Generali Dental Insurance Policy Conditions (English Translation)
An English translation of the Generali Dental general conditions — a dental-care plan combined with a daily cash benefit for hospital stays.
Generali Dental is really two covers in one policy. It gives you dental treatment through Generali's dental network in Spain — with a long list of treatments at no charge and the rest at a fixed, pre-agreed co-payment — and it pays a daily cash sum for every day you spend in hospital through illness or accident. The two guarantees are independent: you can be entitled to one without a claim under the other.
The General Conditions below are completed by your Particular Conditions, which confirm the daily sum insured, the indemnity period and the guarantees you actually hold, and by the Dental Guide (Guía Dental), which lists the network dentists, the free treatments and the co-payments by region. Only the guarantees in your Particular Conditions apply to you.
For a plain-English overview or a quote, see our dental insurance in Spain page or contact our team. As an authorised exclusive Generali agent, Turner Insurance can explain any clause below.
Part 1 — General information & definitions
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 S.A. de Seguros y Reaseguros, 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). Complaints: Generali's Claims & Complaints Service (reclamaciones.es@generali.com), then the DGSFP. Applicable law: Law 50/1980 on Insurance Contracts and related rules.
Key concepts & definitions ↑ top
- Accident (Accidente): a bodily injury from a violent, sudden, external cause beyond the Insured's control.
- Illness (Enfermedad): a change in health of a common, non-accidental cause, confirmed by a legally recognised doctor and needing medical care.
- Sum insured (Capital Asegurado): the amount set in the Particular Conditions for each guarantee — for the hospital cover, the daily amount paid for each day in hospital.
- Co-payment (Franquicia): the part of the cost of a dental treatment you pay yourself. The co-payments are set, by treatment and by province, in the Dental Guide.
- Hospitalisation (Hospitalización): a stay of more than 24 hours as a patient in a proper hospital or clinic. Spas, rest homes, care homes and geriatric centres do not count as hospitals.
- Waiting period (Plazo de carencia): a period from the policy's effective date during which a given guarantee is not yet in force.
- Claim (Siniestro): any event whose consequences are covered by one of the guarantees.
Object of the insurance ↑ top
Within the limits of the guarantees you hold, the policy provides two things: a daily indemnity for hospitalisation caused by illness or accident, and access to the dental and stomatological care you need through the professionals listed in the Dental Guide. The cost of any general medical care you might need is not covered unless the conditions expressly say so. The sum insured for each guarantee is the one shown in your Particular Conditions.
Part 2 — The cover
Dental assistance — the dental plan ↑ top
This guarantee gives you access, in Spain, to the dental services listed in your Particular Conditions and in the “Coded Dental & Stomatological Services” section of the Dental Guide. Key points:
- Services are provided only through the network dentists published in the Dental Guide. You may freely choose any dentist within that network, in your own province or any other where Generali publishes a Dental Guide.
- The policy does not pay cash in place of dental treatment.
- You identify yourself to the network dentist with the card the insurer issues you.
Treatments at no charge
A wide range of coded treatments are provided free of charge, including:
- Oral diagnosis: initial oral examination and diagnosis, treatment estimate, emergency examination, professional consultation and check-ups.
- X-rays: periapical, occlusal, bitewing, orthopantomography (OPG), lateral teleradiography, TMJ X-ray and the periodontal radiographic series.
- Prevention & dental hygiene: annual scale and clean (tartrectomy), oral-hygiene education, brushing-technique instruction, diet planning for caries control, plaque staining/index, and topical fluoride (two sessions a year).
- Children up to 14 (child dental plan, permanent dentition): pit-and-fissure sealing of 1st and 2nd permanent molars, fillings, reconstructions, prefabricated stainless-steel crowns, indirect pulp capping, pulpotomy, apexification, pulp opening and drainage, plus extraction of milk teeth and space maintainers.
- Oral surgery: simple extraction, complicated extraction and/or suture, surgical extraction of a partially impacted wisdom tooth, extraction of a tooth retained in bone, abscess opening and drainage, frenectomy, cystectomy, minor soft-tissue surgery and pre-prosthetic surgery.
Treatments at a fixed co-payment
For every other treatment listed in the Dental Guide, you pay the dentist directly the fixed co-payment (franquicia) set for that treatment in your province. Because these prices are agreed in advance, you always know the cost before you start. The co-payments are revalued each year in line with the price of the services.
Daily hospital cash — illness & accident ↑ top
If illness or accident means you have to be hospitalised, the insurer pays the daily sum insured for each day of the stay, throughout the indemnity period set in your Particular Conditions. The main rules are:
- The benefit is earned in complete 24-hour periods, counted from the date and time you are admitted. Nothing is paid for a stay of less than 24 hours.
- Intensive care: if you are admitted to ICU/UVI, the insurer pays an additional sum for each complete 24 hours there.
- Successive stays for the same cause count as one period of hospitalisation. If a new, unrelated process arises, a fresh indemnity period starts for it.
- No insured may draw the benefit for the same process or diagnosis for longer than the indemnity period set in the Particular Conditions, whether consecutively or across cover periods.
- For insured persons under 5 or over 69, this guarantee is limited to hospitalisation for a surgical operation.
The hospital-cash guarantee applies worldwide, provided the insured's habitual residence is in Spain (see territory below).
Part 3 — Exclusions, waiting periods & claims
Exclusions (risks not covered) ↑ top
The dental guarantee does not cover any service that is not expressly included in your Particular Conditions or in the coded list of the Dental Guide.
The hospital-cash guarantee gives no right to indemnity for, among others:
- Pre-existing conditions — any illness (chronic or not), injury or physical/constitutional defect, and accidents, existing before the Insured joined the policy (even without a firm diagnosis), and their consequences.
- Professional sport and dangerous activities — air sports, motor-sport, boxing, climbing, martial arts, bobsleigh, bullfighting and running of bulls, scientific expeditions, and other clearly hazardous pursuits.
- Mental and certain unverifiable conditions — psychosis, neurosis, psychopathy, personality disorders, depression or stress and psychosomatic illness; neurological conditions not objectively verifiable; processes whose only sign is pain or vertigo not confirmed by tests; and fibromyalgia.
- Wilful or self-caused injury, interruption of treatment, and illness/accident from alcohol, drugs, brawls, duels or attempted suicide.
- Voluntary medical or surgical acts not caused by accident or illness — fertility and purely cosmetic treatments (except reconstructive surgery after an accident or burn during the policy).
- Contagious disease declared a WHO Phase 5+ pandemic; immunodeficiency diseases.
- War, public disorder, officially declared extraordinary/catastrophic events, and nuclear energy (except as part of medical treatment).
- Medical exams and check-ups, and stays in spas, rest homes, care homes or geriatric centres; and claims arising during the waiting period.
Waiting periods ↑ top
Unless otherwise agreed, the following waiting periods apply to the hospital-cash guarantee (counted from the date the guarantee starts for the affected insured):
- 3 months for illnesses needing surgical treatment (except an urgent medical prescription).
- 12 months where the insured declared having received medical treatment in the previous 12 months, for that cause.
- 8 months for pregnancy and childbirth.
- 6 months for any other illness requiring hospitalisation.
- No waiting period applies if the claim is the result of an accident — the periods are automatically waived.
Insurable persons, territory & revaluation ↑ top
Who can be insured: unless otherwise agreed, persons who are under 70 when the policy is taken out.
Territory: the hospital-cash guarantee applies worldwide, provided the insured is habitually resident in Spain; the dental guarantee applies in Spain only. Indemnities are paid in Spain, in euros. A standard sanctions clause applies (the insurer is released where cover would breach UN, EU, UK or US sanctions).
Duration & renewal: the policy runs for the period in the Particular Conditions and renews automatically each year; either side may decline renewal with two months' (insurer) or one month's (policyholder) notice. Annual revaluation is optional: the sums insured (and the dental co-payments) can be index-linked each year, with the premium adjusted accordingly.
Prescription: actions arising from the contract lapse after five years (personal-insurance limitation).
How to claim & how it is paid ↑ top
For dental care, the claim is treated as notified the moment you request the service from a network dentist — simply show your card.
For the hospital-cash benefit, notify the insurer of the admission within seven days (Article 16, Law 50/1980), with a Declaración de Siniestro signed by the doctor who prescribed admission (or a signed medical report giving your details, the admitting doctor, the cause, the treatment, the hospital and the admission date/time). On discharge you provide a document, signed by the doctor and the hospital, confirming the exact dates and times. The insurer's medical service may arrange visits to confirm your condition and may consult the doctors treating you. The benefit is paid once the claim is verified, and the insurer may make payments on account where a stay lasts more than 40 days. Disputes over the cause or amount are resolved by medical experts under Article 38 of the Insurance Contract Act.