REIMBURSEMENT

Reimbursement insurance: cover

The Health Reimbursement insurance policy has many different types of cover. The most relevant guarantees are listed below, together with some of the value-added services also included.

Freedom of choice

• Primary healthcare (80% expenses reimbursed) anywhere in the world.
• Specialised healthcare (80% expenses reimbursed) anywhere in the world.
• Hospitalisation (90% of expenses reimbursed) anywhere in the world.

Mapfre's medical team

The insured parties will not pay anything for primary care, specialised care and hospitalisation, through the services arranged by Mapfre.

Other treatment and special services arranged

• Diagnosis of infertility and assisted reproduction (48 months grace period).
• Domestic and international adoption.
• Emergency medical care abroad.
• Organ transplants.
• Prostheses and implants.
• Psychotherapy.
• Osteopathy.
• Pedicure.
• Biomechanical study of walking.
• Cryopreservation of umbilical cord stem cells.
• Dental guarantee.
• Over-the-phone medical guidance.
• Psychological counselling.
• Paediatric counselling.
• Preventive and rehabilitative medicine, such as: family planning, childbirth preparation, healthy child programmes, early diagnosis of diabetes and breast, gynaecological, coronary and prostate diseases, etc.
• Health channel.

Value added services

• Complementary medicine: acupuncture, homeopathy and natural medicine.
• Refractive surgery for myopia, astigmatism and hyperopia.
• Genetic obesity profile.
• Gastric balloon.
• Personalised home-help services.
• Access to the University Clinic of Navarra.
• Blood screening test for colon cancer.
• Enhanced neonatal screening.
• Discounts at aesthetic medicine and beauty treatment centres.
• Special prices in spas and thermal treatments.
• Benefits in day centres, residences and other services for MAPFRE senior citizens.

Health insurance conditions - Reimbursement of Medical Expenses

Mapfre's Reimbursement of Medical Expenses insurance policy, marketed by Bankinter, is available for people residing in Spain under the age of 65.

Children under 2 years old must be part of a policy that includes their father, mother or guardian to be insured.

What difference is there between the Asistencia Sanitaria Plus health assistance policy and the expense reimbursement policy?

With Healthcare Plus insurance, the insured can choose professionals of all specialties and medical centres from a medical guide without having to make any payments, except for any services that have an excess. Reimbursement insurance allows the insured to choose the professional or centre freely, with the insured paying for the care they receive first.

When do I have to register a newborn child?

The newly-born children of the insured person will be included in the policy from the moment of their birth in identical conditions to those contracted by the insured person, not counting any grace periods other than those that were applicable to them and providing that the following requirements are met:

• That the inclusion of the newborn in the policy is requested within 10 business days from the date of birth by completing the application form.
• The insured (father or mother) joined at least 8 months prior to the birth.
• If these requirements are not met, the inclusion of the newborn will be subject to the insurance company's acceptance and contracting conditions, and the corresponding grace periods and exclusions may apply. If the newborn has any congenital illness or malformation, Mapfre guarantees that it will be accepted as long as the mother/father registers 8 months before the birth.

Can grace periods be revised?

Yes, but only if the insured had contracted a health insurance policy. Grace periods shall be respected, except for the expenses of pregnancy, childbirth, abortion, study and treatment of fertility treatment and adoption. Membership must be applied for within 60 days of withdrawal from the previous entity, and a copy of the terms and conditions or health card, as well as the last bill paid, must be provided. The waving of grace periods does not imply the acceptance of any ailment, illness or accident prior to contracting or of a congenital nature.

What does access to the US hospital network include?

The administration needed for treatment of the insured person in a hospital in the US, with access to a wide network selected by the insurance company in that country, as well as reimbursement to the insured of 60% of the medical and hospital expenses arising from that treatment.

What is the Gran Cobertura (Great Cover) guarantee?

This guarantee is an exclusive additional guarantee for reimbursement insurance. It consists of an increase in the maximum reimbursement limit per insured person up to the percentages provided in the policy, which can be extended every year. Every year, this amount will be reduced for each insured person by any amounts consumed, updating the remainder at the rate of the CPI. Great Cover will start to apply for each insured person once the limits for hospital and outpatient expenses have been consumed. In the case of use of the US hospital network, the insured persons who contract this guarantee will have 100% coverage. The Great Cover supplementary guarantee will only remain in place until the age of 70.

If I am outside Spain for part of the year, how does the insurance protect me abroad?

Mapfre Asistencia covers all travel outside national territory, providing the trip lasts less than 90 consecutive days. It includes emergency expenses for medical, surgical and hospital care in the case of illness or accident, with a limit of €12,000. There is an excess of €15.02 per claim. Emergency dental services are covered up to €120.20. It also includes transfers, repatriation of injured persons and their family members, accompaniment of minors and handicapped persons, as well as transfers using healthcare transport in national territory, when more than 20 km from home.

What is covered by the basic dental guarantee?

It includes a treatment proposal, annual mouth clean, and simple dental x-rays and extractions at no charge. You can extend this cover by arranging the optional dental supplement, with no grace period and no pre-authorisation. The basic dental guarantee is included in all formats at no cost.

What is the national and international adoption guarantee?

It includes reimbursement of expenses arising from activities relating to adoption, up to a total of €12,000. The insured person must have been registered for at least 48 months before they can request the start of this procedure. This guarantee is included in the policy at no additional cost when full coverage is contracted through Healthcare Plus and Reimbursement insurance.

What does the 24-hour medical assistance service include?

This service is staffed 24-hours a day by a team of doctors who are ready to answer questions relating to illnesses, prevention, treatment, use of medication and understanding reports and diagnoses.

What does the cryopreservation of umbilical cord stem cells (SCU) coverage include?

If it provides assistance for the delivery, the insurance company will also cover cryopreservation services for stem cells obtained from the baby's umbilical-cord blood. The guarantee covers the material needed for collecting the sample, and its processing, storage and maintenance in a cell bank for up to 20 years. This guarantee is included in all formats at no cost.

What is early breast disease diagnosis and what does it cover?

This programme is aimed at women with a history of breast disease or a family history of breast cancer. The programme includes: analysis of the risk of the insured person, and consultation and examination by a specialist, and breast ultrasound and mammography, if any risk is detected.

What is it the early diagnosis programme for gynecological issues and what does it include?

This programme is aimed at women who suffer genital infections, who have experienced menstrual changes, who have a family history of gynaecological cancer, who suffer from diabetes, hypertension or obesity, or who smoke. The programme includes: analysis of the risk of the insured person, and consultation and examination by a specialist, colposcopy and vaginal cytology, ultrasound, specific analysis and clinical report with diagnosis, risk assessment and recommendations.

What is the early diagnosis programme for heart disease and what does it include?

This programme is primarily aimed at men and women over forty with high cholesterol, high blood pressure, diabetes, obesity, a sedentary lifestyle or who are smokers, or who have a family history of coronary heart disease. It includes specialist consultation, an electrocardiogram, stress test, specific tests, a clinical report with diagnosis, a risk assessment and recommendations.