PRE-EXISTING MEDICAL CONDITIONS

ABOUT SPANISH MEDICAL INSURANCE :

Article by established Spanish Insurance adviser Francis Payne

IMPORTANT GUIDANCE:

Coverage of Pre-existing Medical Conditions in Spanish Medical Insurance Policies.

Worth noting that 76% of our customers over the age of 55 have a pre-existing medical condition exclusion or two excluded from their policy.

IMPORTANT NOTE:

However, this does not prevent them from seeing a Specialist under the policy we provide.

To Prospective Policyholders,

It is critical that you carefully read and understand the terms and conditions of any private medical insurance policy before purchasing coverage in Spain.

Spanish insurance policies operate under specific regulations and clauses that differ from those in other countries.

This article serves to warn you that entering into a Spanish medical insurance policy will most likely NOT insure you for pre-existing medical conditions, even if you were unaware of the condition when the policy began.

Key Points You Must Understand:

1. Pre-existing Conditions are Excluded by Default

Virtually all private medical insurance contracts in Spain contain a "pre-existing conditions" exclusion clause. This clause legally allows the insurer to deny coverage, treatment, and payment for any illness, injury, or physical condition that you had prior to the start date of the policy.

2. Your Knowledge of the Condition is Irrelevant

A critical and often misunderstood aspect of Spanish insurance law is that your personal knowledge or ignorance of the condition at the time of signing the contract does not guarantee coverage.

If medical records, test results, or a doctor's later diagnosis confirm that the condition originated before the policy was active, the insurer has grounds to refuse the claim entirely, regardless of your good faith when applying.

3. The Importance of the Medical Questionnaire

When you apply for a policy, you will be required to complete a detailed medical questionnaire (a "Declaración de Salud").

• You must be completely honest. If you intentionally withhold information (fraudulent misrepresentation), the insurer can cancel your policy immediately and refuse all future claims.

• The insurer will investigate claims. If you make a claim for a serious or chronic condition, the insurer will likely request access to your previous medical history and records to verify when the condition first appeared.

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4. The Policy Wording is Final

The only guarantee of what is covered is the precise wording within your specific insurance contract (the Condiciones Generales and Condiciones Particulares).

Action Required:

• Read the Fine Print: Insist on receiving a full copy of the policy terms and conditions before you pay anything.

• Seek Clarification: If your Spanish is not perfect, have the relevant clauses regarding "enfermedades preexistentes" (pre-existing conditions) translated by a professional or explained by a qualified, independent insurance advisor.

• Do Not Assume: Do not assume that because you have always been insured elsewhere, the coverage in Spain will be the same.

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We urge new customers to take the time to think carefully about their new life in Spain with regards to their future healthcare.

It is often a good idea to arrange a medical plan via a friendly insurance agency who can provide ongoing help and support.

Remember once you have a Spanish Medical plan that nothing historic pre-dating the commencement of your private healthcare policy will be covered.

Scenario:

You have had a policy for 6 months and visit a specialist and tell the doctor that the same knee that is giving you pain now is a reoccurrence of an issue you had a few years ago. This information is written down in the doctors report. The Doctor asks you to obtain the Insurers approval for an MRI scan. As part of the process you send the report to the insurance company, who read about this issue being historic and reject the pre-approval. The insurer will most likely inform you that from thereon any issue with that knee will no longer be covered.

By signing a Spanish medical insurance policy, you are confirming that you understand and accept these limitations.

Proceed with caution and request the help and guidance that a good helpful insurance agency will provide.

Article written by;

Francis Payne.

Tailor Made Healthcare Spain

www.tailormadehealthcarespain.org

tel: +34 956 777 905