Payment must be made by credit card or bank transfer and can be made in two different ways.
2 payment methods:
– First payment: 30% of the total amount of the program at the time of registration for reservation fee (non-refundable)
– Second payment: 70% of the total amount of the program.
*In monthly programs only single payment is allowed (100% of the amount at the
time of registration).
WITHOUT a situation of force majeure
DUE to force majeure
This policy provides the insured with the medical and/or surgical care needed for all kinds of illnesses or injuries included in the covers and with the limits agreed in the schedule. Under all circumstances AXA Seguros Generales will cover any emergency care needed as a result of an accident.
No cash compensation may be given in lieu of the services provided by AXA Seguros Generales network of medical professionals or centres, except for reimbursement for fillings if dental cover has been taken out.
Benefits, risks and covers insured by the medical provider network
The insured may freely choose from the medical practitioners and hospitals in the provider network for the insurance option they have taken out.
AXA Seguros Generales will arrange for the following risks, benefits and covers through its medical provider network based on the policy schedule and for the insured specified in it:
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.
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.
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.
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.
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.