Sanitas Oro Reembolso. Medical / health insurance Spain. Sanitas English agent ( BUPA Group )

This product has been created for non-Spanish residents in Spain, over 60, who spend at least 6 months a year in Spain. There are 2 versions of this product. The other one is described below (see table)

Details:

The policyholder will be covered 100% of the cost using the Sanitas network and will receive a refund of 70% of the cost of non-Sanitas providers in Spain and other countries.

Cover, waiting period etc...

Cost (Spain - except other regions - 'Oro Reembolso'): ( Rest of Spain - plus taxes)

(Discount of 4% for annual payment and 2% for 6 monthly payment)

S- Reimbursement without franchise - Limits (2005)

REIMBURSEMENT PERCENTAGE OF MEDICAL EXPENSES WITH SANITAS ORO REEMBOLSO

(Non-franchise modality)

Recommended services in Spain 100%

Services in Spain (outside recommended services) and overseas 70%

CONTRACTED GUARANTEES INSURED CAPITAL

(per year and person insured)

	TOTAL		OVERSEAS
	Pesetas	Euros	Pesetas	Euros
OVERALL LIMIT	15,000,000	90,151.82	5,000,000	30,050.61
A. Hospital Treatment	12,000,000	72,121.45	4,000,000	24,040.48
B. Non-Hospital Treatment	3,000,000	18,030.36	1,000,000	6,010.12

CONTRACTED GUARANTEES – PARTIAL LIMITS

	AMOUNT INSURED
	PESETAS	EUROS
A. HOSPITAL TREATMENT
A.1. In-patient (total per day)	32,000	192.32
A.2. UVI/ICU (per day)	53,000	318.54
A.3. Medical fees per procedure (including surgeon, assistant and anesthetist fees)	e	e
- Minor and outpatient surgery (Group 0, OMC classification) (total per operation)	50,000	300.51
- Minor and outpatient surgery (Group 1, OMC classification) (total per operation)	60,000	360.61
- Minor and outpatient surgery (Group 2, OMC classification) (total per operation)	75,000	450,76
- media surgery (Group 3, OMC classification) (total per operation)	250,000	1,502,53
- media surgery (Group 4, OMC classification) (total per operation)	350,000	2,103.54
- Major surgery (Group 5, OMC classification) (total per operation)	450,000	2,704.55
- Major surgery (Group 6, OMC classification) (total per operation)	550,000	3,305.57
- Major surgery (Group 7, OMC classification) (total per operation)	650,000	3,906,58
- Grand surgery (Group 5, OMC classification) (total per operation)	900,000	5,409,11
A.4. Brain sterotaxic surgery (all costs included) (total per year and policyholder)	1,000,000	6,010.12
A.5. Medical fees for consultation (total per day)	15,000	90.15
B. NON HOSPITAL TREATMENT	PESETAS	EUROS
B.1. Medical consultation:
Primary healthcare (total per consultation)	7,000	42.07
Specialised healthcare (total per consultation)	15,000	90.15
B.2. Ambulance (total per policyholder and year)	100,000	601,01
B.3. Dentistry (only extractions, cures and dental cleaning) (total per policyholder and year)	40,000	240.40
B.4. Special domiciliary care and domiciliary services	150,000	901.52
B.5. Chiropody (unlimited)
B.6. Diagnostic tests (total per policyholder and year)	150,000	901.52
Clinical analysis (total per procedure)	10,000	60.10
Clinical analysis (total per policyholder and year)	25,000	150.25
Conventional radiology (total per procedure)	10,000	60.10
Conventional radiology (total per policyholder and year)	25,000	150.25
Ecography (total per procedure)	8,000	48.08
Ecography (total per policyholder and year)	20,000	120.20
Bilateral Mammography (total per procedure)	10,000	60.10
Bilateral Mammography (total per policyholder and year)	10,000	60.10
Bilateral CAT scan (total per procedure)	16,000	96.16
Bilateral CAT scan (total per policyholder and year)	32,000	192.32
Bilateral NMR (total per procedure)	30,000	180.30
Bilateral NMR (total per policyholder and year)	60,000	360.61
Densitometry (total per procedure)	12,000	72.12
Densitometry (total per policyholder and year)	12,000	72.12
Holter (total per procedure)	15,000	90.15
Holter (total per policyholder and year)	30,000	180.30
Ergometry (total per procedure)	10,000	60.10
Ergometry (total per policyholder and year)	20,000	120.20
Echocardiogram (total per procedure)	10,000	60.10
Echocardiogram (total per policyholder and year)	20,000	120.20
B.7. Special treatments
Linear accelerator (total per policyholder and year)	300,000	1,803.04
Cobalt bomb (total per policyholder and year)	200,000	1,202.02
Chemotherapy (total per policyholder and year)	300,000	1,803.04
Renal Lithotripsy (total per policyholder and year)	160,000	961.62
Dialysis (all included) (total per procedure)	16,000	96.16
C. REHABILITATION (total per policyholder and year)	100,000	601.01
§ For psychiatry, “A” and “B” guarantees will have a global maximum limit of Ptas 150,000 / € 901.52 per year and policyholder and the maximum period for psychiatric hospitali sa tion will be 50 days per policyholder a year Diagnostic tests, special domiciliary care and chiropody included in guarantee “B” will exclusively be undertaken via the medical services recommended by the Insurer whenever these services are provided in Spain Expenditure originated by the policyholder for the use of medical and/or hospital services in Spain which have been recommended by the Insurer will not be taken into consideration to calculate the insured capital limit set forth under this Policy Should the Insurer not pay the hospital expenditure described in guarantee “A”, the Insurer would pay a subsidy of Ptas 12,500 / € 75.13 per each day in hospital with a maximum limit of 90 days per policyholder and year (this subsidy does not apply to psychiatric hospitali sa tion). (Rough translation)

General rules (Sanitas Oro Reembolso)

For more information please contact David Harris

saniprof@mail.ddnet.es or saniprof@wanadoo.es Fax: (+34) 91 803 2484

Telephone: (+34) 91 8043802 ( mobile: (+34) 609 522 300 )

Sanitas updates - actualizaciones referentes a su seguro médico...

General rules (Sanitas Oro Reembolso)

General Rules of Use (Sanitas Oro Reembolso)

Special rules (Sanitas Oro Reembolso)

Claims procedure (Sanitas Oro Reembolso)

Primary care and specialist consultations (Sanitas Oro Reembolso)

Home visits by primary care physicians (Sanitas Oro Reembolso)

Prescriptions (this doesn't refer to medicines) (Sanitas Oro Reembolso)

Exempt services (No prior authorisation needed) (Sanitas Oro Reembolso)

Non-exempt services (requiring Sanitas authorisation) (Sanitas Oro Reembolso)

Special services (Sanitas Oro Reembolso)

Hospitalisation (Sanitas Oro Reembolso)

Home emergencies (Sanitas Oro Reembolso)

Preventive medicine programmes (Sanitas Oro Reembolso)

Supplementary care for travel abroad (Sanitas Oro Reembolso)

David Harris ('Mainly Health Plans') English / Spanish after-sales support ...

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Sanitas Oro Reembolso (Reimbursement policy) - general information

A. Hospital Treatment

B. Non-Hospital Treatment

CONTRACTED GUARANTEES – PARTIAL LIMITS

A. HOSPITAL TREATMENT

A.1. In-patient (total per day)

A.2. UVI/ICU (per day)

A.3. Medical fees per procedure (including surgeon, assistant and anesthetist fees)

A.4. Brain sterotaxic surgery (all costs included) (total per year and policyholder)

A.5. Medical fees for consultation (total per day)

B. NON HOSPITAL TREATMENT

B.1. Medical consultation:

B.2. Ambulance (total per policyholder and year)

100,000

601,01

B.3. Dentistry (only extractions, cures and dental cleaning) (total per policyholder and year)

40,000

240.40

B.4. Special domiciliary care and domiciliary services

150,000

901.52

B.5. Chiropody (unlimited)

B.6. Diagnostic tests (total per policyholder and year)

150,000

901.52

10,000

60.10

25,000

150.25

10,000

60.10

25,000

150.25

8,000

48.08

20,000

120.20

10,000

60.10

10,000

60.10

Bilateral CAT scan (total per procedure)

16,000

96.16

Bilateral CAT scan (total per policyholder and year)

32,000

192.32

Bilateral NMR (total per procedure)

30,000

180.30

Bilateral NMR (total per policyholder and year)

60,000

360.61

12,000

72.12

12,000

72.12

15,000

90.15

30,000

180.30

10,000

60.10

20,000

120.20

10,000

60.10

20,000

120.20

B.7. Special treatments

300,000

1,803.04

200,000

1,202.02

300,000

1,803.04

160,000

961.62

16,000

96.16