Generali Critical Illness (Enfermedades Graves) Policy Conditions (English)

Information Clause ↑ top

This clause fulfils the insurer's duty to inform under Article 96 of Law 20/2015 and Article 122 of Royal Decree 1060/2015.

Insurer: GENERALI España de Seguros y Reaseguros S.A. (referred to as the Company, Generali or the Insurer), registered office Pl. de Manuel Gómez-Moreno 5, 28020 Madrid; NIF A48037642; Madrid Mercantile Registry, sheet M-377257. Supervisor: the Directorate-General for Insurance and Pension Funds (DGSFP), under the Ministry of Economy. Complaints: Generali's Claims & Complaints Service (rules at www.generali.es; written to Pl. de Manuel Gómez-Moreno 5, 28020 Madrid, or reclamaciones.es@generali.com) acknowledges receipt and resolves with reasons within a maximum of two months; its decisions are binding on the insurer. You may then escalate to the DGSFP Claims Service (Paseo de la Castellana 44, 28046 Madrid) or go to the competent courts. Applicable law: Law 50/1980 on Insurance Contracts, Law 20/2015 and RD 1060/2015, together with the policy Conditions and the risk questionnaire signed by the policyholder.

Preliminary Article — Definitions ↑ top

• You: the policyholder and/or the Insured, to whom the obligations of the contract fall (except those that by nature must be met by the Insured).
• We / Us: GENERALI España de Seguros y Reaseguros S.A., the insurer assuming the agreed risk.
• Insured: the natural person(s) meeting the conditions in the policy and on whom the covered risk is assumed.
• Beneficiary: the person named in the policy or individual certificate as the Insured-titleholder, entitled to receive the benefits.
• Policy: the set of documents stating the contract terms — General Conditions, Particular Conditions (individualising the risk), supplements/appendices, the application, and premium receipts.
• Premium: the price of the insurance with surcharges and taxes, set on the policy's guarantees and the declared risk.
• Policy year: the period from the effective date to the expiry date, and each subsequent annual renewal.
• Sum insured / contracted capital: the total maximum limit for all medical expenses (whether reimbursed to you or paid to Generali's contracted professionals/centres). It is the maximum for all reimbursable or payable costs over a maximum of 5 policy years, arising from one and the same serious illness.
• Excess (Franquicia): a percentage of the medical expenses that may be borne by you.
• Event: the medical expenses covered by the policy arising from the diagnosis and treatment of one and the same serious illness, regardless of the policy year in which it was diagnosed.
• Accident: bodily injury from a violent, sudden, external cause beyond the Insured's intent.
• Pre-existing illness/accident: one already diagnosed, treated or consulted on, or whose first symptoms appeared, before the Insured joined the policy.
• Doctor: a legally qualified and authorised physician treating the illnesses covered by the policy.
• Hospitalisation: being registered as a patient and admitted for at least 24 hours, or registered in a day hospital for a surgical operation.
• Hospital: a legally authorised public or private establishment for medical treatment, with adequate means and 24-hour medical/nursing staff. Asylums, residences, rest homes, spas and neuro-psychiatric clinics, and facilities for the elderly, disabled, chronically/mentally ill, drug addicts or alcoholics, are not hospitals for this policy.
• Surgical operation: any operation by incision or internal approach for non-diagnostic purposes, in a hospital and by a surgeon, normally requiring an operating theatre.
• Claim (Siniestro): any care given under and in line with a contracted guarantee.
• Emergency: care whose delay may seriously endanger life or physical integrity (in a doctor's judgement), needing to be given within 24 hours.
• Reasonable and customary expenses: medical/surgical costs not exceeding the usual level charged by that provider, or by similar providers in the same area, for a comparable service.

The 10 covered serious illnesses ↑ top

A “serious illness” means a health alteration of common or accidental cause, confirmed by a legally recognised doctor, that matches one of the ten conditions defined below:

Article 1 — Object of the insurance (how it works) ↑ top

Unlike a lump-sum policy, Generali Salud Enfermedades Graves pays the actual cost of treatment. Within the terms and limits of the Particular, Special and General Conditions, Generali guarantees:

• The reasonable and customary expenses of medical and surgical care, in hospital and out of hospital, that you need because of a covered serious illness from the ten described above;
• The benefits of the Second Opinion & Medical Management cover;
• The benefits of the Travel Assistance cover; and
• A daily cash benefit for not using the policy.

Article 2 — Basic guarantees: what is paid ↑ top

1. Medical expenses guarantee

Generali meets the full cost (where you use the Recommended Services in Spain) or reimburses part (under free choice) of the costs of consultations, diagnostic tests, hospitalisations (with or without surgery, ICU, etc.) and other costs relating to the treatment of a covered serious illness, up to the sum insured in the Particular Conditions and for a maximum of 5 years after the date of diagnosis. Using the Recommended Services in Spain, Generali settles the doctors' fees and hospital invoices directly with the centres/professionals; no reimbursement is made when you use the medical panel provided.

Hospitalisation: hospital and general-care costs in a recognised hospital, in a private room with a companion bed. For surgery, Generali covers all costs — surgeon and assistants' fees, anaesthesia, theatre use, materials and medicines — plus medical fees, lab analysis, X-rays and ECGs done in the same hospital while admitted. Stays in the ICU/intensive care are covered where the severity requires it. The stay must be on a doctor's written prescription, for care that cannot be given safely outside hospital. Ambulance transfer to/from a local hospital is covered where prescribed by a doctor.

Special treatments: treatments needed because of a serious illness — radiotherapy, radioactive isotopes, cobalt therapy, dialysis, chemotherapy, magnetotherapy, etc. — carried out in duly authorised hospitals at those hospitals' official rates.

Consultations: covered (except those listed under exclusions) where they relate to risks covered by the policy and are directly linked to a covered hospitalisation and/or special treatment, whether before, during or after it.

Article 2 (cont.) — Second opinion, travel & daily cash ↑ top

2. Second Medical Opinion guarantee

Provides attention and a response to any request for medical information about second diagnoses of serious illnesses, delivered through medical companies of recognised standing (see Annex I). All Insureds on the policy benefit from it.

3. Travel assistance guarantee

Insured by EUROP ASSISTANCE España S.A. (see Annex II). Beneficiaries are policy Insureds who reside in Spain and travel for trips of no more than 60 consecutive days. It is valid in Spain (outside the Insured's province of residence) and worldwide, except countries in a state of war, insurrection or armed conflict. It includes, among others: medical transfer of the sick/injured, transport of the deceased, early return of a companion, travel of a family member, return of a beneficiary on a family death, transmission of urgent messages, and dispatch of medicines abroad.

4. Daily cash benefit for not using the policy

Where the Insured, with Generali's prior approval, chooses not to use this policy's cover and instead uses other means available at no direct cost (such as the public health system / Social Security), Generali pays a compensatory benefit of €50.00 per day of hospitalisation, up to a maximum of 90 days (continuous or in separate periods). The Insured must reliably prove that the hospitalisation would otherwise have been covered under this policy.

Article 3 — Excess (Franquicia) / free choice ↑ top

• Recommended Services in Spain — no excess: Generali pays the doctors and hospitals directly.
• Free choice — if you use any specialist/centre other than the Recommended Services, Generali does not pay directly; you pay and are reimbursed with an excess of 30% for treatment in Spain or 10% for treatment abroad. Any travel and non-hospital accommodation costs are expressly excluded.

Article 4 — General exclusions ↑ top

The following are excluded:

• Any serious illness diagnosed or treated before the policy's effective date.
• Any serious illness suffered as a result of an immunodeficiency.
• Any serious illness due directly or indirectly to drunkenness, brawls, duels, drug addiction, attempted suicide or self-harm.
• Any serious illness not listed in this policy.
• Pharmaceutical products outside the hospital are not guaranteed.
• Cosmetic treatments are never guaranteed.
• Costs from periodic/preventive reviews, general check-ups, gynaecological or paediatric reviews, slimming/weight-gain/dietary treatments and preventive vaccines.
• Pre-existing illnesses/injuries and their after-effects, unless expressly accepted by the insurer in the Particular Conditions or later supplements.
• Acupuncture, laser therapy or biomedicine unless expressly authorised in writing by the insurer.
• Risks from the professional practice of any sport; in particular (amateur or professional): mountaineering, climbing, motor racing, boxing, diving, underwater fishing, caving, horse riding, motorcycling, parachuting, paragliding, hang-gliding and microlight flying — unless declared, expressly accepted and the additional premium paid.
• Risks from notoriously dangerous professions: bricklayer, formworker, public-works machinery operator, firefighter, diver, professional sportsperson, miner and bullfighter — unless declared, accepted and the additional premium paid.
• Only prostheses such as bone-fixation nails, valves, plastic implants in veins/arteries and pacemakers, arising from surgery, are covered.
• Congenital defects are not guaranteed.
• Consequences of illnesses contracted because of: acts caused intentionally/wilfully by the Insured; nuclear reaction/radiation or radioactive/chemical contamination; civil or international war, terrorism, riots, mutinies and public-order disturbances; any contagious disease classed as a WHO Phase-5+ pandemic; and earthquakes, hurricanes, volcanic eruptions and other extraordinary/catastrophic seismic or weather phenomena.

Article 5 — Territorial scope ↑ top

The Insured must reside in Spain a minimum of 300 days in each policy year. If an Insured resides or will reside abroad for more than 60 days, this must be notified for the insurer to accept it expressly and apply any surcharge. The insurer is released from any obligation where providing cover would expose it to sanctions, prohibitions or restrictions under United Nations resolutions or the laws/economic or trade sanctions of the European Union, United Kingdom or United States.

Article 6 — Waiting period ↑ top

Cover is only effective where one of the covered serious illnesses is diagnosed after a waiting period of three months from the contract's effective date.

Article 7 — Using the services & free choice ↑ top

Recommended Services in Spain

You may use Generali's Recommended Services by identifying yourself; the up-to-date panel of doctors and centres is on the website, and you may choose freely within it. To use them you must: (a) identify yourself as a Generali Insured with the means provided; and (b) for hospitalisation, surgery, high-technology diagnostics and special treatments, contact the insurer in advance for acceptance — at least 72 hours ahead for hospitalisation. For an emergency admission the medical prescription or admission report suffices, and you must notify the insurer immediately (even by phone). Generali settles the invoices of its panel directly, provided you identified yourself and obtained prior agreement where required. No reimbursement is made when you use the panel.

Free choice

You may also use any specialist/centre outside the Recommended Services to treat a covered serious illness; in that case the excess in Article 3 applies. Generali does not pay directly — you pay and are reimbursed subject to the applicable excess.

Article 8 — Personal limits & eligibility ↑ top

The maximum entry age is 60. Failure to give clarifications or to undertake requested medical tests suspends the illness guarantees until the insurer accepts the full documentation (claims from an accident remain in full force). If the policy differs from the proposal, the policyholder may, within one month of delivery, ask the insurer to correct the divergence; otherwise the policy stands.

Where there are family histories of hereditary illness, or two or more close relatives (parents and siblings) died young of the same illness, the person is treated as not insurable. Also not insurable: people with cardiovascular disease, diabetes, Down syndrome and mental/nervous illnesses. Generali reserves the right in each case to accept or reject the application, or to propose modified cover or special conditions.

Article 9 — Duration & termination ↑ top

The contract is annual and renews automatically at each expiry. Either party may oppose renewal in writing — the policyholder with at least one month's notice, the insurer with two months' notice — before the current year ends; the insurer must notify any contract change at least two months ahead. The contract ends when an illness is diagnosed; from then, cover continues until the capital limit is used up or five years from diagnosis pass, whichever comes first. In any event it ends when you reach age 79.

Article 10 — Notifying a claim ↑ top

Notify the claim as soon as possible, within seven days of the first diagnosis, to the Insured helpline; the insurer will request the medical tests/reports needed to corroborate the diagnosis and confirm cover. For a Second Medical Opinion, a questionnaire is sent for you to attach your tests. Generali may appoint a doctor to attend the operation or visit you during hospitalisation; refusing the visit (by you or anyone interested) is treated as an express waiver of cover for that illness. Disputes between your doctors and Generali's about diagnosis, timing, duration or other circumstances of treatment are settled by a third doctor agreed by both, or by the provincial Medical College where you are domiciled, at the more diligent party's request.

Article 11 — Premiums ↑ top

The annual premium changes per Generali's tariff for: variations in the family group or individual risk you must notify; change of age; or a tariff change (notified in writing — if you disagree, you may cancel at the end of the current year, notifying in writing before expiry). Premiums, with taxes and surcharges, are paid at Generali's offices; where you pay by direct debit, Generali cannot stop this without 30 days' written notice by certified letter. The first premium is paid on signing and brings the contract into force; if unpaid through your fault and a claim occurs before payment, the insurer is released. For the second and later premiums there is a 30-day grace period from expiry, after which cover is suspended; once paid, cover resumes from 00:00 the next day. On non-payment the insurer may terminate the contract or claim judicially.

Article 12 — Prescription & jurisdiction ↑ top

Actions deriving from this contract (a personal-insurance contract) prescribe after five years. The competent court for disputes is that of the Insured's domicile.

Article 13 — The contract clauses ↑ top

Basis of the contract

The policy is built on your declarations in the application and the health declaration / tele-underwriting interview, which lead us to accept the risk and set the premium. If the policy differs from your application, you may ask us to correct it within one month of receiving it. On an error, inaccuracy or concealment in your application that you knew of, we may rescind within one month of learning of it; if a claim occurs first, our benefit is reduced in proportion (or we are released if there was wilful misconduct or gross negligence).

Taking effect & duration

Subject to the waiting periods, cover takes effect at the time/date in the Particular Conditions once the first premium is paid. The contract is renewed for one year at each expiry; either party may oppose renewal with at least two months' notice. Cover ceases automatically on the policy's extinction. However, if extinction is by our opposition to renewal and you were in known treatment at that date, you remain entitled to the costs or daily benefit while that treatment continues, up to the unused part of the sum insured and not beyond 180 days after extinction (this extension does not apply to Travel Assistance).

Changes in the risk

Notify us promptly of any circumstance aggravating the risk (e.g. profession or sport). Within two months of notice we may propose modified conditions (you have 15 days to accept/reject) or terminate within one month. If a claim occurs without notice, we are released if you acted in bad faith; otherwise the benefit is reduced proportionally. You may also notify circumstances that reduce the risk, with a corresponding premium reduction.

Payment of premium

The premium is paid in advance; the contract does not take effect / is suspended until paid. Claims in the first month of the second or later years are covered if the premium is paid during that month. On non-payment of a renewal premium, cover is suspended one month after expiry, and the contract is extinguished by law if unclaimed within six months.

Communications

Communications between the parties must be in writing, and (where the law allows) by recorded phone with prior consent. The insurer may use post, burofax, fax, email or SMS to the address/number on the policy; communications from you go to the registered office or any public branch. Communications take effect when received (or on the first delivery attempt for post/burofax). Communications via the mediating agent or broker have the same effect as direct ones.

Law, jurisdiction & subrogation

The contract is governed by Spanish law; the competent court is that of the Insured's domicile in Spain (any contrary agreement is void). Once we pay for care, we may subrogate to your rights against those responsible, up to the amount paid — but not against your spouse or relatives to the third degree, adoptive parents or children living with you (unless the liability arises from wilful misconduct or is covered by insurance). Where you and we both claim against the third party, the recovery is shared in proportion to our respective interests.

Annex I — Second Medical Opinion ↑ top

Provided through medical companies of recognised standing in second opinions (the “Provider”). Beneficiaries are Insureds on the policy who have this guarantee. Object: attention and a response to any request for medical information on second diagnoses of serious illnesses — by way of example: cancer, cardiovascular disease, organ transplant, neurological/neurosurgical disease (incl. strokes), chronic renal failure, paralysis and multiple sclerosis. Territory: accessible from anywhere in the world. Services included:

• Access to the most recognised medical experts worldwide and dispatch of the diagnostic documentation to the specialist for a report.
• A report to the Insured (and/or their medical team) summarising the case, the experts' opinions and their CVs, with requests for further information if needed.
• Selection of experts and hospitals for treatment, and assistance if the Insured travels for care (appointments, hospital admission, transfer coordination).
• Obtaining estimates of hospitalisation/treatment costs, and review and control of the treatment invoices.

Annex II — Travel Assistance (Europ Assistance) ↑ top

Valid throughout Spain beyond your province of residence (more than 10 km from home in the Balearics/Canaries) and worldwide while the contract is in force, provided you are domiciled and habitually resident in Spain and absences do not exceed 90 days per trip. Main benefits:

• Medical expenses abroad (unexpected illness/accident) up to €35,000 per period and Insured (fees, first-aid medicines, hospitalisation, local ambulance); in country of residence up to €2,000; emergency dental up to €2,000 (endodontics, cosmetic reconstruction, prosthetics, crowns and implants excluded). Amounts abroad and at home are not additional.
• Hotel-stay extension by illness/accident: €200/day, max 10 days. Medical transfer of the sick/injured (special air ambulance within Europe/Mediterranean, first-class train, sanitary helicopter, ambulance or scheduled flight). Repatriation of mortal remains to the home town in Spain (embalming, minimum coffin and admin), plus return of accompanying insureds and trip resumption.
• Family member to accompany a hospitalised Insured (hospitalisation over 5 days): travel plus stay up to €200/day, max 10 days; companion-stay extension €60/day, max 10 days. Return on death or hospitalisation (over 5 days) of a close relative; escort of minors under 14 or dependants.
• Dispatch of medicines abroad; fund advance up to €5,000; criminal bail advance abroad up to €12,000; legal-assistance costs abroad (traffic accident) up to €600; advance to hospitals up to €6,000 (advances repayable within 30 days); urgent-message transmission; dispatch of forgotten personal objects (up to 10 kg); telephone interpreter; card-cancellation info; digital-legacy management.
• Search & rescue up to €1,500 (mountain/sea/desert rescue excluded); checked-baggage loss/theft up to €1,000; baggage delay (>12h) up to €300; trip delay (>6h) up to €300; missed connection (>6h) up to €300; holiday interruption up to €60/day (€600 total for all Insureds).
• Private civil liability on the trip up to €30,000 (incl. costs and bail; motor/aircraft/boat, professional and dangerous-sport liability excluded).
• 24h information services (health, leisure, travel, motoring, pets); at-home health staff, companion, special and cleaning services (fees at the Insured's cost); telepharmacy (with/without prescription); home-security guard (max 24h after burglary/fire); and a 24h legal-help, legal-advice, lawyer-network, consumer-defence and contract-drafting service (free choice of lawyer; arbitration available).

Travel exclusions include: pre-existing/chronic conditions; refusing the proposed transfer; mental illness, check-ups, spa cures, cosmetic surgery and trips taken to obtain treatment, physiotherapy/rehabilitation, and pregnancy diagnosis/follow-up/birth (except urgent and before the 6th month); bets, brawls; competition or dangerous sports (boxing, weightlifting, martial arts, glacier mountaineering, diving with apparatus, caving, ski-jumping, air and adventure sports such as rafting and bungee); suicide and self-harm; mountain/sea/desert rescue; alcohol, drugs and non-prescribed medication; sudden epidemics/infectious diseases and pollution; war, terrorism, strikes, nuclear events and natural catastrophes; and theft/loss of cash, jewellery and documents. Cover ceases on return home or after repatriation; costs not notified in advance to (or authorised by) Europ Assistance are excluded.

These General Conditions have been drafted in simplified form to aid understanding. Please read them carefully and ask your mediator or any Generali branch for any clarification. Source: GENERALI España de Seguros y Reaseguros S.A. — Generali Salud Enfermedades Graves, Condiciones Generales, refs G50811 / G51626, edition 01/2026.