Generali's essential, budget-friendly medical-network health plan, in plain English.
⚠️ Important — please read. This is a translation intended as a guide only. The wording may be amended by Generali at any stage, and in any dispute the original Spanish version is the only binding text. The official document is Generali MiSalud Esencial — Seguro de Protección Médica (ref. G51721, edition 12/2023).
MiSalud Esencial is Generali's essential, entry-level health insurance — the budget-friendly way into private healthcare in Spain. It gives you access to Generali's Cuadro Médico Premium for the cover most people use day to day, with a co-payment to keep the premium low.
For a plain-English overview or a quote, see our health insurance in Spain page or contact our team. As an authorised exclusive Generali agent, Turner Insurance can explain any clause below.
Insurer: GENERALI España S.A. de Seguros y Reaseguros · Product: MiSalud Esencial — Protección Médica (G51721) · Edition: 12/2023
This clause fulfils the insurer's duty to inform under Article 96 of Law 20/2015 (insurance ordering, supervision and solvency) and Article 122 of Royal Decree 1060/2015.
Insurer: GENERALI España, S.A. de Seguros y Reaseguros (referred to as the Company, Generali, the Insurer or the Insurance Entity), registered office Pl. de Manuel Gómez-Moreno 5, 28020 Madrid; C.I.F. A-28007268; Madrid Mercantile Registry, sheet M-54.202. Supervisor: the Directorate-General for Insurance and Pension Funds (DGSFP). Complaints: Generali's Claims & Complaints Service (rules at www.generali.es; reclamaciones.es@generali.com) acknowledges and resolves, with reasons, within a maximum of two months; you may then escalate to the DGSFP Complaints 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. Right of withdrawal (distance contracts): for a contract concluded at a distance you may withdraw within 14 calendar days of conclusion by e-mailing canalcliente-clientes.es@generali.com with your details and policy number; you then pay only for the cover period actually run. This does not apply where the contract has already been performed or fulfils a compulsory-insurance obligation.
Policyholder (Tomador): the person or company who, with the Insurer, signs the contract and holds its rights and obligations.
Insured / Beneficiary: the person on whom the insurance is established, named in the Particular Conditions.
Company / Insurer: the legal entity assuming the agreed risk.
The policy comprises these General & Specific General Conditions, the Particular Conditions (the individual agreements, which may complete, replace or modify the general conditions), and any numbered, signed appendices. The Insurer also issues an Insured identification card. The Cuadro Médico Premium (the list of contracted doctors and services by specialty, with addresses and phone numbers) is kept permanently up to date on Generali's website. Clauses limiting the Insured's rights are valid only if specifically accepted in writing.
Accident: bodily injury during the policy from a violent, sudden, external cause beyond the Insured's intent.
Calendar year: 1 January to 31 December.
Care for social reasons: care not arising directly from objective, treatable medical conditions, or arising from old-age illness.
Co-payment (Copago): the Insured's share in the cost of each medical act (or series of acts), according to the service used, with the professionals or centres of the Cuadro Médico Premium. Virtual consultations with recommended-panel professionals carry the same co-payment.
Illness: a health alteration of common or accidental cause, confirmed by a legally recognised doctor and requiring care.
Congenital illness/defect: existing at birth from hereditary factors or conditions acquired during gestation (may show at birth or be discovered later).
Pre-existing illness: a health alteration giving evident symptoms or reasonable suspicion before the affected Insured's join date.
Day hospital: an area of a hospital/clinic where care (medical or surgical) is given without admission, for no more than 24 hours.
Hospitalisation: a stay in a clinic/hospital over 24 hours for diagnosis or treatment. Medical / Psychiatric / Surgical hospitalisation are defined by the type of treatment received.
Waiting period (Plazo de carencia): the time from the Insured's join date during which a particular cover is not yet in force.
Claim (Siniestro): any event whose consequences a guarantee of the policy covers.
Article 5 — Start, duration & payment of premiums ↑ top
The contract is perfected by the consent and signature of both parties; cover begins on the date stated in the Particular Conditions, once the contract is perfected and the single or first premium (or agreed instalment) is paid. The term is that stated in the Particular Conditions and, unless otherwise agreed, renews automatically for one year at each expiry. Either party may oppose renewal by written notice — at least one month beforehand by the Policyholder, two months by the Insurer (who must also give two months' notice of any change).
For each Insured the cover ends on: (a) moving residence abroad or not residing at least 180 days a year in Spain; or (b) death.
The premium is annual (or for the shorter contracted period) and may be paid in instalments, all of which are due. If the first premium is unpaid through the Policyholder's fault, the Insurer may treat the contract as void or claim payment by enforcement; if unpaid before a claim, the Insurer is released. For later premiums there is a one-month grace period; thereafter cover is suspended until 24 hours after payment. If the Insurer does not claim within six months of the due date, the contract is extinguished. Legally applicable taxes are borne by the Policyholder or Insured.
Benefits are provided from the policy's formalisation/effective date. The following waiting periods apply from the Insured's join date:
Three months — diagnostic tests: bone densitometry, ergometry, echocardiography, Holter, scintigraphy, MRI, CT scan, neurophysiology tests and pathological anatomy.
Three months — treatments: physiotherapy and aerosol therapy.
The waiting periods are automatically waived where the claim results from an accident.
Articles 7–8 — Declarations & communications ↑ top
The contract is based on the Policyholder's declarations in the application and on the health questionnaire; an exact, correct declaration is essential. Before signing, all known circumstances affecting the risk must be declared. During the policy the Policyholder must declare circumstances that aggravate the risk (the Insurer may then propose a change within two months, or rescind) and may declare circumstances that reduce it (with a proportional premium reduction). Concealment or inaccuracy in good faith reduces the benefit proportionally; bad faith releases the Insurer. Other similar insurance and any subrogation must also be facilitated.
Communications must be in writing and take effect on receipt (a postal/burofax attempt suffices; e-mail/SMS take effect on delivery to the address on file). Communications to or from the intermediary (agent or broker) have the same effect as if made directly.
Part 2 — How it works & the cover
Article 9 — How the policy works (object of the insurance) ↑ top
In return for the premium and the co-payment due in each case, the Insurer covers the need for medical care on an outpatient (ambulatory) basis for the illnesses, injuries, specialties and modalities listed in Article 10, for each Insured. A range of healthcare providers is made available through the Cuadro Médico Premium; in a claim the Insured freely chooses the provider from the panel. The Insurer pays the contracted professionals/centres directly.
This is a product with co-payment: using the panel's services has a cost additional to the premium. No cash indemnity may be paid in place of the healthcare service.
MiSalud Esencial is Generali's entry-level, budget-friendly network plan. To keep the premium low it works on a co-payment basis: for each medical act used from the panel the Insured pays a fixed share of the cost (the copago), set in the Particular Conditions. Virtual / tele-consultations with recommended-panel professionals carry the same co-payment. You only pay a co-payment when you actually use a service.
General & family medicine — general consultation services.
Paediatrics — diagnosis and treatment of children up to 18 years.
Qualified nurse (ATS/DUE) — outpatient nursing services on medical prescription.
Podiatry — limited to 6 chiropody sessions a year, unless there is foot pathology.
Article 10.1.2 — Medical & surgical specialties ↑ top
Cover is limited to consultations, diagnostic tests and treatments that do not require an operating theatre/room or hospital admission, except those expressly detailed here, and that are not excluded under Article 13. The panel covers, among others:
Allergology & immunology (vaccines/autovaccines at the Insured's cost); clinical, pathological, biological, biochemical analysis and hormonal studies for diagnosis only (genetic determinations, special pathology — immunohistochemistry, molecular biology, liquid biopsy — and food-intolerance tests excluded).
Angiology & vascular surgery; digestive system (incl. gastroscopy and colonoscopy with in-room sedation; biliary lithotripsy excluded); cardiology; cardiovascular/cardiac surgery; general & digestive surgery; thoracic surgery.
Maxillofacial surgery (excluding stomatology/odontology and the dental guarantee unless contracted); reconstructive plastic surgery; paediatric surgery (under 18).
Stomatology — simple tooth extractions and related cures only (fillings, endodontics, prosthetics, orthodontics, periodontics and preventive treatments excluded).
Nuclear medicine — isotope diagnostics such as scintigraphy (PET, PET-CT, PET-MRI, SPECT, SPECT-CT, DATSCAN and radioactive-isotope treatments excluded).
Medical & radiotherapy oncology — consultations only; all treatment excluded.
ENT (hearing prostheses excluded); psychiatry (consultations under medical prescription); radiodiagnosis — general X-ray, ultrasound, mammography/tomosynthesis, CT, MRI, angiography, bone densitometry (virtual colonoscopy and full-body check excluded).
Home oxygen / aerosol-ventilation therapy — acute, reversible cases only, max 30 days, on prescription (medication at the Insured's cost).
Rehabilitation — outpatient, functional (not maintenance), max 20 sessions per Insured a year, for conditions arising after the join date and on prescription.
Child prevention (to 18): general check-ups (monthly in the first quarter, then bimonthly to 18 months, then annual); official-schedule vaccines (vaccine cost excluded); vision checks at 3–4, 10–11 and 15–16; hearing checks at 3–4 and 10–11; dental prevention at 6 and 14–15.
Adult prevention (18–65): general check-up (biennial to 35, then annual) with full history, blood pressure, height/weight, skin, cardiorespiratory, abdomen; general blood analysis on medical criteria; prevention of obesity, hypertension and hyperlipidaemia; coronary prevention (resting/effort ECG and cardiologist review by age); annual gynaecological review & cytology, plus annual mammography from 45; family planning (IUD/device cost excluded); tetanus, hearing and eye-disease prevention; digestive-cancer prevention (faecal occult blood; biennial colonoscopy from 50, on medical criteria).
Where expressly contracted in the Particular Conditions, valid throughout Spain beyond your province (10 km in the Balearics/Canaries) and worldwide, for trips of up to 90 days, provided you reside in Spain. Key benefits:
Medical expenses abroad up to €35,000 per period and per Insured (fees, first-aid prescribed medicines, hospitalisation, local ambulance); emergency dental abroad up to €2,000; medical expenses in Spain up to €2,000 (the amounts are not additive; not payable where the Insured is a Social Security beneficiary, save urgent transfer to a non-Social-Security hospital).
Hotel-stay extension by illness/accident (€200/day, max 10 days); medical transfer of the sick/injured (air ambulance within Europe/Mediterranean only); repatriation of mortal remains to Spain (embalming, minimum coffin, formalities; funeral/burial excluded); return of accompanying insureds; trip resumption; dispatch of medicines abroad (repaid by the Insured).
Travel + stay (€200/day, max 10 days) for a family member to accompany an Insured hospitalised over 5 days; companion-stay extension €60/day, max 10 days; return on death/hospitalisation (over 5 days) of a close relative; escort of minors/dependants.
Fund advance up to €5,000; criminal bail advance abroad up to €12,000; legal-assistance costs abroad up to €600; advance to hospitals up to €6,000 (advances repayable within 30 days); 24h urgent-message relay; dispatch of forgotten personal items (max 10 kg); interpreter; card-cancellation info; digital end-of-life management; 24h information services (health, leisure, travel, motoring, etc.).
Search & rescue up to €1,500 (mountain/sea/desert rescue excluded); checked-baggage loss/theft/damage up to €1,000; baggage delay (over 12h) up to €300; trip delay (over 6h) up to €300; missed connection (over 6h) up to €300; interruption of an already-started holiday up to €60/day, max €600 for all Insureds.
Private civil liability up to €30,000 (Civil Code Arts. 1,902–1,910) for involuntary harm to third parties during the trip, incl. legal costs and bail (motor vehicles/aircraft/vessels, firearms, professional activity, fines and dangerous-sport liability excluded).
Home services (at the Insured's cost): home nursing/physio, companion service, hairdressing/podiatry, catering, cleaning, telepharmacy with/without prescription (day or night), home guarding after burglary/fire (max 24h), pet information, social orientation, 24h legal help and telephone legal advice, lawyer network, consumer defence, free choice of lawyer, and contract drafting/review.
Travel exclusions include: pre-existing/chronic conditions; refusal/voluntary change of the proposed medical transfer; mental illness, preventive check-ups, spa cures, cosmetic surgery, alternative medicine, physiotherapy/rehabilitation, pregnancy/childbirth (save urgent care before the sixth month); bets, fights, winter sports, competition/motor sport and dangerous/adventure sports; suicide or self-harm; rescue of persons; alcohol/drug effects; wilful acts; epidemics/infectious diseases and pollution; war, terrorism, riots, nuclear and natural catastrophes; and theft, simple loss, money, jewellery and documents. Expenses under €50 are not reimbursed.
Article 10.2.2–10.3 — Dental Plus, digital & second opinion ↑ top
Dental Plus: access to the coded acts in the Guía Dental, provided only at the published dental-panel providers (no cash; free choice among them).
Digital Pack: 24/7 confidential video / tele-consultation with general-medicine doctors (symptom assessment, medication and report queries — no diagnosis), with access to the clinical history, via the MiGenerali app.
Wellbeing & Health service: a programme of wellbeing services at advantageous rates (where contracted).
Second Medical Opinion: where contracted, a worldwide expert opinion for serious processes (cancer, cardiovascular disease, organ transplant, neurological/neurosurgical disease, chronic renal failure, Parkinson's, Alzheimer's, multiple sclerosis), with diagnosis clarification and treatment coordination.
Part 3 — Claims, exclusions & legal terms
Article 11 — Using the policy / processing a claim ↑ top
A claim is deemed notified the moment you use the services Generali makes available through the Cuadro Médico Premium. The Insurer offers the panel of your locality (and others within the contracted cover). Specialists act as consultants to the GP; you may go to specialists freely, but using the GP first is recommended. Prior authorisation from Generali is required for a limited set of diagnostic tests and treatments, physiotherapy and functional rehabilitation (requestable via Generali's website – Trámites de Salud / Autorización Médica – or the MiGenerali app).
To use the services you must show your identification card (or the virtual card in the MiGenerali app); loss/theft must be reported within 48 hours, and cards returned on termination. The Insurer assumes the fees/costs that a panel professional prescribes, subject to the contracted guarantees and the co-payment set in the policy. For travel assistance, the Insured must call the 24h number on the card from the moment of the event. A sanctions-limitation clause releases the Insurer where providing cover would breach UN, EU, UK or US sanctions.
Policyholder duties (Art. 12): notify any change of address by certified letter at least seven days before requiring a service, and notify additions/removals of Insureds as soon as possible.
In addition to exclusions elsewhere in the conditions, the following are excluded. As an essential outpatient plan, note in particular that urgent care, hospital admission and in-hospital medical/surgical care are excluded, as is any medical act requiring anaesthesia, an operating theatre/room or that is not performed in the professional's own consulting room (except those expressly listed in Article 10):
Urgent care in any setting (hospital, outpatient or home); hospital/clinic admission and the medical-surgical care during admission (in-patient, day-hospital or outpatient, urgent or scheduled), and resulting treatments/costs.
Any act requiring anaesthesia, operating theatre/room, or not done in the consulting room; pain treatment and interventional radiology; and complications/after-effects of any uncovered act.
Pre-existing conditions that had given evident symptoms before the join date; prostheses of any kind, anatomical/orthopaedic pieces and therapeutic/diagnostic apparatus; physiotherapy/rehabilitation other than of the locomotor system; dialysis.
Nuclear/radioactive damage; war, riots, revolutions, terrorism and cataclysms (earthquake, flood and other seismic/meteorological events).
Snoring/obstructive sleep apnoea diagnosis & treatment; psychology, psychoanalysis, hypnosis, narcolepsy, psychosocial/neuropsychiatric rehabilitation, group/individual therapy, psychological tests, sleep cures and experimental/unproven treatments (the Digital-Pack video-consultation psychology of Art. 10.3.1 is not excluded if contracted).
Purely aesthetic visits, tests and treatments (aesthetic dermatology, plastic surgery, varicose sclerosis, cosmetics, slimming/obesity treatment, refractive eye surgery for myopia/hypermetropia/astigmatism/presbyopia); transplants of any kind.
Treatment of any drug addiction (incl. alcoholism), detox and smoking-cessation/dependence cures; care for immunodeficiency illnesses; care arising from suicide, attempted suicide or self-inflicted injury.
Medicines and vaccines; genetic-map determinations; non-scientifically-proven procedures, holistic/biological and alternative medicine (homeopathy, acupuncture, reflexology, osteopathy, etc.).
Voluntary termination of pregnancy and infertility/sterility treatment (incl. related diagnostics); laser/radiofrequency procedures and refractive eye-surgery correction.
Pregnancy monitoring and childbirth (excluded for all guarantees); techniques/apparatus not specifically covered or not usual in Spanish healthcare networks; any act not prescribed by a Generali-panel professional, or by a discipline not in the official specialties list.
Health transport to/from medical centres; care in asylums, residences, spas and similar; balneotherapy/hydrotherapy; dietary/medical slimming or weight-gain treatment, anorexia and eating-disorder treatment.
Voluntary acts not resulting from accident or illness (save Art. 10.1.2); dental services not in the Guía Dental coded list; body-mapping and digital dermatoscopy; speech therapy/phoniatrics for congenital/neurological speech disorders.
Tests for certificates/reports with no clear care purpose; pharmaceutical/parapharmaceutical products, monoclonal antibodies, gene/endocrine/hormone therapy, antitumour immunotherapy; claims directly caused by any disease classified by the WHO as a pandemic at Phase 5 or higher; and any benefit not specifically included.
Articles 14–15 — Indisputability, applicable law & jurisdiction ↑ top
Indisputability: where a medical examination has been carried out or full rights recognised, the policy is indisputable as to the Insured's state of health, and the Insurer cannot refuse benefits on the basis of prior illness (save an express reservation in the Particular Conditions). Where no examination was made and the policy rests on the health questionnaire, the Insurer may rescind within one month of learning of any concealment or inaccuracy. In any event the policy becomes indisputable one year after its effective date, unless the Policyholder acted with wilful misconduct (dolo).
Law & jurisdiction: Spanish law applies unless the Particular Conditions state otherwise. The competent court is that of the Insured's domicile in Spain (the Insured must designate a Spanish domicile if theirs is abroad); any contrary agreement is void. These General Conditions have been drafted in simplified form to aid understanding — please read them carefully and ask your intermediary or any Generali branch for clarification.
Because MiSalud Esencial is a co-payment plan, it is not suitable for a Spanish residence-visa certificate (consulates require cover sin copago – without co-payment). For a visa, use a sin copago plan – see our non-lucrative visa and digital nomad visa pages.
Private healthcare on a budget? MiSalud Esencial is the affordable, entry-level way into Generali's Cuadro Médico Premium — with a per-act co-payment keeping the premium low. See our health insurance in Spain page for an overview and a quote, compare it with the fuller Salud Opción and Salud Elección plans, or contact Turner Insurance — your authorised exclusive Generali agent in Jávea.
Source: Generali MiSalud Esencial — Seguro de Protección Médica, General & Specific General Conditions, ref. G51721, edition 12/2023. English translation provided as a guide; the Spanish original prevails.
