This will be provided only after assessment by AXA Seguros Generales’ emergency service and only at the address specified in the schedule. Furthermore, AXA Seguros Generales must have home care network services available in the town where the insured lives and their illness must prevent them from going to the medical practitioner or nurse’s consulting room.  

• Allergology and immunology, except for vaccinations and extracts. 
• Angiology and peripheral vascular surgery. Includes varicose vein procedures using CHIVA. 
• Digestive system, including gastrointestinal endoscopy. 
• Cardiology, including haemodynamics and cardiology diagnostic tests. 
• Cardiovascular surgery. 
• General and gastrointestinal surgery, including coloproctology. Includes laparoscopic surgery in cases where its effectiveness has been shown and established. Includes laser surgery in coloproctology. 
• Oral and maxillofacial surgery. This cover includes non-dental maxillofacial visits, study and surgery and wisdom tooth extractions. Surgery for dental pathology, the covers included in the dental section and functional oral treatment and surgery such as orthognathic, pre-prosthetic and pre-implant surgery are not considered to be maxillofacial surgery. 
• Paediatric surgery. 
• Plastic and reconstructive surgery.
  Only when required to treat the consequences of an accident or surgery covered by this policy and which the insured has while the policy is in force. Purely cosmetic surgery, rejuvenation, detoxification and/or sleep cures, thermal and climatic cures, spa treatments and gymnastics and maintenance therapies are expressly excluded. 
• Chest surgery. 
• Medical and surgical dermatology and venereology.
  Laser skin treatments (except those with pulsed-light laser) and Mole-Max digitised epiluminescence microscopy are included, with at most one examination per year and based on the recommendations of the Spanish Society of Dermatology. Photodynamic therapy is excluded.
• Endocrinology. 
• Geriatrics. 
• Gynaecology. It includes an annual gynaecological examination consisting of a visit and report, cytology, colposcopy and breast examination. In addition, and in accordance with the medical professional’s judgement, an ultrasound and/or mammography may be performed. Tubal ligation and IUD implantation are included, with the cost of the device being paid by the insured. Laser surgery (CO2, Erbium and diode) is included. Any other family planning methods or therapy, reversal of tubal ligation, non-spontaneous abortions even when allowed by law and sterility/infertility treatment are excluded.
• Diagnostic tests for sterility and infertility, in accordance with the recommendations of the Spanish Fertility Society. 
• Haematology and haemotherapy. Includes autologous bone marrow and hematopoietic stem cell transplant for treating haematological oncological diseases. 
• Internal medicine. 
• Nuclear medicine. 
• Nephrology. 
• Neonatology.  
• Pulmonology – respiratory system. 
• Neurosurgery. Includes surgical navigation assistance as described in point 9 ‘Medical high technology diagnostic and treatment media’. 
• Clinical neurophysiology. 
• Neurology. 
• Dental and oral health. AXA Seguros Generales will pay for visits, extractions, subsequent treatment and material, conventional oral radiology and teeth cleaning annually or when prescribed by a dentist. Expressly excluded are fillings, orthodontics, endodontics, periodontics, gingivectomy and any type of prostheses or implants as well as additional tests and any charges for these treatments. 
• Ophthalmology. Includes laser treatment for photocoagulation techniques for glaucoma, ischemic retinopathies, macular oedema and peripheral retinal tears, excluding photodynamic therapy, antiangiogenic treatments in chronic and irreversible processes and refractive surgery. Also included is laser treatment in cataract surgery and in capsulotomy for capsular opacification after these surgical procedures. Includes pleoptics and orthoptics for strabismus correction treatment in children under 10. 
• Medical oncology. 
• Radiation oncology.
  Coverage includes the insurer’s services catalogue, described in the ‘Diagnostic and treatment services and media’ section, excluding Gamma Knife and NanoKnife radiosurgery, proton therapy, tomotherapy and radioembolisation with Yttrium-90 spheres. 
• Ear, nose and throat. Includes laser and radiofrequency surgery in procedures for turbinates, adenoids, tonsils and sinuses at providers accredited for these techniques. Includes spontaneous otoacoustic emissions in newborns. 
• Psychiatry.
  Any psychoneurological tests, treatments for drug addiction, alcoholism and other addictions and individual and group therapy are expressly excluded.
• Rheumatology. 
• Traumatology and orthopaedic surgery. Includes arthroscopic surgery in cases where its effectiveness has been shown and established. 
• Urology. Includes vasectomy. Includes laparoscopic surgery in cases where its effectiveness has been shown and established. Treatments for erectile dysfunction, sterility/infertility and vasectomy reversal are expressly excluded.

Includes visits, pedicure, ingrown toenail and papilloma treatment; expressly excluded are lower limb studies (gait studies). 

Includes common diagnostic media recognised by medical practice in the insurer’s catalogue of benefits at the time of signing the policy. A medical prescription is required. Diagnostic studies or tests for scientific research or studies and testing for aesthetic and anti-ageing procedures are not covered. Contrast media and radiopharmaceuticals are included in the cover.  

• Linear particle accelerator, treatment with radioactive isotopes endorsed by the Spanish Agency of Medicines and Medical Devices (AEMPS), cerebral stereotactic radiosurgery, intensity-modulated radiotherapy (IMRT); brachytherapy for prostate cancer treatment with iodine or palladium seeds; gynaecological and breast treatments. 
• Aerosol therapy for illnesses requiring this treatment on prescription. In all cases medications will be paid for by the insured.
• Digital arteriography. 
• Bone densitometry. 
• Dialysis and haemodialysis for acute renal failure only and limited to 10 sessions per year per insured. 
• Scintigraphy. 
• Gastrointestinal endoscopy and bronchoscopy: diagnostic and therapeutic, including sedation if necessary. It includes study of the bile duct with contrast medium by endoscopic cholangiopancreatography (ERCP) and of the small bowel with capsule endoscopy. 
• Ergometry and other cardiac diagnostic tests, such as Holter for ECG and blood pressure and echocardiogram. 
• Laboratory: clinical, anatomical pathological and biological testing and hormonal and genetic studies.
  Excluded are genetic mapping to find out the predisposition of the insured or their present or future descendants to illnesses related to genetic alterations as well as pharmacogenetic studies and genetic maps of tumours (except those specifically included in these covers). Genetic determinations are included if they are crucial for deciding on the treatment of a disease in progress or are necessary for obtaining differential diagnosis according to the Agency for Health Technology Assessment and the Spanish Agency of Medicines and Medical Devices (AEMPS). 
• Extracorporeal shock wave lithotripsy for kidney stones and biliary calculi. 
• Magnet therapy. 
• Home respiratory polygraphy. 
• Radiology: diagnostic tests, ultrasound, mammography, interventional radiology and additional examinations. Includes 3D EOS® vertical medical imaging for spinal column studies and only in providers that have this technology. 
• Conventional nuclear magnetic resonance (NMR). 

These special diagnosis and treatment media may only be used in facilities accredited by AXA Seguros Generales for these technologies.  

Any high-tech tool which is in the research phase and has not replaced the existing technology will not be covered. 

• Cardiac radiofrequency ablation guided by the Carto navigation system (3D): indicated for the treatment of cardiac arrhythmias such as paroxysmal atrial fibrillation (more than 3 episodes per year), persistent atrial fibrillation (resistant to pharmacological treatment), atrial or ventricular arrhythmias associated with congenital heart defects and complex atrial arrhythmias in which previous ablations have failed. 
• Digestive endoscopic ultrasound (EUS): it replaces surgery to evaluate submucosal lesions as well as to identify cancer of the digestive and biliopancreatic tract (staging and extraluminal recurrences) and find neuroendocrine tumours. 
• Endobronchial ultrasound (EBUS) indicated for diagnosis and biopsy of lung and mediastinum cancer thus avoiding surgical access. 
• Hepatic elastography (FibroScan) for diagnosis of hepatic fibrosis in chronic liver diseases, excluding any related to excessive alcohol consumption. 
• Urological laser: treatment of benign prostatic hyperplasia with HPS, KTP or XPS green laser is included. Use of holmium surgical laser is exclusively included in lithiasic endourological pathology. 
• Endoscopic mucosal resection: endoscopic resection of gastrointestinal tract lesions as an alternative to surgery in non-invasive lesions. 
• Neurosurgery assisted by neuronavigators: included in interventions for cerebral or spinal tumours and in brain interventions with microsurgery. 
• PET (Positron Emission Tomography), and PET-CT with 18FDG for cancer evaluation using the protocol of indications drawn up by the Ministry of Health. 
• PET Choline in restaging prostate carcinoma in case of biochemical relapse. 
• Hospital polysomnography: indicated in cases of severe apnoea accompanied by other associated morbidities such as cardiac insufficiency, neurological or rheumatic pathology or other sleep disorders in which it is impossible to perform home examination.  
• Genetic and molecular biology tests provided they have an impact on the treatment of an ongoing disease. Only the therapeutic targets listed below will be covered and always as a study prior to personalised cancer treatment and based on the tumour type and stage as specified in the drug Summary of Product Characteristics and which are indicated and approved by AEMPS:
  • FISH HER2: for HER2 inhibitor therapy in advanced breast cancer and advanced stomach cancer.
  • EGFR: for treatment with EGFR inhibitors in lung cancer.
  • KRAS: for treatment with EGFR monoclonal antibodies in advanced colon cancer.
  • c-Kit: for treatment with c-Kit inhibitors in gastrointestinal stromal tumours (GIST).

• Special NMR:
  • MR Angiography: non-invasive study (without introduction of a catheter) of alterations in the blood vessels in any location with contrast injection.
  • Heart MR: indicated in cases of angina or heart attack as a stress test and for studying congenital heart diseases.
  • Arterial MR: NMR with intra-articular contrast injection for diagnosing bone, tendon and cartilage lesions not seen in conventional NMR.
  • Magnetic resonance cholangiopancreatography (MRCP): for cancer and lithiasis diagnosis in the bile and pancreatic duct in patients without a vesicle.

• SPECT (single-photon emission tomography): a nuclear medicine diagnostic test which obtains images of the functioning of different parts of the body (brain, heart, liver, kidney, etc.) or the search for tumour pathology using the administration of a radioactive isotope. Depending on the isotope administered, it may also be called Octreoscan or DaTscan. 
• Special multi-slice CT:
  • CT angiography for arterial and venous study of any location.
  • Cardiac MDCT or non-invasive coronary angiography for study of the coronary arteries when the stress test is inconclusive.
  • Colon MDCT or non-invasive colonography if endoscopic study is contraindicated.
  • CT urography of the urinary system if other diagnostic techniques are contraindicated.

• Shockwave therapy exclusively for chronic muscle/tendon calcification (history over 6 months) in which other treatments have failed.
• Radiofrequency treatments for surgical reduction of tonsillar tissue, adenoids, sinuses and turbinates. 
• Pain management: chemonucleolysis and rhizotomy with radiofrequency for spine conditions. Nerve blocks. These treatments are carried out on an outpatient basis at units specialised in these therapies. 

By a qualified specialist (rehabilitation doctor) on written prescription by a medical practitioner in facilities accredited for that purpose, only for musculoskeletal system diseases which are secondary to these treatments and for urinary incontinence rehabilitation.

Phoniatric and/or speech therapy services are included when required as a direct consequence of laryngeal surgery. Likewise and in case of organic pathologies of the vocal cords (traumatic, oncological or infectious) affecting speech, language or voice, a maximum of 10 sessions per year will be provided. In all cases the prescription of the ENT specialist will be required. 

Urinary incontinence rehabilitation consists of a series of exercises to strengthen the perineal muscles in mild to moderate urinary incontinence (grade I/II) which is provided as a single package of up to 8 sessions throughout the term of the policy. 

Any transport to or from rehabilitation and/or physiotherapy, any maintenance and occupational gymnastics and therapy, rehabilitation of chronic diseases maximum functional recovery from the injuries has been achieved and the condition has become stable and insuperable, and rehabilitation as a result of neurological disease are expressly excluded. 

The musculoskeletal system means the interrelated muscles, ligaments, bones and joints which enable movement and protect other organs. 

Includes intravenous, subcutaneous or intramuscular cytostatic drug treatments in authorised special units which do not require overnight stay in hospital. AXA Seguros Generales will authorise the cycles as necessary and the doctor responsible for the care of the patient will prescribe the chemotherapy treatment to be carried out. In these treatments AXA Seguros Generales will only pay for specifically cytostatic and adjuvant pharmaceuticals that are sold in the domestic market, duly authorised by the Ministry of Health and used according to the directions contained in the Summary of Product Characteristics.

Cell and genomic therapies and immuno-oncology treatments are specifically excluded.

In case of emergency and medically proven need for the patient to go to AXA Seguros Generales network clinics and hospitals. When travel is impossible in another type of vehicle and on prescription, AXA Seguros Generales will pay for the return trip from the clinic or hospital to the insured’s home.

Includes the use of patient-controlled analgesia (PCA) in our network for this technique, only for cases of open chest and/or abdominal surgery (laparotomy), vertebral fixations and total knee or hip replacement in trauma surgery. 

Surgery in an AXA Seguros Generales network clinic or hospital. The patient will have a single room with a bed for a companion. AXA Seguros Generales will pay for stay, full board for the patient and their companion when the hospital has this service in the room, nursing care and the material required for it, operating theatre charges, anaesthesias and drugs used in it and those used throughout the insured’s stay in the hospital. Drugs must be duly authorised by the Spanish Agency of Medicines and Medical Devices (AEMPS) and included in the Spanish National Health System funding.

Also covered is stay in an intensive care unit if required due to surgery. 

Only the following prostheses are covered: mechanical and biological heart valves, pacemakers, vascular bypass prostheses,vascular stents (except aorta), coils, chemotherapy infusion pumps, Port-a-Cath, Implantable Cardioverter Defibrillator (ICD) pacemaker, monofocal intraocular lens (IOL) in cataract surgery, hip replacement, osteosynthesis material and other orthopaedic internal prostheses and surgical meshes in abdominal hernia surgery. Also covered are breast implants due to mastectomy but contralateral prostheses are excluded. Testicular prosthesis is included exclusively in the case of oncological orchiectomy. Bioprostheses of any kind (except heart), heart prostheses and/or valves, sutureless biological valves and valves implanted in percutaneous surgery are excluded. 

Admission to an AXA Seguros Generales network intensive care unit for the treatment of illnesses and conditions due to any cause and including medication costs throughout the stay. Drugs must be duly authorised by the Spanish Agency of Medicines and Medical Devices (AEMPS) and included in the Spanish National Health System funding. A bed for a companion is not included due to the type of admission. 

For the diagnosis and/or treatment of acute or worsening chronic processes at an AXA Seguros Generales network clinic or hospital on written prescription by a medical practitioner, including full board for the patient and medication costs throughout their stay. Drugs must be duly authorised by the Spanish Agency of Medicines and Medical Devices (AEMPS) and included in the Spanish National Health System funding. The insured is entitled to an individual room with a bed for a companion if possible in the hospital.

Expressly excluded is admission on grounds of social problems, any that can be replaced by outpatient care and rest and/or sleep cures.  

Treatment in an AXA Seguros Generales provider network clinic or hospital on written prescription by a medical practitioner for at most 60 days per year and including full board for the patient and medicine costs throughout the covered period. The medicines must be duly authorised by the Spanish Agency of Medicines and Medical Devices and included in Spanish National Health System funding. Where the patient’s condition so allows, they will have an individual room if possible in the facility. Admission for eating disorders is only possible at the Institut de Trastorns Alimentaris (ITA – Food Disorders Institute). Expressly excluded is admission on grounds of social problems, any that can be replaced by outpatient care and rest and/or sleep cures. 

Pregnancy cover includes follow-up visits by the specialist in all types of pregnancies with the usual diagnostic and therapeutic tests included in the protocol of the Spanish Society of Gynaecology and Obstetrics (SEGO). Three high-resolution ultrasound scans are included, which must be performed at a prenatal diagnostic centre accredited for this purpose, consisting of ultrasound at week 12 (first trimester combined test), week 20 and third-trimester ultrasound. Non-invasive prenatal screening is also included for diagnosing trisomy 13-18-21 if the risk of foetal abnormality is greater than 1/250, and early amniocentesis in cases that meet SEGO criteria or have positive non-invasive prenatal screening. 

Birth preparation from the 2nd trimester of pregnancy for physical and psychological preparation for the time of delivery and postpartum pelvic floor recovery exercises to prevent urinary incontinence are included (at most 8 sessions). 

Water, home and other alternative birthing methods are expressly excluded.  

Care during normal, abnormal or premature childbirth in the clinic or hospital, attended by a medical practitioner and midwife, includes admission to an AXA Seguros Generales network hospital with an individual room with a bed for a companion. AXA Seguros Generales will meet the cost of the stay, full board for the insured and their companion when the hospital has this service in the room, operating theatre or delivery room charges, anaesthetic products, material and medication during the entire stay and anaesthesiologist fees. During the 30 days following birth AXA Seguros Generales will also pay for the cost of an incubator for the newborn, neonatologist fees and paediatric charges. From the 31st calendar day these expenses will only be covered if the newborn is added to the policy as specified in the section about insured persons in these terms and conditions. 

If the child is not included in the policy as insured within 30 days of birth, AXA Seguros Generales may claim back any medical and health expenses it has paid from the policyholder. If services have not been paid for by AXA, the policyholder will have to pay these expenses. 

AXA Seguros Generales covers the cost of the transfusion procedure in all cases and the blood and/or plasma used in the transfusion for patients admitted to hospital. 

Includes chemotherapeutic treatments required by the patient and as many cycles as necessary. The medical practitioner responsible for the care of the patient will decide on the chemotherapy treatment to be carried out. In these treatments AXA Seguros Generales will only pay for specifically cytostatic and adjuvant pharmaceuticals that are sold in the domestic market and are duly authorised by the Ministry of Health and used following the instructions in the Summary of Product Characteristics. Cell and genomic therapies as well as immuno-oncology treatments are specifically excluded. 

This comprises treatment with continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP). AXA covers the cost of home-based liquid oxygen therapy as long as it has to be administered for more than 15 hours a day. AXA Seguros Generales will only authorise one type of therapy. 

Emergency care provided to any insured person who is temporarily outside their home province and in Spain under the same conditions as established in this policy for each type of service and in the centres specified by AXA Seguros Generales for people outside their home province. 

• Medical check-ups. Insured people over 14 are entitled to a medical check-up every two years and every year when they are aged over 40 with pre-authorisation from AXA Seguros Generales under its protocol and in a centre it has specified.
  Children under 14 are not entitled to this service. 
• Early diagnosis of breast cancer via annual mammography for Insured women over the age of 35. For insured women over 40 years of age with dense breasts and those at high risk or with a history of breast cancer, AXA Seguros Generales will authorise a 3D mammography (tomosynthesis). 
• Early diagnosis of gynaecological diseases, aimed at: insured women older than 20 who have already had a pregnancy or who have other risk factors. It includes an annual gynaecological examination that can be complemented with a specific analytical ultrasound. · Early diagnosis of prostate cancer via a trans-rectal ultrasound and PSA testing. 
• Early diagnosis of colon cancer via a faecal occult blood test. 
• Early diagnosis of hearing loss in new-borns via spontaneous otoacoustic emissions (SOAE) or A-ABR testing in the first month of life, pursuant to regulations in force in each self-governing region. 
• Early diagnosis of skin cancer (melanoma) via epiluminescence microscopy, as stated in the Medical and surgical dermatology and venereology section. 
• Early diagnosis of glaucoma: for people with a family history of glaucoma who are diagnosed with cardiovascular disease, diabetes, migraine or other conditions, or who have not had an ophthalmologic check-up from the age of 40. Intraocular pressure and optic nerve condition will be measured in the specialist’s office, and if they are altered the study will be completed with other specific tests such as campimetry and optical coherence tomography based on the condition identified. 
• Dental health programme for pregnant women: it sets out disease prevention guidelines including examining gums and providing oral hygiene and diet tips and also tells women about the most prevalent oral diseases in their future child. A visit to the dentist before pregnancy and at the latest during the first trimester is recommended so action can be taken as soon as possible to avoid future problems. 

If you have taken out dental cover in the schedule you will have a network of dental services offering oral and dental care at a reduced price. 

Telemedicine distance training programme provided exclusively by the Guttmann Institute for insured people under 18 with memory or learning problems, difficulties in activities of daily living and in organising as a result of brain damage occurring during the term of the policy due to head trauma, tumours or infectious diseases of the central nervous system, stroke due any cause and after brain surgery. It is provided as a single package for the entire duration of the policy. 

Benefits, risks and covers insured by reimbursement of expenses

In addition to the AXA Seguros Generales medical provider network, the insured can also freely choose the following benefits and covered charges will be reimbursed up to the sum insured specified in the schedule: 

a) Emergency general medicine and paediatric visits in the insured’s home when their illness prevents them from going to the medical practitioner’s consulting room, with reimbursement of 80% of charges up to the quantitative limit set in the schedule, if there is no AXA Seguros Generales emergency service medical practitioner available in the place of residence. 

b) The nurse service in the insured’s usual home when the home service is requested by a medical practitioner, with reimbursement of 80% of expenses up to the limit set in the schedule, if there is no AXA Seguros Generales emergency service medical practitioner available in the place of residence. 

c) Preservation of umbilical cord blood. The insured has the right to choose freely but exclusively from the stem cell banks recommended by AXA Seguros Generales for the preservation of umbilical cord blood (UCB) under advantageous financial conditions. The insurer will provide contact details to the insured who will sign the service contract with the UCB bank and directly pay the cost of the service in all cases. As long as one of the parents is insured by the policy and the newborn is enrolled for it, cover includes reimbursement of 50% of the cost of the preservation kit and processing and freezing the sample up to €650 and 80% of any annual maintenance fee up to 70 per policy year and for at most 20 years provided that the policy is still in force.

Reimbursement of expenses from UCB banks not recommended by AXA Seguros Generales is expressly excluded. 

d) If dental cover has been taken out in the policy schedule, AXA Seguros Generales will reimburse the cost of simple or complex fillings up to the limit set in the schedule carried out by its dental network with a maximum of four per year.  

e) Reimbursement of 80% of charges for in-person psychology visits prescribed by a psychiatrist and carried out by members of professional psychology associations up to at most 20. This cover is provided for a maximum of twelve visits per policy year and insured. 

f) TOT and TVT meshes in urinary incontinence surgery: Under this cover AXA Seguros Generales will reimburse 90% of the cost of TOT and TVT meshes implanted in urinary incontinence surgery up to at most 500 provided that this surgery technique is included in the policy schedule and AXA has authorised the procedure. Limited to one mesh per insured during the entire term of the contract. 

g) Intraoperative neurophysiological monitoring in head and neck surgery including but not limited to brain malformations and tumours, vascular lesions and malformations, laryngeal and inner ear surgery, thyroid surgery and spine surgery involving more than two vertebrae. AXA Seguros Generales will reimburse 90% of the cost up to 600.

h) Bone growth factors. Administration during musculoskeletal surgery in a single application. Reimbursement of 80%, up to at most 350 , of costs arising from the use of bone growth factors from autologous platelet-rich plasmas. This cover is only valid when these growth factors are administered as a supplement during surgery to treat musculoskeletal injuries. 

i) Postpartum home care: following authorisation by AXA Seguros Generales, 80% of the cost of midwife visits up to a total limit of 100 will be reimbursed for postpartum care as described in point 7 in the section “Services provided directly and solely by the insurer”. This cover is only available if there are no midwives available in the town of residence stated in the policy.