GENERAL TERMS AND CONDITIONS - Sanitas

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.

ID NO. A-28037042

3 - 52 Contents

General terms and conditions

CONTENTS

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

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

Clause I: Purpose of the Insurance...........................................................................12

Clause I: Benefits........................................................................................................13

PRINCIPAL BENEFITS......................................................................................................................................13

1. Primary care.................................................................................................................................................13

1.1. General Medicine....................................................................................................................................... 13

1.2. Paediatrics and Childcare...........................................................................................................................13

1.3. Nursing Service..........................................................................................................................................13

2. Emergencies................................................................................................................................................13

Sanitas 24 Hours...............................................................................................................................................14

3. Medical specialities.....................................................................................................................................14

3.1. Allergology..................................................................................................................................................14

3.2. Clinical Analysis..........................................................................................................................................14

3.2.1. Genetic Studies...................................................................................................................................14

3.3. Anatomic Pathology....................................................................................................................................15

3.4. Anaesthesiology.........................................................................................................................................15

3.5. Angiology and Vascular Surgery................................................................................................................15

3.6. Digestive System........................................................................................................................................15

3.7. Cardiology...................................................................................................................................................15

3.8. Cardiovascular surgery...............................................................................................................................15

3.9. General and Gastrointestinal Surgery........................................................................................................15

3.10. Maxillofacial Surgery.................................................................................................................................16

3.11. Traumatology and Orthopaedic Surgery...................................................................................................16

3.12. Paediatric Surgery....................................................................................................................................16

3.13. Reconstructive Surgery............................................................................................................................16

3.14. Chest Surgery...........................................................................................................................................16

3.15. Dermatology.............................................................................................................................................16

3.16. Endocrinology...........................................................................................................................................16

4 - 52 Contents

3.17. Geriatrics..................................................................................................................................................16

3.18. Haematology and Haemotherapy.............................................................................................................16

3.19. Internal Medicine......................................................................................................................................16

3.21. Nephrology...............................................................................................................................................17

3.22. Pneumology..............................................................................................................................................17

3.23. Neurosurgery............................................................................................................................................17

3.24. Clinical Neurophysiology..........................................................................................................................17

3.25. Neurology.................................................................................................................................................17

3.26. Obstetrics and Gynaecology.....................................................................................................................17

3.26.1. Breast Surgery....................................................................................................................................18

3.26.2. Neonatology Care.............................................................................................................................18

3.26.3. Newborn care....................................................................................................................................18

3.27. Ophthalmology:........................................................................................................................................ 18

3.28. Medical Oncology.....................................................................................................................................19

3.29. Ear, Nose and Throat...............................................................................................................................19

3.30. Psychiatry.................................................................................................................................................19

3.31. Radiodiagnosis-Diagnostic Imaging.........................................................................................................19

3.32. Interventional or invasive radiology:.........................................................................................................20

3.33. Radiotherapy............................................................................................................................................20

3.34. Rehabilitation............................................................................................................................................20

3.35. Rheumatology.......................................................................................................................................... 20

3.36. Urology.....................................................................................................................................................20

4. Other care services.....................................................................................................................................21

4.1. Ambulance:.................................................................................................................................................21

4.2. Special home care:.....................................................................................................................................21

4.3. Obstetric-Gynaecological Nursing (Midwifery)............................................................................................21

4.4. Physiotherapy.............................................................................................................................................21

4.5. Speech and Phoniatric Therapy.................................................................................................................22

4.6. Nutrition......................................................................................................................................................22

4.7. Odontology.................................................................................................................................................22

4.8. Podiatry (chiropody):...................................................................................................................................22

4.9. Prostheses..................................................................................................................................................22

4.10. Mother and Baby Programme.................................................................................................................. 23

4.11. Psychology...............................................................................................................................................23

4.12. Home-based respiratory therapy..............................................................................................................23

5. Hospital admission........................................................................................................................................24

6. Preventive medicine......................................................................................................................................24

ADDITIONAL COVERAGES OF YOUR INSURANCE......................................................................................26

Overseas emergency healthcare cover...........................................................................................................27

5 - 52 Contents

Cover in the United States................................................................................................................................29

Second medical opinion cover.........................................................................................................................29

Clause II: Exclusions from cover...............................................................................31

Clause III: Qualification periods................................................................................35

Clause IV: Form of service provision........................................................................36

Clause V: Other features of the insurance................................................................40

1. Basis and loss of rights of the policy........................................................................................................40

2. Maximum age for taking out the policy.....................................................................................................40

3. Duration of insurance................................................................................................................................. 41

4. Insurance premiums...................................................................................................................................41

5. Registering newborns.................................................................................................................................42

6. Provision of reports.................................................................................................................................... 43

7. Complaints...................................................................................................................................................43

8. Other important legal points...................................................................................................................... 44

9. Data Protection clause................................................................................................................................44

10. Jurisdiction................................................................................................................................................52

11. Prevention of money laundering and financing of terrorism................................................................52

12. How to contact us......................................................................................................................................52

6 - 52 General Terms and Conditions

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 by theinsurance distribution directive and thematters agreed 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 Health Plan Complete insurance product, thefollowing 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.

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

HEALTH QUESTIONNAIREDeclaration that must be truthfully and fullycompleted and signed by the Policyholder orInsured before formalisation of the policy andused by SANITAS to assess the risk subjectto 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.

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

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

POLICYWritten document that contains the Termsand Conditions governing the insurance 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 signing thehealth questionnaire.


BENEFITAcceptance of payment of the care service bySANITAS of the guarantees committed to inthe 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 ofservices arising from the same cause isconsidered to constitute a single claim.

SECOND EUROPEAN COUNTRYCOVERThis is a country (besides Spain) named bythe Insured in the Particular Conditions at thetime of subscribing to the policy to receivemedical cover, in accordance with the Policy.sterms and conditions. Once named it cannotbe changed without the Insurer.sauthorisation.

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/WITHADMISSION TO HOSPITALThis is the care provided in a medical centreor hospital under admission to hospital,recording admission and the insured beingadmitted as a patient for at least one night inorder to undergo medical treatment,diagnosis, surgery or therapeutic treatment.

HEALTHCARE IN A DAY HOSPITALThis is the medical, diagnostic, surgical ortherapeutic care provided in a medical centreor hospital that requires non-intensive,short-duration care that does not require anovernight stay.

In the case of surgical treatment at a dayhospital, it will be performed in the operatingroom under general, local or regionalanaesthesia or sedation and requiresnon-intensive, short-duration care that doesnot require an overnight stay.

H E A L T H C A R E W I T H O U THOSPITALISATION / OUTPATIENTHEALTHCAREThis is the medical, diagnostic, surgical ortherapeutic care provided in the hospital thatdoes not involve admission or a day hospital.

In the case of an outpatient surgicaltreatment, it is performed in the consultingroom on surface tissues and generallyrequires local anaesthesia.

SOCIAL CAREMedical admission becomes social admissionwhen a patient with functional deterioration oraffected by age-related chronic processesand/or disorders have surpassed the acutephase of the disease and require healthcarebut not under admission to hospital.

CYTOSTATIC MEDICINESCytotoxic medicine, which is used inoncological chemotherapy and can stop theproliferation of cancer by acting directly on theintegrity of deoxyribonucleic acid chains(DNA) and cell division, inhibiting normal cellmultiplication, of both healthy and cancercells. They are a mixture of heterogeneoussubstances used in antineoplastic treatment.


CONSULTATIONAssistance and examination of a patient by adoctor, performing the necessaryexaminations and medical tests to obtain adiagnosis 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 NURSEGraduate in Nursing legally qualified andauthorised to perform nursing activities.

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 orbodily 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.

The centres, services and establishments,regardless of ownership, authorised by thehealth authorities of the autonomouscommunities and cities with a Statute ofAutonomy are listed in the Registro Generalde centros, servicios y establecimientossanitarios, of the Ministry of Health. Centres,services and establishments, regardless ofownership, not within the national territorymust appear accredited as healthcareestablishments according to the lawapplicable in each country.

PROCEDUREThe action of subjecting a person with adisease to the necessary control orexamination, carrying out the correspondingtests, for either diagnostic or therapeuticpurposes, for the symptoms or alterationsreported during the consultation with thehealthcare professional. There are differenttypes of procedures: surgical, therapeutic anddiagnostic. In all cases, they must be carriedout by a competent specialist doctor in anauthorised centre (hospital or outpatientcentre) that usually requires a specific roomwith the necessary equipment.

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 MATERIALExternal anatomical parts of any kind used toprevent or correct body deformities such as,for example, a back brace, harness orcrutches.

MEDICINAL PRODUCTSAny substance or combination of substancespresented as having properties of treating orpreventing disease in human beings or thatmay be used by or administered to humanbeings with a view to restoring, correcting ormodifying a physiological function by exertinga pharmacological, immunological ormetabolic action or making a medicaldiagnosis.

Coverage by the insurer will be contingentupon the prescription of the most efficienttherapy available at the time, by activeingredient and always using the generic drugor biosimilar if authorised by the SpanishAgency of Medicinal Products and MedicalDevices and marketed in Spain.

RADIOPHARMACEUTICALS: These aremedicines that contain a small amount ofactive substance, known as a tracer, which istagged with a radionuclide, causing them toemit a dose of radiation and which is used forboth diagnostic and therapeutic purposes.

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

Indicate as an example that all lithotripsy,radiotherapy, chemotherapy, interventionalradiology, haemodynamic and endoscopyprocedures and procedures covered thatrequire laser will be included.

SIMPLE THERAPEUTIC PROCEDUREA simple therapeutic procedure is defined asa therapeutic procedure prescribed by adoctor on the medical chart during theconsultation for which highly complexequipment and medical staff are not required,as it is carried out by non-medical healthcarestaff. This header also includes woundtreatment, injectable drugs, some types ofphysiotherapy, etc.

NEWBORNPerson in the life stage of the first four weeksafter birth.

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

ORGAN DISEASEStructural injury to tissue or organs of thehuman body.

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

BASIC DIAGNOSIS TESTThis test is essential for diagnosing adisease, regardless of whether the test issimple or complex (e.g. blood in faeces,cervical cytology, colonoscopy, etc.).

COMPLEX DIAGNOSIS TEST


A complex diagnostic test is defined as anytest that requires a healthcare facility orhospital with technical equipment andspecialised health professionals in order toperform it and/or to interpret the results due totheir complexity. Similarly, the healthcarefacility where it is performed must haveappropriate staff and resources to addressany complications that the patient mightexperience as a direct or indirectconsequence of the test. For example, thisincludes all tests: CAT scan, MRI,neurophysiology, nuclear medicine, genetic,molecular biology, endoscopy,haemodynamics, interventional radiology, etc.

SIMPLE DIAGNOSTIC TESTA simple diagnostic test is defined as a testprescribed by a doctor on the medical chartduring the consultation for which highlycomplex equipment and specific interpretationby a specialist are not required. This headerwill include simple blood and urine tests andsimple radiology.

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 to the insured’s home at the Insured'srequest of a general practitioner, paediatricianor registered nurse, when the insured isunable to travel to attend the consultation dueto their illness, provided that SANITAS has anarrangement for providing the service in thisplace.

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 ofthe patient, that requires immediate medicalcare.

LIFE-THREATENING EMERGENCY /MEDICAL 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 which could involve the loss orsignificant deterioration of a function, memberor body organ.


Clause I: Purpose of theInsurance

Within the limits and conditions stipulated inthe policy and following payment by thePolicyholder of the corresponding premiumthat may correspond, SANITAS incollaboration with Bupa Global provide itsInsured with a network of participantprofessionals, clinics and hospitals formedical, surgical and hospital care, accordingto normal medical practice, in the specialtiesand modalities included in the cover of thispolicy. Where the Insured has obtainedpre-authorisation for treatment from SANITASin collaboration with Bupa Global, and/orwhere the Insured uses a participatinghospital or clinic, the cost of care provided tothe Insured can be paid directly to thoseprofessionals, hospitals or centers. Note:SANITAS in collaboration with Bupa Globalaim to arrange direct settlement whereverpossible, but it has to be with the agreementof whoever is providing the treatment.

Also, SANITAS provides its Insured in Spainwith a wide contracted network ofprofessionals, clinics and hospitals formedical, surgical and hospital care, accordingto normal medical practice, in the specialtiesand modalities included in the cover of thispolicy, their cost being assumed by directpayment to the contracted professionals orcenters that have performed the Insuredservice. In all cases, these services arecarried out by professionals and medicalcentres and hospitals that meet the legalrequirements for doing their job in thecountry.

SANITAS will not undertake any serviceincluded in this policy cover if it constitutes aninfringement of Spanish, British, EuropeanUnion regulations or international laws, ingeneral. SANITAS reserves the right, whereapplicable, to deregister the insured affectedby the infringement. Similarly, it may rejectthe registration of a new insured should thisconstitute the infringement of any of theseregulations.

This policy offers international cover in thegeographical area set out in the contract.Notwithstanding the above, some countriesmay demand the healthcare policy meetcertain cover requirements or otherconditions. SANITAS cannot guarantee thatthis policy meets said requirements, thus thepolicyholder is responsible for checking anysuch requirements, without SANITAS beingliable for this reason.

For us to cover any treatment, it must satisfyall of the following requirements:

• It is at least consistent with generallyaccepted standards of medical practice inthe country in which treatment is beingreceived

• It is clinically appropriate in terms of type,duration, location and frequency, and

• It is covered under the terms andconditions of the plan

We will not pay for treatment which in ourreasonable opinion is inappropriate based onestablished clinical and medical practice, andwe are entitled to conduct a review of yourtreatment, when it is reasonable for us to doso.

Additionally, only active treatment is covered.By this we mean treatment of a disease,illness or injury that leads to the Insured’srecovery, conservation of their condition or torestore them to their previous state of healthas quickly as possible.

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 thePolicyholder of the terms and treatments tobe included in the cover of the Policy for thefollowing period.

The present agreement also includes themodality of reimbursement of expenses,according to which, SANITAS will assume,within the limits and conditions stipulated inthe policy, the medical, surgical and hospitalcare mentioned in the first paragraph of this


clause, by means of the restitution to theInsured of all or part of the medical expensesadvanced by him/her, according to the limitsof the overall annual maximum limitapplicable, and reimbursement percentagesestablished in the Particular Terms andConditions of the policy, it not being possibleto apply jointly both modalities for the samebenefit.

SANITAS will only pay for reasonable andcustomary costs. This means that the costscharged by the Insured’s treatment providershould not be more than they would normallycharge and be representative of charges byother treatment providers in the same area.Guidelines for fees and medical practice(including established treatment plans, whichoutline the most appropriate course of carefor a specific condition, operation orprocedure) may be published by agovernment or official medical body. In suchcases, or where published insurance industrystandards exist, SANITAS may refer to thesewhen assessing and paying claims. Chargesin excess of published guidelines orreasonable and customary costs may not bepaid.

Clause I: Benefits

The benefits covered by this policy areconditional on compliance with thequalifying periods indicated below andalways when they are conditionssubsequent to the contracting of the policyand not known by the insured or in case ofprior conditions known to the insured,were declared to the insurance companyby the insured when taking out the policywithout the insurance company excludingthese conditions.

PRINCIPAL BENEFITSAccreditation of the procedures and servicescorresponding to a medical speciality, that is,the services that a healthcare professionalfrom this speciality can perform, are based onthe Clasificación Terminológica y Codificaciónde Actos y Técnicas Médicas (Nomenclátor)of the Spanish Medical CollegesOrganisation.

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. Paediatrics and Childcare

This includes the care of children until theyare 15 years old in consulting room and athome, the indication and prescription of testsand basic diagnosis procedures (analysis andgeneral radiology), being applicable all otherregulations mentioned for the benefit ofGeneral Medicine.

1.3. Nursing Service

Includes healthcare at the healthcare centreand at home.

2. Emergencies

In the Insurer's medical network in Spain,healthcare in the event of outpatientemergencies will be provided in thepermanent emergency centres listed in theUser Guide to Doctors and Services. TheInsured may also call the telephonenumber which appears in the User Guideof Doctors and Services for this verypurpose. In justified circumstances, ahouse call may be made by the 24 hour


on-call service but only in those towns andcities where the Insurer has arranged theprovision of this service.

Healthcare for outpatient emergenciesreceived by a healthcare provider otherthan that listed in the Insurer's medicalnetwork in Spain or in the secondEuropean country covered named in theParticular Conditions, is not subject to thatestablished in the paragraph above, itshould be provided in centres authorisedfor the purpose by the relevant authoritiesof the country in which the medical serviceis received. If it is medically justified, caremay be received in the Insured’s ownhome by a general practitioner or familyphysician who is legally trained andrecognised by the relevant authorities ofthe country in which care is received.

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

The cover includes determination of completeallergen-specific IgE (natural extracts) butexcludes specific IgE determination ofrecombinant allergens and IgG4.The lgEantibody qualitative test and moleculardiagnosis of the allergy (microarrays) areexcluded.

3.2. Clinical Analysis

Intestinal dysbiosis tests, ALCAT foodsensitivity tests, DAO enzyme activity(DAO) tests, qualitative antibody screen kitand multiple PCR tests are not included.

3.2.1. Genetic Studies

It includes only genetic studies, in affectedand symptomatic patients, whose purposeis to diagnose a certain disease thatcannot be diagnosed through otherstudies or complementary tests, or geneticstudies that are essential in order toprescribe treatment (except for geneticstudies expressly excluded in theexcluded risks section). All genetic studieswith a low diagnostic performance arealso excluded from the cover, that is,when the probability of being able todiagnose the disease by carrying out thegenetic study is less than 10%. Requiresprior authorisation from SANITAS afterassessing the medical report.

Includes the study of BRCA 1 and BRCA 2genes or the gene panel for studyinghereditary breast and ovarian cancer inperipheral blood under the followingindications:

A) patient without personal history of breast orovarian cancer who meets the followingrequirements:• 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


HLA DQ2/DQ8 molecule study is included forunder 16s that meet the following threecriteria only:

• with justified clinical suspicion• p o s i t i v e I g A a n t i - t i s s u e

transglutaminase antibodies in bloodwith values that are 10 times higher thanthe normal value

• positive IgA anti-endomysial antibodiesin blood

It excludes HLA class I and II DNA typing,PCA3 study, genome sequencing, full geneclinical exome study, microarray,pharmacogenetics (except for the studyfor diagnosing dihydropyr imidinedehydrogenase deficiency) and genetherapy.

3.3. Anatomic Pathology

Includes the performance of therapeutictargets: BRAF, ALK, K-RAS, N-RAS, HER2,EGFR, C-KIT, ROS-1, PDL-1, microsatelliteinstability in colon cancer, MGMT methylationin brain tumours, somatic BRCA1 and BRCA2in ovarian cancer prior to the administration ofcertain pharmaceutical products, providedthat the summary of product characteristicsas established by the Spanish Agency ofMedicinal Products and Medical Devicesrequires that such targets be determined.These criteria also apply to the speciality ofgenetic testing.

3.4. Anaesthesiology

3.5. Angiology and Vascular Surgery

3.6. Digestive System

Liver elastographs are covered annually bythe Insured solely to evaluate theprogression 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 or

incipient malignant colorectal/gastricmucosa in which conventionalpolypectomy has been ruled out andwhere surgical treatment is beingconsidered. Prior authorisation fromSANITAS is required after assessment ofthe medical report.

MR-enterography is included.

Gastric balloon treatment and anyendoscopic treatment for obesity areexcluded.

Barret radiofrequency treatment of theoesophagus for extensive low-gradedysplasia over 5 cm and moderate orhigh-grade dysplasia is included.

Prior authorisation from SANITAS isrequired after assessment of the medicalreport.

3.7. Cardiology

Includes a cardiac MRI scan and a cardiacstress perfusion MRI, and the medicationrequired for these tests. Determination oftroponin is covered under admission tohospital only.

Three-dimensional electrophysiologicalcardiac mapping is included for the followingcases only: atrial fibrillation, arrhythmiasin congenital heart disease, hereditaryventricular arrhythmias and ventriculartachycardia associated with ischemicetiology scarring.

Excludes implantable loop recorder.

3.8. Cardiovascular surgery

The cryoablation technique andpercutaneous techniques for thereplacement or repair of heart valves areexcluded.

3.9. General and Gastrointestinal Surgery

Includes laparoscopic surgery. Laser andextirpation techniques for haemorrhoidtreatment and treatment for sclerosis using


elastic bands are included; the elastic bandsbeing covered by the Insured.

The Bariatric Surgery cover for treatingmorbid obesity is subject to themulti-disciplinary protocol set out bySANITAS and will only be performed in thecentres appointed for this purpose.

3D Laparoscopy, Metabolic surgery indiabetes and any type of abdominoplastyor cosmetic surgery are excluded.

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. Endoscopicspinal surgery and other new techniquesare excluded, unless SANITAS hasinformed the policyholder in writing that itis included in the cover.

3.12. Paediatric Surgery

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

3.13. Reconstructive Surgery

Septorhinoplasty, diastasis recti andlipoedema surgery are excluded. Alloperations with a cosmetic component,including those based on psychologicalreasons, are excluded.

3.14. Chest Surgery

3.15. Dermatology

3.16. Endocrinology

3.17. Geriatrics

3.18. Haematology and Haemotherapy

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

Leukocyte immunophenotypic study onlycovered in the study of leukaemias andlymphomas.

3.19. Internal Medicine

3.20. Nuclear Medicine

Contrast agents are paid for by SANITAS.

PET and PET/ CT scans exclusively with18-fludeoxyglucose (18 FDG) are coveredfor:

A) the diagnosis, staging, monitoring oftreatment response and detection inreasonable case of relapse in cancerprocesses and

B) the following non-cancer indications(authorised by the Spanish Agency ofMedicinal Products and Medical Deviceson the 18-fludeoxyglucose (18 FDG) factsheet):

b.1- Cardiology• Evaluation of myocardial viability in patients

with serious left ventricle dysfunction andwho are candidates for revascularization,only when conventional imaging techniquesare not conclusive.

b.2- Neurology• Localisation of epileptogenic foci in the

pre-surgical assessment of partialtemporary epilepsy.

b.3- Infectious or inflammatory diseasesLocalisation of abnormal foci to guideetiological diagnosis in the case of idiopathicfever.

Infection diagnosis in the case of:• Suspected chronic infection of bones or

adjacent structures: osteomyelitis,


spondylitis, discitis or osteitis, includingwhen there are metallic implants

• Diabetic patients with a foot indicative ofCharcot foot and ankle, osteomyelitis or asoft tissue infection

• Painful hip prosthesis• Vascular graft• Fever in AIDS patients• Detection of septic metastatic foci in the

case of bacteraemia or endocarditis (alsosee section 4.4)

Detection of extension of inflammation in thecase of:• Sarcoidosis• Inflammatory bowel disease• Large vessel vasculitis• Treatment monitoring:

Unresectable alveolar echinococcosis in thedetection of active outbreaks of the parasiteduring medical treatment and followingtreatment suspension.

Includes PET-MRI exclusively foroncological processes.


Any radiotracer other than 18FDG isexcluded.

3.21. Nephrology

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

3.22. Pneumology

Includes endobronchial ultrasound in thefollowing indications:• Negative TBNA (endobronchial

ultrasound-guided transbronchial needleaspiration)

• cancer staging of a radiologically normalmediastinum in suspected or confirmedlung cancer

• re-staging following inductionchemotherapy

• diagnosis of mediastinal masses,peribronchial, paratracheal orintrapulmonary hilar.

Requires prior authorisation fromSANITAS after assessing the medicalreport.

3.23. Neurosurgery

Includes only surgery with surgical navigationassistance for intracranial processes andintraoperative electro-physiological monitoringfor intracranial processes and for spinesurgery.

Endoscopic spinal surgery and other newtechniques are excluded, unless SANITAShas informed the policyholder in writingthat it is included in the cover.

3.24. Clinical Neurophysiology

3.25. Neurology

3.26. Obstetrics and Gynaecology

Includes laparoscopic gynaecological surgery.

It includes for diagnosing fertility thefollowing tests only: analytical basalhormone determinations (except theanti-müllerian hormone), ultrasound scan,hysterosalpingography and hysteroscopy,only up until diagnosis, that is, oncetreatment starts no other related serviceswill be covered.

It also includes family planning: tubal ligation,IUD implantation (the IUD is paid by theInsured), regardless of the therapeuticpurpose, and follow up of treatment withanovulation medicines.

The following genetic tests are included:• Karyotype• Factor V Leiden and mutation 20210 of the

prothrombin gene, with these twodeterminations requiring prior authorisationfrom SANITAS following assessment of themedical report, being covered when there isa personal history of recurrent miscarriageand/or thromboembolic processes.


Any other genetic test other than thosementioned shall be excluded.

Includes breast tomosynthesis and use ofgenome sequencing platforms for breastcancer prognosis (ONCOTYPE,MAMMAPRINT, PROSIGNA) prescribed by aspecialist on the medical chart and whenevernecessary for the treatment in accordancewith the recommendations set out for eachgenomic platform mentioned above.Requires prior authorisation fromSANITAS after assessing the medicalreport.

Includes the study of circulating foetal DNA inmaternal plasma (non-invasive pre-natalscreening) for foetal trisomy screening (13,18, 21 and sex chromosomes) when the riskratio from combined screening in the firstquarter is between 1:50 and 1:250 and thepregnant woman is in her 10th to 18th weekof pregnancy. Requires prior authorisationfrom SANITAS after assessing the medicalreport.

PLGF and SFLT1 levels (indicators ofpreeclampsia) are excluded.

Includes pelvic floor rehabilitation only forwomen with moderate-severe urinaryincontinence due to pregnancy anddelivery, with a limit of 1 year after deliveryand provided that it has been authorisedby SANITAS. A maximum of 5 sessions perdelivery are covered.


The Insured can also access the pelvicfloor recovery plan via the phoneprogramme (917 522 904), provided by ourspecialised phone platform SanitasResponde, which comprises amultidisciplinary team, to recover muscletone and prevent and treat secondarydysfunctions or conditions.

3.26.1. Breast Surgery

Breast surgery is covered in the followingsituations:• Benign tumours. Excludes breast

reconstruction.• Malignant tumours: includes surgery on the

affected breast and prophylactic surgery onthe contralateral breast if considered atherapeutic option following the BRCA1 andBRCA2 result. Includes posterior breastreconstruction.

• Individuals not affected by breast cancer inwhich prophylactic breast surgery isconsidered a therapeutic option followingthe BRCA1 and BRCA2 result. Includessubsequent breast reconstruction.

Requires prior authorisation fromSANITAS is required after assessment ofthe medical report.

The only reconstruction methods included inthe cover are: post-mastectomy breastreconstruction, with expanders andprosthesis, reconstruction with dorsimyocutaneous flap, DIEP flap and TRAMflap.

3.26.2.Neonatology Care

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

3.26.3.Newborn care

Covers the costs of a newborn's healthcare,provided that the child has been registeredwith SANITAS and has this cover.

This policy does not cover the expensesarising from gestational surrogacy, forneither the mother nor the newborn.

3.27. Ophthalmology:


Includes laser photocoagulation forischaemic retinopathies, macular oedema,glaucoma and peripheral retinal lesions(holes or tears), kerataconus treatmentand cornea transplant surgery only. Thetransplantable cornea is paid for by SANITAS.

Orthoptic, pleoptic and refractive surgery(for myopia, hypermetropia, presbyopiaand astigmatism) are excluded.

In addition, it includes an eye test permember per year. Excludes cosmeticcauses.

3.28. 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.

It includes specifically cytotoxic medicinesthat are authorised for sale on the Spanishmarket and provided that they are used forthe treatments expressly specified inaccordance with the product datasheetand whose administration is via parenteralin as many cycles as necessary, or viabladder instillation.

Includes intraperitoneal chemotherapy incases of peritoneal carcinomatosis due totumours of the ovary or of digestive origin;and intrathecal chemotherapy in cases ofhigh-grade lymphomas or meningealcarcinomatosis.

It also includes medication withoutanti-tumour effect, administered along withcytostatic medications during thechemotherapy session in order to preventadverse or side effects.

Includes the use of sodium iodide I 131 fortreating overactive thyroid and thyroidcancer and the use of 90Y-Yttrium Citratefor radioisotopic synoviorthesis.

It includes a study to rule outd ihydropyr im id ine dehydrogenasedeficiency in patients who are candidatesfor parenteral d ihydropyr im id inetreatments.

Experimental treatments, treatments forcompassionate use, hormonal therapy,immunostimulants, immunosuppressants,gene therapy and treatments carried outfor indications not included in the productdatasheet of the medicine are expresslyexcluded.

3.29. Ear, Nose and Throat

Includes CO2 laser surgery andradiofrequency surgery.

The cost of cochlear implants and all pre-and post-surgery consultations anddiagnostic tests for adjusting the deviceare excluded. Any type of rhinoplastyoperation is also excluded, except surgerysecondary to trauma or non-cosmeticpre-surgery, which always requires priorassessment of the medical reports by adoctor from this speciality.

3.30. Psychiatry

Limited to a total of 90 days throughout thelife of the policy and of any other with Sanitasor Bupa Global.

3.31. Radiodiagnosis-Diagnostic Imaging

It also comprises the colonographyperformed by computerised tomography(CT) in the following indications:

• Screening for colon cancer andpolyposis of the colon in patients withno known clinical history of coloncancer, polyposis or inflammatory boweldisease, provided they have a familyhistory of these conditions or arecandidate to screening for their age(from 50 years of age).

• Screening for colon cancer andpolyposis of the colon in patients where


conven t i onal co l onoscopy i scontraindicated for their clinicalcondition or involves a higher risk.

• As a complement to conventionalcolonoscopy when this has not reachedthe entire length of the colon.

Cover for this diagnostic test is subject tothe Insured sharing the cost of the serviceto the extent expressly stipulated in theparticular terms and conditions of his/herpolicy.

3.32. Interventional or invasive radiology:

With a prescription from a Company doctorand after authorisation from the Company.

3.33. Radiotherapy

The radiotherapy cover includes oncologicalprocesses only and only the followingmethods: intens i ty modu latedradiotherapy (IMRT), 3D external conformalradiotherapy, stereotactic brain and bodyradiotherapy (IGRT/SBRT), interoperativeradiotherapy and brachytherapy.

It also includes stereotaxic radiosurgery fortreating tumour processes, mainly malignant,cerebral arteriovenous malformations and asthe final stage of therapy in trigeminalneuralgia.

Proton therapy and neutron therapy areexcluded, and any techniques other thanthose expressly mentioned are excluded,unless SANITAS has informed thepolicyholder in writing that it is included inthe cover.

Requires prior written authorisation fromSANITAS after evaluation and with adoctor’s report provided by the insured.

Radioembolization with spheres isexcluded.

3.34. Rehabilitation

It comprises the consultations which have thepurpose of diagnosis, evaluation and

prescription of the physiotherapy treatmentsincluded in the cover of Physiotherapy.

3.35. Rheumatology

3.36. Urology

Includes Multi-parametric MagneticResonance of the prostate in the followingindications:

• Local, regional or distance staging• Detection or guide for diagnostic biopsy

where there is a suspicion of clinical risk inthe following cases:• PSA 4-10 (grey area) with a ratio

(free/total) lower than 0.13. It will benecessary if it continues to increase after3 months of monitoring/treatment.

• PSA>10 and/or ratio lower than 0.13.Involves Multi-parametric MRI.

• Therapeutic monitoring.

Requires prior authorisation fromSANITAS after assessment of the medicalreport.

It includes Fusion-guided prostate biopsy butonly when the result of themulti-parametric MRI is PIRADS 4 orPIRADS 5.


Includes laser photo-vaporization andenucleation of the prostate.

Includes laser endourethral and vesicallithotripsy.

Prostate cryotherapy, i r reversib leelectroporation and other focal therapiesare excluded.

It includes for diagnosing fertility thefollowing tests only: basal hormonedeterminations, basic semen analysis andbacteriological cultures of semen, only upuntil diagnosis, that is, once treatment


starts no other related services will becovered.

4. Other care services

4.1. Ambulance:

Transfers in ambulance from the place wherethe insured is located to the hospital wherehe/she will be admitted or to which he/shepresents for an emergency and underSANITAS coverage shall be covered. Alsocovered are return transfers of the insuredfrom the hospital to their home and thosemade between hospital centres on theSANITAS list of healthcare providers if thecare resources at the hospital where theInsured is found are not those that theirmedical care requires. Transfers forchemotherapy and radiotherapy treatments ata Day Hospital are also covered. In all thesecases the service will be provided by landwithin the national territory using the meansagreed on by SANITAS and so long as thephysical state of the Insured impedes his/hertransfer by other ordinary means (taxi, privatecar, etc.) and is authorised via the Sanitas24-hour hotline.

This benefit does not include transfersrequired for diagnostic tests or to attenddoctor's visits nor generally any other typenot covered in the paragraph above.Service provisions by providers notagreed with or by the Spanish regional ornational public health service are thereforeexcluded.

4.2. Special home care:

This will be performed by the healthcareteams designated by the Insurance Company,provided that SANITAS has arranged forthe service to be provided in the place inquestion when the patient's illness requiresspecial care but does not require admission tohospital nor specialised equipment, alwaysunder prescription from a doctor and withthe authorisation of SANITAS, afterassessment of the medical report providedby the Insured. The medicines, materialand equipment will always be covered by

the Insured. Does not include care forsocial problems.

4.3. Obstetric-Gynaecological Nursing(Midwifery)

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

4.4. Physiotherapy

It is provided solely on an outpatient basisand exclusively for conditions originatingin the musculoskeletal system, consideringas such exclusively those structures of thehuman body that perform the locomotive ormovement function and therefore not thosesuch as the temporomandibular or theabdominal wall/muscles, which do notperform this function and always provided it isnot a chronic (more than 6 months ofevolution) or degenerative process, through tothe greatest possible functional recovery ofthe patient, determined by the rehabilitationdoctor and provided by qualified andregistered physiotherapists.

It includes shockwave therapy for chronicosteotendinous injuries (more than 6months’ evolution) of the musculoskeletalsystem with a maximum of 5 sessions perjoint and year.

Requires prior authorisation fromSANITAS after assessment of the medicalreport.

Under admission to hospital, it will beprovided only and exclusively for therecovery of the musculoskeletal systemsecondary to an orthopaedic operationand recovery of the heart immediately afteran acute myocardial infarction and aftersurgery with extracorporeal circulation.

It also includes lymphatic drainage aftersurgery for an oncology process. Requiresprior authorisation from SANITAS afterassessing the medical report.

Includes pelvic floor rehabilitation exclusivelyunder the criteria set out in the Obstetricsand Gynaecology section.


Neurologic rehabilitation, early care,occupational therapy, heart rehabilitationas an outpatient, respiratory rehabilitation,temporomandibular joint rehabilitation,vestibular rehabilitation, water-basedr eh ab i l i t at i o n , o p h t h al m o l o g i c alrehabilitation and those performed usingrobotic equipment are excluded.

Any type of home physiotherapy treatmentis excluded.

Physiotherapy and rehabilitation areexcluded when functional recovery hasbeen achieved, or as close as possible toit, or when it becomes maintenancetherapy, in addition to neuropsychologicalrehabilitation and cognitive stimulation.

4.5. Speech and Phoniatric Therapy

Requires prior authorisation fromSANITAS after assessment of the medicalreport and must be prescribed by an ear,nose and throat specialist (in the case oforganic processes of the larynx and vocalcords) or by a neurologist (in the case ofacute cerebrovascular accident).

It covers up to 80 sessions per year andinsured.

Only the following are covered:

Organic processes associated to thelarynx and vocal cords:

1. Inflammation: oedemas2. Tumours:

a) Benign: modules, polyps.b) Malignant: cancer of the larynx (partialor total)

3. Changes to the vocal cords:a) Paresis (reduction of cord movementbecause either the muscle or nerve areinjured)b) Paralysis (reduction of cord movementbecause either the muscle or nerve areinjured)

4. Congenital malformations

The insured cover includes only speechtherapy and language therapy forprocesses der ived f rom acutecerebrovascular accident.

4.6. Nutrition

Access to this speciality must be prescribedby specialists in endocrinology, oncology,internal medicine, geriatrics or paediatricsauthorised by SANITAS. It is covered whena medical condition exists (cancerpatients, diabetes, obesity with BMI >30 ora severe eating disorder).

4.7. Odontology

Only includes tooth extractions (simple teeth,third molars, impacted teeth and rootremains), related stomatological cures andbuccal cleaning, performed in consultationonly and prescribed by the Insurer'sdentist.

Similar programmes which do not formpart of the Insurer's medical network andare in the second European country ofcover named in the Particular Conditionsare not included.

4.8. Podiatry (chiropody):

It covers only chiropody, which isunderstood as treatment for removingcalluses and alterations to the toe nailsperformed by a chiropodist.

Limited to 12 sessions a year. This service isnot included if it does not form part of theInsurer's medical network and is in thesecond European country of cover named inthe Particular Conditions.

4.9. Prostheses

Only covers internal prostheses andinternal implantable materials expresslylisted below.

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


1. Ophthalmology: It includes only simplemonofocal intraocular lenses, excludingtoric, monofocal plus and extendeddepth-of-focus lenses and any other modelof advanced monofocal lens used incataract surgery. Also includes corneal tissueexclusively from national tissue bank forcornea transplant.

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: stents, peripheral orheart bypasses, medicalised ornon-medicalised, aortic endoprothesis, whichwill require express authorisation fromSANITAS after assessing the medical report;cardiac valves except for values or valverepair devices implanted via percutaneousor transapical replacement; aortic valveducts, provided they are associated to aorticvalve surgery; pacemakers, except any typeof defibrillator or artificial heart; coilsand/or embolization materials.

4. Chemotherapy or Pain Treatment:reservoirs.

5. Other surgical materials: abdominal wallmeshes, except biological meshes; biliarystent; oesophageal endoprosthesis, duodenaland colonic; urethral endoprosthesis;urological suspension systems; cerebrospinalfluid (hydrocephalus) derivation systems;testicular prosthesis; breast implants andexpanders, in both the breast affected byprevious tumour surgery and in cases inwhich prophylactic mastectomy is considereda therapeutic option after the results ofBRCA1 and BRCA2.

6. Bone fixation materials in craniumand/or maxillofacial surgery. Includes bone

substitutes, only for bone void filler aftertumour surgery.

4.10. Mother and Baby Programme

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

4.11. Psychology

This comprises individual psychological careprescribed by Psychiatrists, Family HealthAdvisors, Paediatricians or MedicalOncologists the purpose of which is to treatdisorders which could be treated viapsychological intervention.

It also includes simple psychologicaldiagnosis. Psychometric tests will becovered by the insured.

Psychoanalysis, psychoanalytical therapy,hypnosis, narcolepsy treatment, andpsychosocial and neuropsychiatryrehabilitation services are excluded.

4.12. 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.

Portable oxygen concentrator is excluded.

b) Generation of positive airway pressurewith CPAP to treat obstructive sleep apnoea.Auto-CPAP machines for this treatment areexcluded.

c) Partial BiPAP ventilation therapy andaerosol therapy.


5. Hospital admission

In the Second European Country of Cover,and when not part of the Insurer's MedicalNetwork in Spain, a prior prescription from thephysician will be written. For Hospitalisation inthe Insurer's Medical Network in Spain a priorprescription from the Insurer's physician willbe necessary.

Hospitalisation will be in a clinic or hospitalwhereby the patient occupies a conventionalsingle room with a bed for an accompanyingperson, except in psychiatric, intensive careand incubator hospitalisations.

In the Second European Country of Cover noadditional expenses are covered for theaccompanying person's stay.

The Insurer will bear full payment or partialreimbursement of hospital expenses relatingto treatment, stays, patient's board, cures andmaterials thereof, as well as surgicalexpenses, anaesthetic products andmedication provided that they are used inaccordance with the indications set out onthe product datasheet, except medicinethat is not authorised for sale in Spain)and bed and board of the patient.

The use of radiopharmaceuticals fortherapeutic purposes is excluded, exceptfor the use of sodium iodide I 131 fortreating thyroid cancer.

5.1. Medical hospitalisation: Providedsubject to prior prescription by one of theInsurer's doctors, at the centres it maydesignate for the care of persons over 14years of age.

5.2. Paediatr ic hospital isation:Hospitalisation shall take place, subject toprior prescription by one of the Insurer'sdoctors, at an Insurer-designated centre forthe care of children under 14 years of age.The cover includes conventional andincubator hospitalisation (in the latter case abed for an accompanying person is notincluded).

5.3. Psychiatric hospitalisation: Admissionsshall take place, subject to prior prescriptionby one of the Insurer's doctors, at psychiatriccentres designated by the former, in anindividual room, if the condition so requires,without a bed for an accompanying person.Comprises the costs of the stay, medicationand relevant medical therapies. To beprovided for treatment of acute attacks notcorresponding to chronic conditions, thestay being limited to a maxim period offifty (50) days throughout the life of thispolicy and of any other taken out with theInsurer.

5.4. Intensive-care hospitalisation:Provided subject to prior prescription by oneof the Insurer's doctors, at the centresdesignated by the former, in suitable facilities,not including a bed for an accompanyingperson.

5.5. Surgical hospitalisation: Surgicaloperations so requiring shall be performed atthe clinic designated by the Insurer. Dystociaand premature childbirth also qualify for thisbenefit.

5.6. Obstetric hospitalisation (normalnursing-home delivery): Attended by anobstetrician aided by a midwife, and includingdelivery room expenses.

6. Preventive medicine

Includes programmes applied to a healthypopulation and covers a range of activities,such as medical consultation, physicalexamination and basic diagnostic testsprescribed by the corresponding specialist forearly detection of diseases, based onpopulation screening criteria set out inuniversal clinical practice guides. They arethose detailed below only:

6.1. Paediatrics: Provides for consultationwith a specialist, newborn health checks(including metabolic screening and earlyhearing impairment detection via OAEs orAEPs where necessary) and regular health


checks to monitor child development (frombirth to 11 years of age).

6.2.Gastrointestinal Tract: Includesconsultation with a specialist and a physicalexamination as well as basic diagnostic tests(e.g., test for blood hidden in faeces orcolonoscopy).

6.3. Cardiology: Includes consultation with aspecialist and a physical examination as wellas basic diagnostic tests (e.g., ECG, basicblood and urine tests) and a stress test toestablish coronary risk.

6.4. Pneumology: Includes consultation witha specialist and a physical examination aswell as basic diagnostic tests (e.g., chestx-ray).

6.5. Gynaecology: Provides for an annualgynaecological check for cervical, endometrialand breast cancer prevention. Includesconsultation with a specialist and a physicalexamination as well as basic diagnostic tests(e.g., ultrasound scan, mammogram, papsmear test or gynaecological ultrasoundscan).

6.6. Urology: Provides for a medicalconsultation with a specialist and basic bloodtests (including PSA determination) and urinetests, along with other basic diagnostic tests(e.g., ultrasound scan and/or prostate biopsy).

The recommended frequency for theseexams varies in line with the characteristics ofeach case, which is why it is up to thespecialist to establish recommendations inaccordance with the risk.

Similar programmes which do not formpart of the Insurer's medical network andare in the second European country ofcover named in the Particular Conditionsare not included.

ADDITIONALCOVERAGES OF YOURINSURANCE


Overseas emergencyhealthcare cover

What is it? Use of services and timelimit

This is a policy add-on which will coveremergencies abroad due to illness oraccident, provided that the care requiredoccurs within 90 consecutive days fromthe start of the trip.

For everything that does not expressly goagainst the provisions of this add-on, theprovisions of the policy terms and conditions,including its limitation clauses andexclusions, will apply to the urgent medicalcare abroad guarantee.

To cover this care, it is essential for theInsured to be up to date with payment and,before any medical service is provided(except in a life-threatening emergency),SANITAS must be contacted and priorauthorisation sought via the phone numberon the back of the card.In the event of alife-threatening emergency, the Insured shallvisit the nearest clinic or hospital and mustreport this to SANITAS within a maximum of7 days starting from the date of admission,supplying Sanitas with a copy of theemergency report.

For Sanitas to accept the care provision, allthe required documents must be supplied(travel receipts, medical report justifying theemergency and all other reports needed, billsand payment receipts).

What is not included?

• medical expenses 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;

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

What services are included?

1. Medical Costs

During the validity of the policy SANITASguarantees the Insured emergencyhealthcare assistance abroad for:

• medical expenses (doctors, surgeons andhospitals/clinics)

• medicine prescribed by a doctor• emergency dentist expenses up to €241

per Insured, excluding expenses relatedto endodontic treatments, cosmeticreconstructions of previous treatments,teeth cleaning, caps, and implants

• Hospital fees• Fees for an ambulance ordered by a

doctor for a local journey

All of these expenses must be incurredoutside of Spain and provided throughthe centres appointed by SANITAS.

Limits

€10.000 per person and claim.

2. Transfer of sick and injured individualsto a care centre

What is included?

SANITAS ill pay for this transfer undermedical observation through to the carecentre where the patient can be treated.

The SANITAS medical service shall decideon and choose the means of transport andmedical centre/hospital the Insured mustattend, in accordance with the medical orderapplicable to the case.

3. Extension of a companion’s hotel stayfor hospitalisation of the Insured

When the Insured has to be admitted tohospital on a doctor’s orders and inaccordance with the medical service,SANITAS shall reimburse the costs arisingfrom the necessary extended hotel stay fortheir companion - if also Insured by Sanitas -up to a maximum of €60 per day and up toa maximum of 10 days.


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

If during the trip the Insured should behospitalised for more than five days and nodirect family member is with him or her,SANITAS shall make a regular-flight, returnplane ticket (economy class) or train ticket(first class) available to a companion withregular place of residence in Spain.SANITAS shall pay up to €60 per day for upto 5 days in respect of hotel accommodationto cover this person’s costs.

5. Transport in the event of death

In the event of the death of the Insured,SANITAS shall organise and meet theexpenses for the transfer of the coffin to theplace of burial in the country of his or herusual place of residence, as well as theminimum compulsory coffin expenses,embalming costs and administrativeformalities. Where applicable and following arequest from the Beneficiaries, SANITASshall meet the costs of incineration in theplace of death and transportation of theashes to the place of burial in the country ofhis or her usual place of residence. SANITASwill not meet funeral or burial expenses.

6. Early return of Insured accompanyingrelatives

If the Insured is transferred by reason ofdeath under the cover “Transfer in Event ofDeath” and this circumstance preventsaccompanying Insured family members fromreturning to their homes by the meansplanned originally, SANITAS will bear thecost of their travel to their permanent place ofresidence in Spain. Maximum two adultsand accompanied children under the ageof 14.

7. Accompanying children

If, during the term of the contract, Insuredpersons travelling with disabled persons orchildren under 14 years of age cannot lookafter them due to a sudden illness oraccident covered by the Policy, SANITASshall arrange and cover the costs of

outbound and inbound travel of a personresiding in Spain named by the Insured orhis/her family to accompany children on theirreturn to their habitual residence in Spain asquickly as possible.

8. 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.

9. Dispatch of documents and personalbelongings overseas

SANITAS shall organise and take care ofessential 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.

10. Advance of funds

SANITAS shall advance funds of up to€1,500 to the Insured, whenrequired.SANITAS shall require some kind ofspecial guarantee ensuring the Insuredrepays the advance. In any event, theamounts advanced shall be returned toSANITAS within a maximum period of 30days.

11. 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 for the legalassistance provided. If this service is coveredby the Motor Insurance Policy, it shall be


considered an advance and SANITAS shallreserve the right to request a specialguarantee from the Insured to ensurepayment of the advance.

12. 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 up to amaximum of €10,000. SANITAS reservesthe right to request a special guarantee fromthe Insured to ensure repayment of theadvance. In any event, the amountsadvanced shall be returned to SANITASwithin a maximum period of two months.

13. Dispatch of medication

What is included?

If the Insured needs a medicine prescribedby a doctor and cannot acquire it in the placewhere he or she is holidaying, SANITAS shalllocate it and send it to him or her by thefastest means and in compliance with locallaws.

What is not included?

Cases where the medicine is no longermanufactured and is unavailable in theregular distribution channels in Spain areexcluded. The Insured shall repaySANITAS the price of the medicine uponpresentation of the bill.

14. Transmission of urgent messages

SANITAS shall, through a 24-hour service,accept and transmit urgent messages fromthe Insured, so long as they have no othermeans of making them reach theirdestination and so long as they are aconsequence of a guarantee covered by thecontract.

Cover in the United States

The services included in this policy covermay be provided to the insured in the UnitedStates:• Only in the centres appointed by

SANITAS for this purpose.• It is an essential condition that these

services are previously authorised bySANITAS, which will manage and processthe services covered.

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

• Total limit in the United States:€500.000.

• Hospital care up to €500.000, with asub-limit for childbirth of €5.000.

• Outpatient care up to €35.000.

This cover is provided under a partnershipagreement with these healthcare facilitiesarranged by SANITAS and will be withouteffect if that agreement terminates.

Second medical opinioncover

Includes a second opinion on medicaldiagnosis or treatment in the event of seriouschronic diseases requiring scheduled care ofwhich the course may require new diagnostictests or therapeutic measures and whereofthe life prognosis is seriously compromised.This second opinion shall be issued by amedical report by leading specialists,healthcare centres, physicians or academicsin any country in the world, designated bySANITAS.

To use this service, the Insured can call 9325 40 538 for an explanation of theprocedure to follow and the documentation tosupply, which shall include written medicalinformation, X-rays or other image


diagnoses, excluding dispatch of anybiological or synthetic materials. The dossiershall be sent, with due confidentiality, to thespecialist or centre concerned, according tothe disease being treated.

When the process ends, the Insured will besent a second medical opinion report whichwill include:

• Summary of their clinical history.

• Opinion of the experts consulted.

• Curriculum vitae of these experts.

During the whole of this process the Insuredshall be accompanied by a consultantphysician responsible for managing the caseand advising the patient at all times.

Acute diseases or those requiring anurgent answer are excluded from thisservice.

Consultations, tests or treatments notperformed in accordance with the rules orcovers of the healthcare policy will not becovered.


Clause II: 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 situationexisting prior to the registration date ofeach Insured party in the policy and/orthose as a result of accidents or diseasesand their consequences arising prior tothe date of inclusion of each Insured partyin the policy.

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:

• Arising as a consequence ofinternational and civil wars, acts ofterrorism in any form (chemical,biological, nuclear, etc.), revolutionsand military manoeuvres, even in timesof peace time, and officially declaredepidemics.

• Directly or indirectly related to nuclearradiation or radioactive contaminationand those resulting from officially

declared catastrophes.

• Arising from working or professional

accidents.

• Any services associated to roadaccidents, whether they occur in Spainor abroad are excluded from theInsured cover, except any urgentattention required or unless the roadaccident add-on has been taken out.

• Those occurring whilst the Insured isdoing extreme sports as an amateur, forexample aerial activities, high speedmotor sports, scuba diving, off-pisteskiing or ski jumping, bobsleigh, rockclimbing, boxing, any type of wrestling,bull fighting and encierros, martial arts,rugby, quad biking, caving, sailing orrafting activities, bungee jumping,h y d r o s p e e d i n g , c a n y o n i n g ,parachuting, paragliding, hot airballooning, free flying, gliding, hunting,horse riding and any other activity witha similar risk and those resulting fromsports competitions, including trainingsessions.

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 intent or grossnegligence of the Insured, infection byHuman Immunodeficiency Virus, AIDSand related diseases.


G. All diagnostic, surgical or therapeuticmethods, procedures or techniques thatappear after the date of taking out thepolicy except where SANITAS, incompliance with art 126.2 of Royal Decree1060/2015 of 20 November on theOrganisation, Supervision and Solvencyof Insurance and Reinsurance Companieshas communicated to the Policyholder inwriting that they have been included inthe Insured covers under the terms andwithin the limits established in saidcommunication.

Also excluded are any therapeuticmethod, surgical technique or diagnostictest performed within a clinical trial or notused in regular clinical practice due tolack of safety or efficacy, consideringthese to be those not approved by theEuropean Medicines Agency and/or theSpanish Agency of Medicinal Productsand Medical Devices, as well as by thehealth technology evaluation agencies ofSpain’s regional health services ornational Ministry of Health.

Also excluded from coverage aretherapeutic methods, surgical techniquesand diagnostic tests that have beenclearly surpassed by other available ones.

H. Any type of service relating to:

• Conditions or treatments that are notcovered or any other medical benefit witha direct relation to a treatment that wasnot done under the policy's insurancecoverage for not being covered by it.

• Specific diagnosis and treatment,including surgery, aimed at addressinginfertility in both sexes, except for thetests listed in the correspondinggynaecology and urology section (in vitrofertilization, artificial insemination, etc.),or impotence and erectile dysfunction,including sex change surgery.

• Voluntary interruption of pregnancy.

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

• Heterologous transplants.

• Any surgical procedure on unbornbabies.

• Any surgical technique using roboticsurgery equipment.

• Genetic studies for ascertaining thepredisposition of the Insured or theircurrent or future ascendants or descentsof suffering diseases related to geneticalterations. Tumour and liquid biopsygenetic studies are expressly excluded,except: BCRA1 and BCRA2 determination,the genetic panel for studies of hereditarybreast and ovarian cancer and genomictests for breast cancer (ONCOTYPE;MAMMAPRINT and PROSIGNA) under theconditions detailed in previous sections.It excludes HLA class I and II DNA typing,PCA3 study, genome sequencing, fullgene clinical exome study, microarray,pharmacogenetics (except for the studyfor diagnosing dihydropyr imidinedehydrogenase deficiency) and genetherapy.

• Prostheses and implantable material,except those set out in the correspondingsection of the general terms and conditions.Exclusions include: any type of externalprosthesis; personalised prostheses; anytype of orthopaedic material; externalfixation devices; biological or syntheticmaterials; grafts; valved conduits, exceptvalved conduits associated to aortic valvesurgery; cardiac valves and valve repairdevices implanted via percutaneous ortransapical replacement; implantableinfusion pumps for medicine, spinal cordstimulation electrodes, defibrillators andartificial hearts.


• Operations, infiltrations and treatments,as well as any other action that is purelyfor questions of appearance or of acosmetic nature. In terms of breastsurgery, only those caused by tumourdisease are included, the following beingexpressly excluded: prophylacticoperations, except those that meet thecriteria detailed in the breast cancersection; and those performed to correctbreast hypertrophy and/or gynecomastia.Any kind of disorder or complicationwhich may occur subsequently and whichis directly and/or mainly caused by theInsured’s undergoing an operation,infiltration or treatment of a purelyaesthetic or cosmetic nature are alsoexpressly excluded.

• Tr eatm en t w i th p l atel et - o rgrowth-factor-rich plasma.

• Hyaluronic acid, whether sold as amedicine or health product.

• 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, pressotherapy, ozonetherapy, chiropractic, etc. All careprovided in integrative medicine medicalcentres or clinics or that combine medicalcare and non-conventional therapiesrecognised as pseudo-therapies by theSpanish Ministry of Health and theSpanish Medical Association is excluded.

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

• Orthosis, orthopaedic products,anatomical products, glasses, contactlenses, hearing devices, and others.

• All treatments with hyperbaric chamberare excluded.

• Any radiofrequency treatment atmusculoskeletal level, except vertebrae.

• Endoscopic spine surgery is excluded.

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

• Ophthalmic photocoagulation exclusivelyfor ischaemic retinopathies, macularoedema, glaucoma and peripheral retinallesions (holes or tears).

• Corneal cross-linking for keratoconustreatment.

• Haemorrhoid treatments.

• Clinical (not cosmetic) peripheral vascularsurgery.

• Ear, nose and throat CO2 laser.

• In musculoskeletal physiotherapy.

• Laser endourethral and vesical lithotripsy.

• Laser vaporization and enucleation of theprostate.

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 human medicines:

• Those administered to the patientoutside of hospital or in a day hospital,except chemotherapy administered viaparenteral by a healthcare professionalin appointed centres and using bladderinstillation in the case of MITOMICINA


and BCG. Medication in ventilationtherapy or aerosol therapy, as well asover-the-counter products.

• Medicinal products not on the marketin Spain.

• The following special medicines:• Vaccines/autogenous vaccines and

other biological medicinal products• Medicines of human origin• Advanced therapy medicinal

products (gene and cell)• Medicinal plant products• Homeopathic medicinal products• Rad i o p h a r m ac eu t i c a l s f o r

therapeutic purposes (for exampleyttrium (90Y) chloride, ibritumomabt iuxetan (90Y), rad ium-223d ichlo r ide, lutet ium (177Lu)oxodotreotide, etc.) except thosementioned in Medical Oncology,such as sodium iodide I 131 fortreating overactive thyroid andthyroid cancer, as well as the use of90Y-Yttrium Citrate for radioisotopicsynoviorthesis.

• Adoptive cell transfer therapies (forexample CAR T-cell therapy,adoptive transfer of autologoustumour infiltrating lymphocytes(TIL)) and any other therapies notexpressly mentioned, are excluded,unless SANITAS has informed thePolicyholder in writing that it isincluded in the cover.

All pharmacokinetic studies areexcluded.

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

N. Metabolic surgery is excluded indiabetes, and gastric balloon andendoscopic treatments for obesity arealso excluded.

Q. Sclerosis treatments with foam andmicrofoam in the Angiology and Vascular

Surgery speciality and any other specialityare excluded.

R. Treatment with High Iintensity FocusedUltrasound (HIFU) is excluded.


Clause III: Qualificationperiods

All benefits which under this policy areassumed by the Insurer, on the basis of theapproved medical network, will be providedfrom the time this contract becomes effective.HOWEVER, THE FOREGOING GENERALPRINCIPLE DOES NOT APPLY TOMEDICAL, SURGICAL AND/OR HOSPITALHEALTHCARE IN THE EVENTS DETAILEDBELOW, TO WHICH SHALL APPLY THESPECIFIED QUALIFICATION PERIODS:

• 180 days for vasectomy and fallopiantube ligation (in all cases in which coveris included in the policy).

• Eight months for childbirth healthcare.

• 2 years for psychiatric treatment on bothan inpatient and outpatient basis. Thisqualification period is not applicable inthe Insurers medical network in Spain.

• 90 days for surgical operations andhospitalisations. This qualificationperiod is not applicable in the servicesprovided through the Insurers medicalnetwork in Spain or in the SecondEuropean Country of cover.

• 150 d ays f o r r ad i o t h er ap y,ch em ot her ap y, c obal t o th er ap y,radioactive isotopes, linear accelerator,scanner, magnetic resonance, nuclearmedic ine, bone dens i tometry,lithotrypsy, digital arteriography,rad io-neuro logy and prostatehyperthermia. This qualification periodis not applicable in the servicesprovided through the Insurer,s medicalnetwork in Spain or in the SecondEuropean Country of cover.

• 90 days for physiotherapy, rehabilitation,laser therapy, pathological anatomy, andfor special home care. This qualificationperiod is not applicable servicesprovided through the Insurers medical

network in Spain or in the SecondEuropean Country of cover.

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


Clause IV: Form of serviceprovision

The Insurer hereby assumes, on the termsand with the limits set forth in the General,Particular and, when applicable, SpecialTerms and Conditions and PolicySupplements that may be issued, the medicaland surgical care throughout Spain, accordingto standard practice, both on an outpatientand inpatient basis, of the diseases or injuriescomprised in the description of the Policyservices.

To subscribe to an insurance policy theInsured must be resident in Spain, hold abank account in Spain and have named asecond European country in which he/shewishes to receive healthcare cover.

As specified in article 103 of the InsuranceContract Act, the Insurer assumes thenecessary care of an emergency nature inaccordance with the Policy Terms andConditions

1. In Spain

1.1. Hospital and out-patient care in theInsurer,s medical network.

Medical care costs shall be paid directly bythe Insurer, the Insured does not need tomake any payments. As specified in theapplicable regulatory provisions, such careshall be provided in all Spanish towns andcities where the Insurer possesses dulyauthorised representation or has an approvedmedical facilities arrangement.

This cover includes expenses arising fromsurgical procedures, provided they areprescribed and conducted by a doctor (feesdue to surgeon and his/her assistants,anaesthetist, use of operating theatre,materials and medicinal products), stays inintensive care units, and hospital expensesincluding board and a conventional room witha supplementary bed.

Upon receiving the due services, the Insuredshould show his/her Sanitas Health Plan card

and the last premium payment receipt, ifrequired.

The Insured is also obliged to show his/hernational identity card, passport or any otherofficial document proving identity, if required.

As a rule, the Insurer's prior authorisation isneeded for surgical procedures,hospitalisation, consultants and certaintherapeutic methods and diagnostic tests inthe arranged medical facilities, subject to priorprescription by one of its physicians. Thisauthorisation shall be given unless it isconsidered to be a service not covered by thepolicy. This authorisation shall be financiallybinding on the Insurer.

In particular, for the highly complex surgicaloperations detailed in the following (surgeryon the central nervous system, cardiacsurgery, bariatric surgery and spinal surgery),the Entity reserves the right to designate thehealthcare centre and the professionals whowill complete the operation, in each individualcase and prior to the realisation of the specificsurgical operation.

The foregoing paragraph notwithstanding, inemergency cases an order by one of theInsurer's physicians shall suffice for thesepurposes, although the Insured shall notifythe Insurer of the fact and obtain itsconfirmation within 7 days of admission to thehospital institution or the provision of thehealthcare service. In these emergencycircumstances, the Insurer shall be boundfinancially up to the time when it expressesobjections to the physician's order, in theevent of considering that the policy does notcover the medical act.

Any change thereof must be communicatedby registered post at least eight days prior tothe request of any service.

In the event of travelling temporarily to placeswhere the Insurer does not have an office ofits own but does have approved facilities, theInsured shall present his/her Sanitas HealthPlan card to request service at the offices ofthe entities approved by the Insurer andcomply with the administrative formalities ofsaid entities.


Where exceptional healthcare needs sorequire, the Insurer may refer or move theInsured to a public hospital for medicaltreatment or hospitalisation.

1.2. Hospital and out-patient care not coveredby the Insurer.s medical network.

As a rule, the Insurer shall reimburse only thepercentage set out in the General Terms andConditions of the Policy of the medical and/orhospital costs. The remaining percentageshall be paid by the Insured.

To process a claim partly covered by thisPolicy (reimbursement of the costspercentage set out in the Special Terms andConditions of the Policy), the following rulesapply

1. The Insured party or any person on itsbehalf must report any hospital admission,operation and in general insured medicalservice within a maximum of seven (7) daysfrom learning of it, except if a longer periodhas been set. In the case of a scheduledoperation or hospital admission, this must becommunicated to the Insurer as soon as thereis notice of the date that the operation orhospital admission will take place.

2. For surgery, hospitalisation, diagnostictests and therapeutic methods, together withthe notice of illness or accident thePolicyholder or Insured shall send the Insurera medical report specifying the diagnosis(es)and nature of the illness(es), and, ifapplicable, the healthcare facility, date ofadmission and type and likely duration oftreatment.

3. The Insured must, furthermore, faithfullyfollow all the prescriptions of the physician incharge of treatment and provide the Insurerwith all details of the circumstances andconsequences of the claim.

4. The Policyholder or the Insured or his/herfamily relatives must allow the Insurer.sappointed physicians to visit the Insured anynumber of times thought fit by the Insurer andany investigation or check the Insurer deemsnecessary on his/her state of health.

5. After termination of any hospitalisation, thePolicyholder or the Insured shall advise theInsurer of such, stating the duration of thehospital stay.

6. The Policyholder or, as the case may be,the Insured shall file the followingdocumentation with the Insurer:

6.1. A duly completed reimbursementapplication form.

6.2. Proof(s) of payment or original invoice(s)for the expenses actually incurred by theInsured, duly broken by invoice item,indicating:

a/ The person receiving medicaland/orhospital care.

b/ The nature of the medical act(s) performed(consultation, diagnostic tests, therapeuticmethods, surgery, etc.) and their dates andcosts.

c/ Identity of the natural person or bodycorporate providing the healthcare (doctor,registered nurse, clinic, hospital, etc.),indicating, as applicable, name or corporatename, address, medical associationmembership number and tax registrationnumber.

6.3. Proof or original certification of paymentof the invoice(s) by the Insured.

6.4. Original medical prescriptions for themedical and/or hospital services provided tothe Insured, except podiatry consultations andservices, for which prescriptions need not befiled.

6.5. Original medical report explaining themedical and/or hospital services provided tothe Insured, the disease process and itsprogression; and the medical or hospitaldischarge report, indicating, if applicable, anyneed for continued healthcare. Non-fulfilmentof the requirements set forth in the sixsub-paragraphs above shall operate as anexpress waiver of the respectivereimbursement, unless fulfilment wasunfeasible for reasons beyond the


Policyholder.s, the Insured.s or his/herrelatives. control.

If the Insured suffers any of theconsequences set out in the Policy Termsand Conditions giving rise to reimbursement,the Insurer shall pay the Policyholder orInsured, as applicable, by such means asshall be agreed, the respectivereimbursement amount. performance ofappropriate checks to establish the existenceof the claim, the Insured shall within tenworking days reimburse or deposit theassured amount in accordance with theknown particulars.

If the claim lasts more than three months, thePolicyholder or, if applicable, the Insured,shall send the Insurer the invoice(s) for theexpenses incurred in the previous quarter.

If within three months from occurrence of theclaim the Insurer fails, on unreasonablegrounds or for reasons attributable to theInsurer, to pay the respective benefit, theoutstanding amount shall increase at thelegally applicable interest rate in force at thetime of accrual, increased by 50 percent. Thisinterest shall be deemed to accrue dailywithout need of application to a court.However, two years after occurrence of theclaim, annual interest may not be less than 20percent (article 20 of the Insurance ContractAct).

Reimbursement of the care received in Spainoutside the medical facilities arranged by theInsurer shall be made in euros only, by way oftransfer to a Spanish bank account belongingto the Insured or the Policyholder.

2. In the second Europeancountry covered

2.1. Hospital care in approved hospitals andclinics.

Outside Spain the Insurer shall provideaccess for the Insured to approved clinics andhospitals in the Second European CountryCovered only.

In order to access these services the Insuredmust identify themselves with the SanitasHealth Plan.

In this event the Insurer shall pay thecorresponding percentage of the amount ofmedical costs covered by the policy which arelaid down in its Special Terms andConditions, paying the hospital directly for thecorresponding services. The remainingpercentage shall be paid by the Insured whoshall pay the hospital directly before beingdischarged.

As a rule, the Insurer's prior authorisationshall be required for surgical procedures andhospitalisation in approved hospitals andclinics, unless the treatment required is notcovered by the policy.

In emergencies the Insured shall request theauthorisation mentioned in the paragraphwithin 7 days following admission to hospitalor provision of care.

The Insured shall, in any event, complete areimbursement form before leaving hospitalso the Insurer can pay the correspondingpercentage of the medical costs incurred.

2.2. Hospital care in hospitals and clinicsother than those approved and out-patientcare.

For out-patient care or operations or hospitaladmissions in hospitals or clinics which arenot approved, the Insured shall pay the fullamount of medical care received directly tothe care provider.

Once care is received, the Insured shall sendall documentation to the Insurer who, oncethe claim is accepted, shall reimburse thecorresponding percentage of care costs asdetermined in the policy's Special Terms andConditions. To be entitled to reimbursementof costs, the Insured shall send the Insurerthe following documentation, within a periodnot exceeding six months following the date oftermination of care:

• Duly completed reimbursement applicationform.

• Original invoices with receipt of payment.


If the Insurer wishes, the Insured shall alsoprovide:

• Medical prescriptions (except forconsultations).

• Medical reports (for surgical proceduresand hospitalisation).

• Diagnostic test results.• Written confirmation stating whether costs

may be recovered from another person orentity.

Reimbursement shall be made in a period notexceeding fifteen days, by way or cheque orbank transfer in the official currency of thecountry in which care has been provided or ineuros. Reimbursement shall not be made inany other currency.

If the Insurer needs to change currency forthe reimbursement, the rate of exchange shallbe the mean of buyer and seller rates set bythe Bank of England for the actual exchangeand the exchange rate in force on the date ofissue of the invoices or on the date of the lasttreatment, if later, shall be used. In the eventthat this date is a national holiday, theeffective exchange shall be applied to the lastworking day.

Inclusion in the policy cover of new diagnosticand therapeutic techniques and newtechnologies shall made according to theprinciples of the medicine based on theevidence once effectiveness and safety hasbeen proven and there are adequateresources for such inclusion as arranged bythe Company. The fact that a healthcaretechnique, consultation, diagnostic or therapyresource is prescribed or arranged by aphysician does not automatically imply that itis required from a medical point of view.


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, whereapplicable, a single premium) unlessotherwise agreed (Art. 15 of the InsuranceContract 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. Maximum age for taking outthe policy

The maximum age for taking out the policy is75 years old. Only those who are under 75years old can be included as Insureds on thepolicy, unless agreed otherwise and without


affecting the maximum ages that may be set,where applicable, for additional orsupplementary benefits on this Policy.

3. Duration of insurance

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

3.2. If the insurance policy is terminatedunilaterally at the discretion of SANITAS, itmay not suspend the provision of cover whilethe Insured is undergoing hospital treatment,until discharge, unless the Insured waives tocontinue the treatment or unless the policyis terminated due to fraud or grossnegligence on the part of the Insured.

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.

3.3. 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 andcredits such circumstance.

c) For any action of the Insured againsthealthcare or administrative staff that mayviolate the right to personal honor anddignity or may be a crime.

3.4. 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.

4. Insurance premiums

4.1. The Insurance Policyholder must paythe premium when the contract isaccepted. The cover in the contract willnot come into force until the contract hasbeen signed and the first premium hasbeen paid.

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

4.3. 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.

4.4. 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 topay the full premium agreed to for theremaining Insurance period.

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

4.5. 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.

4.6. 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.

4.7. SANITAS is only bound by theinvoices issued by the Management or byits legally authorised representatives.

4.8. The Insurer may modify the premiumand the amount of participation of theInsured in the cost of services with eachrenewal of the Contract. This review isbased on technical-actuarial criteria madeand based on the variation in the cost ofhealthcare services, the type, thefrequency of use of the benefits coveredand the inclusion of technological medicalinnovations that were not covered on theinitial effective date of the policy.

The premiums to be paid by the Policyholderwill vary according to the age achieved byeach of the Insured, the geographical zonecorresponding to the place of performance ofthe services, the tariffs established 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.

4.9. The Policyholder, after receivingnotification from SANITAS about thevariation to the premium for the next yearcan choose to accept the InsuranceContract renewal for the premiumproposed by the Insurer or terminate itwhen the Insurance term in progress ends,in the latter case notifying SANITAS inwriting, at least one month before theexpiry date, of your wish to terminate it.

4.10. 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.

5. Registering newborns

Newborn children can be included in thepolicy with all its rights since their date of birthif the care provided to the mother whilst thechild delivery has been provided by SANITASwithin the coverage of the mother’s policy and


if the inclusion of the father as an Insured inthe policy has taken place at least 240 daysprior to the child delivery. For this to beeffective, the Policyholder must communicateto SANITAS such circumstance within the 30natural days following the date of birth, bymeans of completing an InsuranceApplication.

In any case, SANITAS will only cover thenewborn’s healthcare when and if he/sheis included as Insured in SANITAS. If theinclusion of the newborn is communicatedonce the term mentioned above has elapsedor without fulfilling all the requirementsindicated in the paragraph above this,SANITAS by virtue of the informationprovided by the Policyholder in the InsuranceApplication can deny the inclusion of thenewborn as Insured member.

In the event of gestational surrogacy, thePolicyholder must notify SANITAS to add thechild as an insured on the policy within 30calendar days of registering the child on theSpanish Civil Register as the child of theinsured/insureds. The insured cover shallcome into effect on the date the insured isadded to the policy and any expensesincurred before adding the insured to thepolicy shall not be covered and theexpenses incurred before the mother ornewborn are discharged from hospitalafter the birth shall not be covered underany circumstances.

6. 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.

7. Complaints

7.1. Complaints control and procedure

a) Supervision of the business activity ofSANITAS lies with the Spanish State and isexercised through the Directorate General forInsurance and Pension Funds of the Ministryof Economic Affairs and DigitalTransformation.

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. Pursuant to Ley de Consumo de Cataluña22/2010 de 20 de julio (Consumer Law ofCatalonia 22/2010, of 20 July), published inthe Diari Oficial de Catalunya no. 5677,customers domiciled in Catalonia may submitan incident or file a complaint on freephone900 841 275 or at any of our offices inCatalonia (head office in Av. Diagonal 443,Barcelona).

3. 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,on paper or electronically with a digitalsignature, via its website. Accordingly, theclaimant must prove that the established


period for the settlement of the complaint bySANITAS Complaints ManagementDepartment has expired, that the complainthas been denied leave to proceed or hasbeen dismissed.

4. 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.

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

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

8. Other important legal points

8.1. 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.

8.2. How to accept the Terms andConditions

SANITAS will send the Policyholder an emailat the address provided in the applicationform, which will include a link for registeringon the website and choosing a security ID.Any notifications sent by an insurance brokeron behalf of the Policyholder will have thesame effect as if they were sent by thePolicyholder, unless the latter specifiesotherwise.

After receiving the password, the Policyholdermust go to www.sanitas.es, where theGeneral and Individual Terms and Conditionsof the policy are available, which he/she mustaccept using a code that will be sent to themobile phone number provided in the

insurance application form. For all intents andpurposes, using the security ID will be legallyequivalent to the policyholder’s writtensignature. SANITAS may refuse to providethe insured cover if the Policyholder does notaccept the Policy terms and conditions.

8.3. Notifications

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

8.3.2. Notifications from SANITAS to thePolicyholder, Insured or Beneficiary will besent to the physical or electronic address or tothe phone number provided by thePolicyholder for each of them when filling outthe insurance application form, unless theynotify any changes. The Policyholderauthorises SANITAS to send any notificationsvia electronic means, provided that it ispermitted by law.

8.3.3. The Policyholder authorises SANITASto use his/her mobile phone number andemail address to send all notifications,communications and information associatedto the policy and to requestconsent/authorisation for certain medicalservices via electronic means, provided that itis permitted by law.

8.3.4. The Policyholder accepts the fullvalidity and effectiveness of any notificationsent by SANITAS to their home, emailaddress or telephone number provided in theinsurance application form, until notified ofany changes.

8.3.5. The policyholder accepts the terms andconditions above on his/her behalf and onbehalf of the insureds on the policy.

9. Data Protection clause

Personal Data will be processed, including,but not limited to, identifying and health data(hereinafter, "Personal Data") belonging tothe Applicant, the Policyholder and theInsured Parties (hereinafter, "the DataSubjects") and provided through the


insurance application, in addition to thosecollected and provided during the term of thecontract. Any Personal Data is confidentialand adequately protected. The Applicantand/or Policyholder warrants that all theinformation relating to the Policyholder andthe Insured Party(ies) provided to SANITAS istrue, and no information regarding the healthstatus of each of the Insured Parties has beenomitted. The Applicant will be solely liable forany direct or indirect loss or damages thatthey could cause Sanitas or any third partydue to the documentation provided toSANITAS containing false, inaccurate,incomplete or outdated information.

The Policyholder is responsible forcommunicating to all the Insured Partiescovered by the policy the informationcontained in this Personal Data processingclause, so that both the Policyholderthemselves and the Insured Parties canexercise the rights described in the section"Rights of the Policyholder/Insured Parties".In addition, the Applicant/Policyholderdeclares that they are acting on their ownbehalf and that of the Insured Parties whenthey consent to the processing described inthis clause. Likewise, theApplicant/Policyholder declares that theInsured Parties understand and agree thatthey have provided or will provide theirPersonal Data to Sanitas, as well as Sanitasproviding the Applicant/Policyholder withidentifying information about the medicalservices for the Insured Parties covered bythe policy. This is unless the Policyholderreleases Sanitas in writing of its legal duty toinform them or this is requested by any of theInsured Parties.

In the case of a collective policy, the Sanitas’client entity (which may coincide in somecases with the Policyholder) and Sanitas mayprovide to each other, in a timely manner andon a strictly need-to-know basis, the minimaland essential identification data of the InsuredParties with the sole purpose of verifying thatthey meet the characteristics allowing them tobenefit from the policy agreed between theSanitas client entity and Sanitas, and/or tomonitor insured events and consequentlyagree the insurance premium to be applied.The Sanitas client entity is responsible for

communicating this situation to all the InsuredParties. Such data processing is necessaryfor the correct implementation anddevelopment of the insurance contract.

9.1 Personal Data Controller

The Personal Data Controller is SANITAS,SOCIEDAD ANÓNIMA DE SEGUROS,whose registered address is at C/ Ribera delLoira, 52, 28042, Madrid, Spain (hereinafter,"Sanitas"). Data Subjects may contact theData Protection Officer (hereinafter, the"DPO") of the Sanitas Group via the emailaddress "[email protected]" or at theabovementioned postal address for anyqueries or requirements that they may haveregarding personal data protection.

9.2 Main purposes and lawfulness ofprocessing Personal Data

(a) Formal i s i ng , develop ing , andimplementing the insurance contract.Processing Personal Data is necessary tofinalise the contract between theApplicant/Policyholder/Insured Parties andSanitas, as well as for running, developingand implementing the contractualrelationship, consisting, among otherthings, of managing and supporting theData Subjects’ health care. Thus, Sanitaswill process the Data Subjects’ PersonalData, among other things, to manage therelationship with them, manage the policyetc. and, in certain cases, it may makeautomated decisions based solely on theanalytical procedures used for suchpurposes. In these cases, the DataSubjects through the channels referred toin paragraph 8.6 "Rights of thePolicyholder/Insured Parties" will have theright to review and challenge the decision,as well as to request human intervention.Sanitas may process Personal Data,including health data, to conduct customersatisfaction surveys about the servicesreceived as a result of the contractualrelationship as well as to managecoinsurance, where applicable. Thispurpose is based on the need forprocessing to implement these terms andmanage health and social care systemsand services.


(b) Financial solvency analysis. Sanitasmay process the Applicant/Policyholder'sPersonal Identification Data to consultcredit report file systems as a step foranalysing financial solvency, as well as forpreventing and detecting possiblefraudulent conduct, based on Sanitas'legitimate interest in taking the necessarymeasures to identify and manage theabove.

(c) Technical analysis. Sanitas may processPersonal Data to conduct statisticalanalyses regarding the operation of thetechnology supporting the servicesprovided, in order to make technical,security improvements, etc. To do this,Sanitas may use the information theygenerate when using the technologicalresources placed at their disposal toimprove quality, correct errors, improveusability, etc., based on Sanitas'legitimate interest in improving the qualityof its technological resources.

(d) Managing the provision and coverageof the healthcare service which is thesubject to the insurance contract, andto this end being able to request andobtain information regarding their healthfrom healthcare professionals. Sanitas willprocess the Policyholder’s/InsuredParties’ Personal Data to manage theprovision of the services which are thesubject matter of the contract consisting,among other things, of making theappropriate payments to health providersor reimbursing the insured party or itsbeneficiaries for the costs of healthcare.For this purpose it may share PersonalData, including health data, with thehealthcare professionals providing thehealthcare service, requesting andobtaining from these professionalsinformation regarding their health, inparticular to assess the coverage and theappropriate payment or reimbursement forthe services provided. In addition, as partof managing the provision and coverageof the healthcare service subject to,among other things, supporting thePolicyholder/Insured Party in caring fortheir health, Sanitas may prepar profilesbased on their Personal Data, including

health data, to provide personalisedinformation, such as recommendationsand advice that will assist thePolicyholder/Insured Party in taking careof their health. This purpose is based onthe need for processing to implementthese terms and manage health andsocial care systems and services.

(e) Research for designing models ofassistance which are the subjectmatter of the insurance contract.Sanitas may process the Personal Data,including health data, of thePolicyholder/Insured Party to developprofiles allowing it to design assistancemodels in accordance with the aforesaidprofiles, for the purposes of takingpreventive health steps regarding thePolicyholder’/Insured Party as part of theobject of the insurance contract. Thispurpose is based on the need forprocessing to implement these terms andmanage the provision of health servicesand treatment.

(f) Offering and managing healthprevention and service programs underthe insurance contract. Sanitas, thanksto the analyses and profiles performedand as part of the healthcare supportprovided to the Policyholder/Insured Partywill offer them the healthcare service andprevention programs designed inaccordance with the above section.Offering and managing the healthcareservice and prevention programs will becarried out taking into account thePolicyholder’s/Insured Party’s specificcharacteristics and needs. Therefore,Sanitas will be required to process theirPersonal Data, including their health data,in order to offer and manage the differenthealthcare models specifically tailored tothe Policyholder/Insured Party. Thispurpose is based on the need forprocessing to implement these terms andmanage the provision of health servicesand treatment.

(g) Manage the provision of the healthpromotion service which is the subjectmatter of the insurance contract. As


part of Sanitas' health care support underthe existing contractual relationship,Sanitas needs to process thePolicyholder’s/Insured Party’s PersonalData in order to manage the design ofspecific health management plans forevery Policyholder/Insured Party. To thisend, Sanitas, as a result of profiling basedon the Policyholder’s/Insured Party’sPersonal Data, manages the preparationof personalised health plans and proactivemonitoring programs, supports themanagement of complex cases (such asserious illnesses or prolongedhospitalisations), manages healthcareprovision to chronic patients and alsoemergency care. This purpose is basedon the need for processing to implementthese terms and manage the provision ofhealth services or treatment.

(h) Manage access to and use of the "MiSanitas" tool made available as a resultof the insurance contract. Sanitas mayprocess the Policyholder’s/Insured Party’sPersonal Data in order to manage andprovide them with access to "Mi Sanitas"(an insurance management portal) as wellas ensuring its correct operation, eitherthrough the website or the applicationdeveloped for this purpose. Sanitas, in thecontext of using "Mi Sanitas", will processPersonal Data to, among other things,offer health recommendations, place atthe Policyholder’s/Insured Party’s disposalreceipts and refunds, manage theirappointments, etc. This purpose is basedon the need for processing to implementthese terms and manage the health andsocial care systems and services.Furthermore, Sanitas makes a "HealthFile" service (accessible through"MiSanitas") available to thePolicyholder/Insured Party so that theycan request that Personal Data, includinghealth data (e.g. medical reports ordiagnostic tests), be transferred andarchived in a tool used exclusively by thePolicyholder/Insured Party. However, ifthe Policyholder/Insured Party decides touse this service, privacy information willbe provided to them separately.

(i) Allow Sanitas to manage the provisionof the video consultation service.Sanitas will process, and whereappropriate, assign to the third partiesdesignated by the Policyholder/InsuredParty, their Personal Data to provide thevideo consultation, chat or other services,made available by Sanitas to the extentthat they form part of thePolicyholder’s/Insured Party’s insurancebenefits. Thus, the Policyholder/InsuredParty may, through the programs andapplications downloaded for this purpose,communicate remotely with healthpersonnel and provide documentation inorder to address any queries that theymay have in the context of the medicalassistance services provided by Sanitas.This purpose is based on the need forprocessing to implement these terms andmanage health and social care systemsand services.

Likewise, Sanitas will be able to managethe recording of the video queries takingplace arising from using the "24-houremergency" service in order to be able tomanage any eventual claims made by thePolicyholder/Insured Party in relation tothe service received through the videoconsultation. This is based on the need forprocessing for the purpose referred to andsatisfying Sanitas’ legitimate interest inpreserving the documentation allowing itto attend to the queries and possibleclaims made by the Policyholder/InsuredParty. Sanitas may also manage therecording of video queries that are notcarried out within the framework of the"24-hour emergency" service in order toimprove the quality of the servicesupplied, provided that it has theirconsent.

(j) Actuarial risk management. Sanitas willn e e d t o p r o c e s s t h ePolicyholder’s/Insured Party’s PersonalData, including health data, in order toconduct a statistical-actuarial analysisboth to determine the associated risk andfor charging for customer and potentialcustomer’s policies, either prior to thesigning of the insurance contract or duringits term of application in accordance with


the Insured Party’s new circumstances orany changes to the actuarial grounds.This purpose is lawful since theprocessing is necessary in order tocomply with a legal obligation imposed bythe regulations governing insurers andreinsurers; and for managing health andsocial care systems and services.

(k) Recording telephone conversationsbetween the Data Subjects and Sanitasin connection with this policy. Theserecordings will be carried out to be used inSanitas’ quality control processes, in orderto improve the quality of the serviceprovided to the Data Subjects, based onSanitas’ legitimate interest in upholding itsquality control processes and managingits health and social care systems andservices. Likewise, Sanitas may use theserecordings, if any, as evidence regardingany claim that may arise between theparties, in every case treating asconfidential the conversations held, basedon Sanitas’ lawful interest in formulating,exercising and/or securing its defenceagainst claims, and the need forprocessing to ensure it. The Data Subjectmay request from Sanitas a copy orwritten transcription of the content of theconversations recorded between the twothrough the channels indicated in thesection "Rights of Data Subjects".

(l) Complying with the obligationsimposed on Sanitas by legal mandate.On certain occasions, Sanitas will need toprocess the Applicant’s and/orPolicyholder’s/Insured Party’s PersonalData to comply with certain legalobligations. Among other things, Sanitaswill process Personal Data in order tocomply with the obligations set out in theinsurance regulations, laws and theregulations on personal data protectioncurrently in force. This purpose is lawfulsince processing the data is necessary inorder to comply with the legal obligationsapplicable to Sanitas; and for managingthe health and social care systems andservices.

(m) Profiling for the purpose of marketingand improving the business servicesprovided by Sanitas. In order to offer theApplicant and/or the Policyholder/InsuredParty the products and services that bestsuit their interests and needs, Sanitasmay create profiles based on theApplicant's Policyholder´s/Insured Party´sPersonal Data, including their health data,in order to ensure that their experiencewith Sanitas is as tailored to them aspossible and to continue customising itwhile providing the service which is thesubject matter of the insurance contract.These profiles will be outlined inaccordance with the Personal Data of theData Subjects available to Sanitas, forexample the type of insurance contracted,allowing Sanitas to select the products orservices best adapted to the Data Subject,and thus being able to customise theirexperience. In particular, the above will becarried out to:

• Manage and send commercialcommunications based on theApplicant’s and/or Policyholder’s/InsuredParty’s profile by any channel, includingelectronically, about products andservices similar to the insurancecontract. This purpose is lawful based onSanitas' legitimate interest in providinginformation about its services, news,offers, etc. that best suit the Applicant’sand/or Policyholder’s/Insured Party’sprofiles, related to the contractedservices and for managing health andsocial care systems and services. Incases where an insurance policy has notbeen contracted with Sanitas, thepurpose is lawful based on the consentof the data subject, since the processingwill be carried out with prior authorisation.

• Send commercial communications basedon t he App l i can t ’ s and/ orPolicyholder’s/Insured Party’s profiles byany channel, including electronically,about new products and services. Thispurpose is lawful based on the consentof the data subject since the processingwill be performed with prior authorisation.

• Allow Sanitas to send commercialcommunications based on theApplicant’s and/or Policyholder’s/Insured


Party’s profiles by any channel, includingelectronically, about third-party productsand services. This purpose is lawfulbased on the consent of the data subject,since the processing will be performedwith prior authorisation.

• Anticipate the Policyholder’s/InsuredParty’s health needs, to improve theservices provided and offered to them,including, for example, ascertaining whenit is necessary to increase resources forthe personalised care of thePolicyholder/Insured Party. This purposeis lawful based on Sanitas' legitimateinterest in providing the best possibleservices by support ing thePolicyholder/Insured Party in taking careof their health, and the need for theprocessing to manage the health andsocial care systems and services.

(n) Carry out procedures to anonymise andp s e u d o n y m i s e t h ePolicyholder’s/Insured Party’s PersonalData, including their personal healthdata, for marketing purposes,improving the relationship with them,and for scientific and/or statisticalresearch. Sometimes, Sanitas may applycertain procedures to thePolicyholder’s/Insured Party’s PersonalData in such a way that either it will beimpossible to find a link between anidentified or identifiable natural person andthe Personal Data processed, or saidPersonal Data cannot be attributed to aparticular person without using additionalinformation appearing separately. Theseprocedures will be applied so that theanonymised or pseudonymised data canbe processed for scientific or statisticalresearch purposes, or in order to be ableto identify individual health status trends,establish patterns of disease, etc., as wellas to understand which services may bestfit certain groups and be able to informthem of this. This treatment is lawful sinceit is based on Sanitas’ legitimate interestand its need to manage the health andsocial care systems and services, as wellas on the basis of the requirement forscientific and/or statistical researchpurposes.

(o) Assign Data Subjects’ Personal Data toGroup Companies, to:

• Send commercial communications aboutproducts and services of said groupc o m p a n i e s b a s e d o n t h ePolicyholder’s/Insured Party’s profiles byany means, including electronically,based on the consent granted by theData Subject.

• Anticipate the Policyholder’s/InsuredParty’s health needs, developing theGroup's company profiles and carryingout statistical analyses in order toimprove the services provided by theGroup’s entities to be able to offer themto the Policyholder/Insured Party, inaccordance with their particularcharacteristics, based on the consentgranted by the Data Subject.

• Internal administrative purposes, basedon Sanitas' legitimate interest intransmitting personal data within itsbusiness group for this purpose, whichincludes processing Personal Data.

(p) Assign Personal Data to third parties.Sanitas may assign the Data Subject’sPersonal Data to any other entity withwhich they establish collaborative links toimprove the effectiveness of thecontractual relationship with the DataSubject. In particular, the categories ofrecipients, identified in the AdditionalInformation, who may receive PersonalData will be, among other things,co/insurers and reinsurers, insurancebrokers, entities with which a commerciallink is established, health professionals,medical centres and hospitals.Assignments will be made for:• Risk reinsurance purposes, based on

Sanitas' legitimate interest in managingthe risk assumed, and the need forprocessing to manage the health andsocial care systems and services.

• Sending commercial communicationsabout third-party products and servicesby any channel, including electronically,based on the Applicant’s and/orPolicyholder’s/Insured Party’s profiles,based on the consent granted by theData Subject.


• Analyse the use of Sanitas’ websitesand applications, based on the consentgranted by the Data Subject.

9.3 Admissibility of Personal Data

The origin of the Personal Data processed bySanitas may vary from case to case. Inparticular, Sanitas may process PersonalData, including health data that (i) theApplicant/Policyholder and/or Insured Partyprovides through the corresponding forms; (ii)has been generated as a result of the serviceprovided by Sanitas and; (iii) which Sanitashas obtained through brokers, insuranceagents or third-party collaborators.

9.4 Time Personal Data is kept

Sanitas will process the Data Subjects’Personal Data and keep it for the duration ofthe contractual relationship between Sanitasand the Policyholder/Insured Party or until theapplicable legal obligations expire. For thosepurposes where the Data Subject hasconsented to their Personal Data beingprocessed or where there is the possibility ofobjecting, Sanitas will stop processing thePersonal Data, for that particular purpose,immediately following the withdrawal ofconsent or the exercise of the right to object.All of the above is without prejudice to thesubsequent conservation that is necessary toformulate, exercise or defend againstpotential claims, comply with obligations topreserve clinical documentation, provided thatit is permitted by applicable legislation or tomake the Personal Data available to judgesand courts, the Public Prosecutor's Office orpublic bodies. During this additional period,Sanitas will keep the Personal Data blocked.Once the abovementioned period has cometo an end, Sanitas undertakes to ceaseprocessing all the personal data.Notwithstanding all of the above, wherenecessary Personal Data may be held forlonger periods provided that it is processedexclusively for health care, medical, scientificand/or statistical research purposes andtaking into account the specific case.

9.5 Accessing Personal Data

The optimal service delivery that Sanitasoffers may require that its third-partyproviders access the Data Subject’sPersonal Data as processors. Data Subjectsunderstand that some of these serviceproviders are located in countries outside theEuropean Economic Area or do not offer alevel of security equivalent to that in Spain. Toensure that the Personal Data is processedwith a level of protection equivalent to thatwhich already exists, Sanitas has adopted theappropriate safeguards. These internationaltransfers are made under the protection of anadequacy finding of the EuropeanCommission, providing sufficient guaranteesrecognised by the regulations (such asstandard contractual clauses), or theauthorisation of the Spanish Data ProtectionAgency, complying with appropriate securitymeasures. More information can be found inthe International Data Transfers Section ofthe Additional Information. To obtain a copy ofsaid authorisation, you can contact Sanitas bythe means set out in the section "Rights ofInsured Parties".

In addition to the access that third-party,national or international, providers as dataprocessors may have to the Personal Data forwhich Sanitas is responsible in the context ofproviding a service, Sanitas will assignPersonal Data to other entities, as specified inthe section "Main purpose and lawfulness ofPersonal Data processing".

In addition to the above, the Data Subjectsunderstand that Sanitas may makeassignments or communicate Personal Datato meet its obligations to Public bodies incases in which it is required to do so inaccordance with the legislation in force fromtime to time and, where appropriate, also toother bodies such as the State SecurityForces and Bodies and Judicial Bodies. Inaddition, the Policyholder/Insured Partyunderstands that Sanitas may request,require, and share their Personal and HealthData from professionals or health facilities,hospitals, with entities with which it has aco/reinsurance or collaborative relationship.They therefore understand that it will benecessary to provide each other with theirPersonal Data, to manage reinsurance,coinsurance, comprehensive care programs,


share best practices and assess the risks tobe covered, to prevent fraud, determinehealthcare, make payments to health careproviders or reimburse thePolicyholder/Insured Party for healthcarecosts and the costs of any claims submittedby the Policyholder/Insured Party themselves.

9.6 Rights of Data Subjects

Sanitas informs Data Subjects about theirability to exercise the rights to access,rectify, object, erase, portability and limitprocessing as well as to refuse theautomated processing of any Personal Datacollected by it. Such rights may be exercisedfree of charge by the Data Subjects, andwhere appropriate by the person representingthem, by written and signed request,accompanied by a copy of their ID orequivalent document proving their identity,addressed to: Calle Ribera del Loira no 52,28042, Madrid, Spain, Att. LOPD Insurance.The Policyholder/Insured Party may alsoexercise their rights through Mi Sanitashttp://www.sanitas.es/misanitas/online/clientes/contacto/index.html. Data Subjects mayalso exercise their rights through the formsprovided for this purpose in the AdditionalInformation section, in the subsection "DataProtection Rights". A more detailedexplanation of the rights can also be found inthis section. Where the Data Subject has arepresentative, this must be proven by awritten document, attaching a copy of their IDor an equivalent document proving therepresentative’s identity or other supportingdocumentation as indicated in the "Rights"section under Additional Information.

In addition to the above rights, Data Subjectswill have the right to withdraw any consentgiven at any time through the proceduredescribed above, without such withdrawal ofconsent affecting the lawfulness of theprocessing prior to the withdrawal of thesame. Sanitas may continue to process DataSubjects’ Personal Data to the extentpermitted by any applicable law. Sanitasreminds Data Subjects that they have theright to present a claim before the relevantsupervisory authority.

Notwithstanding the above, Sanitas informsthe Data Subject that they have at theirdisposal an internal conflict resolution systemin which the Data Protection Officer takes anactive role as a mediator attempting tomanage as flexibly as possible, any claim thatthe Data Subject sends to the postal addressor electronic mail indicated in the section"Personal Data Controller". Sanitasencourages the Data Subject to contact theData Protection Officer prior to making acomplaint to the relevant supervisoryauthority.

9.7 Unsubscribing from the commercialcommunications mailing service

As mentioned in the section above, the DataSubject has the right to revoke at any time theconsent given for the sending of commercialcommunications by notifying Sanitas that theydo not wish to continue to receive them. Todo this, the Data Subject may either revoketheir consent in the manner described in thesection above or click on the link included ineach commercial communication, therebycancelling the sending of electroniccommercial communications.

9.8 Minors

In general, Sanitas will only process thePersonal Data of children under the age ofeighteen when their parents or legalguardians have given their consent for suchprocessing, when it is necessary to implementthe insurance contract or to comply with alegal obligation and/or satisfy a lawful interestof Sanitas.However, in accordance with currentregulations, those over the age of 14 (or theage that may be legally set for this purpose)will have the right to access their own medicalinformation and those rights recognised bylaw.

9.9 Additional Information

Sanitas at www.sanitas.es/RGPD, under thesection "Sanitas Insurance", makes availableto the Applicant, Policyholder and InsuredParty Additional Information about theprocessing of their Personal Data and invitesthem to consult it.


9.10 Amending the Privacy Policy

Sanitas may change its Privacy Policy inaccordance with applicable legislation fromtime to time. At all events, any amendmentsto the Privacy Policy will be duly notified tothe Data Subject to inform them of anychanges made to processing their PersonalData and, if the applicable regulations sorequire, to request they consent to it.

10. Jurisdiction

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

11. Prevention of moneylaundering and financing ofterrorism

SANITAS shall not undertake any service inthe Insured cover of this policy if thisconstitutes an infringement of Spanish, UnitedKingdom, European Union, United States ofAmerica, or international laws in general,reserving the right, in the correspondingcases, to cancel the membership of theInsured affected by said offense. Similarly,you may reject the inclusion of a new Insured,if this may lead to a breach of any of theselaws.

12. How to contact us

Customer Service

Assistance in Spain: +34 91 200 04 30 / 900909 077Assistance ROW: +1 305 275 3439

Executed in duplicate in Madrid, 21 October 2021For the Insured / For SANITASPolicyholder

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GENERAL TERMS AND CONDITIONS - Sanitas

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