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How does this plan work?

Who is Sanitas Health Plan Complete for? Hide

Sanitas Health Plan Complete is an international healthcare plan that has been designed especially for non-Spanish residents who spend part of or the whole year in Spain, and also require medical insurance in a second European country. To apply, you must have a Spanish residence and bank account.

Where can I be treated? Hide

You can receive treatment from any recognised hospital, clinic, or legally qualified medical professional. The Sanitas policy brochure (PDF) details how some benefit limits can vary depending whether treatment is received in or out of the Sanitas Spanish network.

How do I arrange treatment? Hide

When you know that you need to seek medical advice and/or treatment, we ask that you contact us first. This allows us to check your cover, confirm that your proposed treatment is eligible for payment, and in many cases, contact your medical provider to arrange direct settlement.

In Spain, you can opt to receive your treatment through our Doctors Network which consists of more than 20,000 professionals and 520 private medical centres. This extensive medical team also includes multi-lingual staff, including English speakers.

How does the claims process work? Hide

When receiving medical treatment in Spain through the Sanitas Network, your Sanitas Health Plan card will entitle you to 100 percent cover, which will be settled directly by Sanitas, within the limits and conditions of your policy.

If you visit a doctor or medical provider that is not included in Sanitas’ Doctors Network, you must pay the doctor or medical provider the full cost of the treatment received, at the time of treatment.

You will then need to send the original invoice and receipt, together with a completed claim form, to Sanitas:

Sanitas S.A de Seguros

Departamento de Reembolsos

C/ Ribera del Loira, 52

28042

Madrid

España

They will then reimburse 90 percent of your medical expenses, within the limits and conditions of your policy.

There are two ways that your medical treatment received outside of Spain can be paid:

Direct settlement

• You contact us to advise what treatment you intend to receive.
• We confirm that treatment is eligible and that we can ‘pre-authorise’ (guarantee payment) of it.
• We send pre-authorisation to you and the provider of your treatment.
• You complete and sign the pre-authorisation form.
• Your medical provider attaches the invoice(s) for your treatment and returns with the pre-authorisation documents to us.
• We process the claim and pay your medical provider directly.
• We send you a ‘payment statement’ advising when and how it was paid, and who received the payment.
• You settle any shortfall with your medical provider.

Pay and claim

You contact us to advise what treatment you intend to receive.

• We confirm your cover and benefit limits.
• You receive treatment and pay your medical provider (usually at time of treatment).
• You and your medical provider fully complete a claim form and return the claim form to us.
• We process the claim and pay you*.
• We send you a ‘payment statement’ advising when and how it was paid, and who received the payment.

How does Bupa International make claim payments? Hide

Wherever possible, we will follow the instructions given to us in the payment section of the claim form.

• We can pay you, the principle member (applicant) or your medical provider.
• We can pay by cheque or by electronic bank transfer (where applicable).
• We can pay in over 80 currencies.

What are waiting periods? Hide

Some treatments are only eligible for payment after a certain amount of time has passed since you joined the Sanitas Health Plan Complete policy.

Inside Sanitas Network

Vasectomy and sterilisation – 180 days

Childbirth delivery – 300 days

Outside Sanitas Network/in chosen second country

Hospitalisation and surgery – 90 days

Childbirth delivery – 300 days

Radiotherapy, chemotherapy, CAT scans, MRI scans – 150 days

Physiotherapy, rehabilitation, ultrasound, pathology, special home care – 90 days

Psychiatric treatment – two years

Do you have a limit for the cost of treatment I may receive? Hide

Beyond the benefit limits of your plan, we only pay costs when the charges made by the provider of services are reasonable and customary. By this we mean that the charges are the same as those made to our members by the majority of other service providers in the same country; and also that they are not more than the provider would normally charge.

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Services available to you

How can I track the progress of my claim? Hide

We will process your claim as quickly as possible. You can check the progress of claims** you have made via our MembersWorld website or by contacting General Enquiries on +44 (0) 1273 323 563.

How can I contact Bupa International? Hide

As a Bupa International member, you can call our Medical Centre at any time of the day or night, and day of the year, and speak to medically trained people who understand your situation and can give you the healthcare advice, support and assistance you need.

We also have a team of expertly trained people ready to help with any general enquiries you may have.

Medical Centre: +44 (0)1273 333 911

General Enquiries: +44 (0)1273 323 563

Email us via our MembersWorld website

What is your complaints process? Hide

We are always pleased to hear about aspects of your membership that you have particularly appreciated, or that you have had problems with. If something does go wrong, here is our simple procedure to ensure your concerns are dealt with as quickly and effectively as possible.

Getting in touch

If you have any comments or complaints, you can call the Bupa International customer helpline on +44 (0) 1273 323563, 24 hours a day, 365 days a year. Alternatively, you can email via www.bupa-intl.com/membersworld, or write to us at:

Bupa International

Russell Mews

Brighton

BN1 2NR

UK

We want to make sure that members with special needs are not excluded in any way. For hearing and speech impaired members who have a textphone, please call +44 (0) 1273 866557.

We also offer a choice of Braille, large print, or audio for our letters and literature. Please let us know which you would prefer.

Taking it further

If we have not been able to resolve the problem and you wish to take your complaint further, please call the Bupa International customer helpline on +44 (0) 1273 323 563 or write to the Head of Customer Relations at:

Bupa International

Russell Mews

Brighton

BN1 2NR

UK

It’s very rare that we can’t settle a complaint, but if this does happen, you may refer your complaint to the Financial Ombudsman Service.

You can:

write to them at:

South Quay Plaza

183 Marsh Wall

London

E14 9JR

Call them on:

0845 080 1800 (from inside the UK only)

+44 (0) 20 7964 1000 (from outside the UK)

Find details at their website:

www.financial-ombudsman.org.uk

Please let us know if you want a full copy of our complaints procedure. (None of these procedures affect your legal rights).

Can I access my plan online? Hide

Yes, as a Bupa International member you will have access to our MembersWorld website where you can:

• view your plan
• update your personal details
• make payments online
• search our international hospital directory
• download claim forms and other useful documents
• talk to us online using our free Webchat service

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Managing your plan

Can I change my level of cover? Hide

If you want to change your level or type of cover, please contact our customer services helpline (+44 (0)1273 323563) before renewal to discuss your options.

How can I cancel my plan? Hide

As soon as we accept you as a member of Sanitas Health Plan Complete, we will send you a copy of your membership guide which clearly explains the rules and benefits of the plan.

If you change your mind, you can either:

Sign and return the documents with ‘cancel’ written clearly on them, or:

• call us and tell us you would like to cancel your membership
• if you do this within 14 days of receiving the pack, and you have made no claims, we’ll give you a full refund of any subscriptions you have paid

What happens if I can no longer pay for my plan? Hide

If you do not pay subscriptions and other charges in full by the date they are due, your membership may be suspended and claims submitted whilst there are subscriptions and charges due will not be paid.

Your membership may also be suspended if you do not settle in full any annual deductible payable by you for a claim which has been paid direct to your medical provider. Claims submitted whilst repayment of an annual deductible is due will not be paid.

I haven't been able to find the answer to my question Hide

We are continuously adding information to this website and are sorry that you haven’t found the information you were looking for on this occasion.

For the information you require, please contact us on +44 (0)1273 718 306 or send us an email enquiry.

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