Act, SANITAS provides 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 life-threatening emergency,wherever the Insured needs to be admittedto a centre not included in the medicalnetwork, SANITAS must be reliablyinformed of this admission as soon aspossible so that it can transfer the insured toa partner centre, provided his/her medicalcondition allows as such.

1.9. Care in providers not recognised bySANITAS.

Notwithstanding what is mentioned in theabove paragraph for cases oflife-threatening emergency, SANITAS shallnot pay for the fees of professionals notbelonging to its medical network, nor forthe expenses of internment or servicesthat such professionals could order. Also,SANITAS shall not pay, under thecontracted medical network modality thatis the object of insurance of this policy, forthe expenses originated in private orpublic centres not contracted for thisproduct, no matter who the prescribing orperforming professional is.

2. Video consultation

The Insured may access certain physiciansand specialities from the partnered medicalnetwork to receive customised medical carevia distance communication channels (videoconsultation).

2.1. Description:

• The service shall be provided by specialistphysicians selected by SANITAS fromwithin the SANITAS partnered medicalnetwork.

• SANITAS will provide information at alltimes at www.sanitas.es regarding thespecialities and physicians who you can

http://www.sanitas.es


access via this form of distancecommunication medical consultation.

• This service shall always be provided aftera previous appointment has been madeand is not valid for emergency care, whichshall be attended in SANITAS partnercentres for due management.

• Subject to the availability of eachspecialist's schedule and opening hours.You can check these hours at Mi Sanitas.

• A service accompanied by the instantmessaging functionality, during the videoconsultation and afterwards if the doctorconsiders it appropriate.

• The video consultation may involveexchanging medical documentation thatcan be filed in the Mi Sanitas Health File atwww.sanitas.es.

• SANITAS has adopted the legally requiredtechnical resources to guarantee dueconfidentiality of information exchanged inthis fashion.

• In order to guarantee said confidentiality,recording images and sound from the videoconsultation or attaching them to any typeof capturing medium is strictly prohibited.The full or partial copying, reproduction,distribution, dissemination, makingavailable to third parties or any other way ofpublicly communicating, transforming ormodifying by any means, whetherelectronic or any other, the image or soundobtained or produced during the videoconsultation is also strictly prohibited,without the express written consent of thephysician concerned or Sanitas S.A. deHospitales. However, the physician maykeep a copy of the video consultation forthe purpose of storing it with the clinicaldocumentation.

• The service shall be provided exclusively tothose Insured who expressly appear asregistered as such on the policy. EachInsured must book an appointment toreceive the service. The video consultationmust be customised for each Insured party.

• If the Insured is under 18 years of age, thevideo consultation may only be performedwith the prior authorisation of the minor'slegal representative.

• The Insured must have and shall beresponsible for all technical (hardware andsoftware) and distance communicationmeans needed to guarantee the correctperformance of the video consultation.SANITAS shall not be held responsible forany harm that may be caused due to failureof computer equipment, connections orshortfalls of these means on the part of theInsured.

• This form of consultation is simply to aiddecision-making on the part of thephysician and does not replace aface-to-face consultation or make itpossible to diagnose diseases or prescribediagnostic tests or medical treatments incases where, in the doctor's opinion, theInsured must be present in the consultingroom for a personal and direct assessment,including a physical examination of theInsured by the specialist. The results of theface-to-face consultation will always prevailover any assessments and criteriaperformed in the video consultation.

• Consultations performed by videoconsultation by professionals not expresslyauthorised by SANITAS to attend theInsured by video consultation are notcovered, regardless of whether they belongto the SANITAS partnered medical networkfor this product or not.

2.2. Procedure:

• The Insured must request this service viaMi Sanitas at www.sanitas.es or via themobile app.

• The Insured must connect the app in MiSanitas on the date and time of theappointment to establish contact with thedoctor and begin the video consultation andfollow any other instructions provided bySANITAS at all times.




Clause V: Other features ofthe 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 even whenSANITAS did, 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 makesthe statement to which the precedingparagraph refers, the provision will bereduced proportionally to the differencebetween the agreed premium and that whichwould have applied had the true risk beenknown. If there was fraud or gross fault on thepart of the Policyholder, the Insurer will be

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

1.3. Notwithstanding the foregoing, theInsured also loses the right to theguaranteed benefit, if the incident occursbefore the premium has been paid (or,where applicable, a single premium)unless otherwise agreed (Art. 15 of theInsurance 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, whowill have available for the Insured, at all times,in SANITAS Offices, the complete andupdated list of such consultants, for theInsured’s information.

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 signed. However, wherethe Policyholder has not received the termsand conditions of the policy and the priorinformation note about the contracting of theInsurance policy, the term for exercising theright to terminate shall begin to count on thedate 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 one


year. 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, if it is SANITAS that gives thisnotice and one month if it is the Policyholderwho gives it.

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 the date onwhich the Insured communicates and creditssuch circumnstance.

2.4. Persons under 14 years of age can onlybe included in the insurance if the personsthat hold their custody or guardianship arealso insured, unless the parties agreeotherwise.

3. Insurance premiums

3.1. The Insurance Policyholder must paythe premium when the contract isaccepted. The arranged covers shall not

take 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 thePolicyholder 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 to


pay 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 shallauthorise the bank to pay them.

3.7. SANITAS is only bound by theinvoices issued by the Management or byits legally authorised 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 oftechnological 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 zone

corresponding to the place of performance ofthe services, the tariffs established bySANITAS on the date of renewal of eachpolicy being applicable. Such variation ofpremiums shall be communicated in writingby SANITAS to the Policyholder with at leasttwo months’ notice with respect to the renewaldate.

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, with at least one month’snotice before the expiry date of the currentinsurance period.

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 invoice in return.

4. 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.

5. Complaints

5.1. Complaints control and procedure

a) Supervision of the business activity ofSANITAS lies with the Spanish State and isexercised through the Directorate General for


Insurance 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. SANITAS Complaints ManagementDepartment , by means of a signed writtencomplaint with the claimant's NationalIdentification Document or a documentaccrediting their identity, addressed to calleRibera del Loira Nº 52 (28042 Madrid) orfax to 91 585 24 68 or to the email [email protected] , which willacknowledge receipt in writing and issue areasoned written decision within thestatutory deadline of two months from thedate of filing the complaint, so long as itmeets all the requirements sought, pursuantto Order ECO /734/2004, of 11 March, on thecustomer care departments and services offinancial entities and the Customer ProtectionRegulation available at your disposal in ouroffices.

2. Once this internal process has beenexhausted or in the event of disagreementwith the decision of SANITAS, a signedwritten complaint, with the claimant’s NationalIdentification Document or a documentaccrediting their identity, may be lodged withComplaints Service of the DirectorateGeneral for Insurance and Pension Funds,Paseo de la Castellana, 44, 28046 Madrid .Accordingly, the claimant must prove that theestablished period for the settlement of thecomplaint by the SANITAS ComplaintsManagement Department has expired or thatthe complaint has been denied leave toproceed or has been dismissed.

3. Please be informed that SANITAS is notbound by any consumer arbitration board.The insured may initiate administrative andlegal proceedings as set down in thecomplaints procedure described in theGeneral Terms and Conditions of their policy.

4. In any case, action may be brought beforethe relevant Courts.

5.2. Actions in connection to this InsuranceAgreement shall be subject to a five-year timelimit (Article 23 of the Insurance Act).

6. Other important legal points

6.1. Subrogation

Once payment of the covered benefit hasbeen assumed, SANITAS may exercise therights and actions corresponding to theInsured due to the claim caused with regardsto the persons responsible for it, up to thelimit of compensation paid.

The Insured must sign the necessarydocuments for subrogation in favour ofSANITAS.

6.2. Notifications.

6.2.1. Notifications to SANITAS on the partof the Policyholder, the Insured or Beneficiaryshall be sent to the Insurer’s registeredoffice as stated in the policy.

6.2.2. Notifications from SANITAS to thePolicyholder, the Insured or Beneficiary shallbe sent to the physical or email address of thePolicyholder or to the telephone numberprovided by the Policyholder that at the timethe Insurance is arranged, except where achange has been notified to SANITAS. ThePolicyholder authorises SANITAS to send anynotifications by email as permitted by law.

6.3. Protection of personal data

The information collected through thisdocument is confidential and protected.ThePolicyholder undertakes to ensure that allinformation provided to the Insurer 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.


Furthermore, the Insurer informs thePolicyholder and the insured parties and theyconsent to all their personal data beingentered in files held by the Insurer for thepurpose of the company's activities, theeffectiveness of contractual relations, theprovision of integrated care programmes thatwill allow them to improve their health, theunderstanding of reasons for cancelling thepolicy, loyalty programmes and fraudprevention.

Nevertheless, he/she authorises the Insurerto ask physicians, clinics, hospitals, etc. andhe/she therefore authorises such persons toprovide to the Insurer, any data on the healthof the persons included under the policy thatthe Insurer may deem expedient for themanagement of the insurance, for offeringcomprehensive healthcare programs that theInsurer 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.

For the purpose of preventing fraud, theinsured parties expressly consent to theInsurer keeping such data as are necessary,even after the contractual relationship hasended.

If the Policyholder/Insured withholds consentfor his/her data to be entered in such files andsubsequently processes, the insurancecontract cannot be arranged.

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 the Insurer 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.

In addition, the insured parties and thePolicyholder expressly authorise assignmentof those data to companies of SANITASGroup identified at http://www.sanitas.es,relating to financial, insurance, social andhealthcare, and/or health and welfareproducts and services, and for the reason ofco-insurance and/or reinsurance of the riskand any other person with which the Insurercreates ties of cooperation, for theeffectiveness of contractual relations with theinsured and for sending advertising fromthose companies.

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 del Loira 52, 28042 Madrid, LegalAdvice Department, or through Mi Sanitas onhttps://www.sanitas.es/misanitas/online/clientes/contacto/index.html. If the Policyholderand/or insured parties do not wish to receivecommercial information from the Insurer or,as applicable, from other companies theInsurer collaborates with, or who do not wishtheir data to be transferred to othercompanies except for the effectiveness ofcontractual relations, they must make thisknown in writing by the same means.

In the event that no written communication isreceived within 45 days from the date onwhich the Policyholder had knowledge of theinformation 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.

7. Others

The Policyholder and/or Insured grantSANITAS their authorisation so that, ifconsidered necessary, it may record the


telephone 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.

8. Jurisdiction

The Court competent to hear actionsarising from the insurance contract shallbe the one corresponding to the Insured'saddress in Spain.

Executed in duplicate in Madrid, 02 June 2017For the Insured / For SANITASPolicyholder

Documents

GENERAL TERMS AND CONDITIONSsanitasinternationalstudents.com/docs/CG_Sanitas_International_Students_en.pdfThis is the care provided when admitted to a hospital, with a record of admission