Generali Salud Elección Health Insurance Policy Conditions (English Translation)
An English translation of the Generali Salud Elección general conditions — private health cover you can use through the Generali medical network or with any doctor and claim it back.
Salud Elección is a private medical insurance (asistencia sanitaria) policy with a reimbursement option. It gives you two ways to get treatment, and you can mix them freely, claim by claim:
- Use the Generali medical network (Cuadro Médico Premium) — Generali settles the cost directly with the doctor or hospital, so there is nothing to claim back.
- Use any doctor or hospital you like, in Spain or abroad, pay the bill and claim it back — Generali reimburses a percentage of the cost up to the limits of the reimbursement tier you hold.
The reimbursement side is set by a separate special-conditions annex — the tier (50, 150, 300 or 600) fixes your annual limit and the percentage paid back. We explain and compare those tiers on the Salud Elección Reembolso page.
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.
Part 1 — The policy & how it works
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). 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
- Cuadro Médico Premium: Generali's panel of approved doctors, specialists, clinics and hospitals. Using it, Generali pays the provider directly.
- Reimbursement (reembolso): where you use a provider outside the network, pay, and Generali pays back a percentage of the reasonable & usual cost.
- Franquicia (excess): the percentage of a reimbursable cost that stays with you (e.g. 10–20%, depending on tier and age).
- Reasonable & usual costs: charges that do not exceed the normal level for the same service by comparable providers in the same area.
- Hospitalisation: a stay of more than 24 hours as an inpatient; a day hospital stay is up to 24 hours.
- Pre-existing condition: a condition showing clear symptoms or reasonable suspicion before the insured joined the policy.
- Waiting period (carencia): a period from the start date during which a particular cover is not yet active.
How the policy works — network & reimbursement ↑ top
Within the limits of the policy, Generali covers the medical, surgical and hospital care you need for illness or injury across the specialities listed below. You choose, for each claim:
- The network route: pick a provider from the Cuadro Médico Premium — Generali settles directly and (unless your Particular Conditions say otherwise) there is no reimbursement to claim because nothing is out of pocket.
- The free-choice route: use any doctor or hospital in Spain or abroad, pay, and claim reimbursement under your reimbursement tier.
Urgent, life-threatening care is always covered (Article 103 of the Insurance Contract Act). The maximum the policy reimburses each year is the figure in your Particular Conditions and reimbursement annex.
What is covered ↑ top
The guarantees (Article 10) group the cover as follows:
Primary care
General medicine, paediatrics (to age 14), qualified nursing (ATS/DUE), podology (6 sessions/year unless foot pathology), a home medical-emergency service, and psychology (individual sessions prescribed by a psychiatrist — max 4/month, 20/year; psychoanalysis, hypnosis and similar are excluded).
Medical & surgical specialities
The full range of specialities — allergology, cardiology and cardiovascular surgery, digestive, dermatology, endocrinology, gynaecology & obstetrics (incl. pregnancy monitoring, delivery, epidural), haematology, internal medicine, nephrology, neurology and neurosurgery, oncology (medical & radiotherapy), ophthalmology, ENT, psychiatry, rheumatology, traumatology & orthopaedics, urology, and more. It includes diagnostics (lab, X-ray, ultrasound, CT, MRI, scintigraphy, endoscopy), hospitalisation (medical, surgical, paediatric, ICU; psychiatric capped at 60 days/year), an ambulance, chemotherapy & radiotherapy, dialysis, a defined list of internal prostheses (heart valves, pacemaker, hip, intraocular lens, etc.), rehabilitation, and a companion bed. Dental cover (stomatology) covers basic treatment and extractions; an infertility-treatment programme is available subject to conditions (both partners insured 24 months, woman under 42, up to 3 IUI + 2 IVF).
Preventive medicine & dental
Preventive-medicine programmes (check-ups, paediatric prevention, cardiovascular, gynaecological and prostate screening) and a dental guarantee are included as set out in the Particular Conditions.
Waiting periods (carencias) ↑ top
Cover starts on the effective date, except for these waiting periods from the date the insured joins (unless otherwise agreed):
- 3 months — surgery (with or without hospitalisation) and non-surgical hospitalisation; complex diagnostics (CT, MRI, scintigraphy, endoscopy, etc.); and special treatments (radiotherapy, chemotherapy, physiotherapy, etc.). Simple tests, X-rays and abdominal/gynaecological ultrasound have no waiting period.
- 8 months — anything to do with pregnancy and childbirth (no waiting period for a vital-emergency or premature birth).
- 3 months — preventive-medicine services (no waiting period for child prevention).
Waiting periods are automatically waived in a vital emergency or where the claim results from an accident.
Travel assistance abroad ↑ top
A travel-assistance guarantee (provided by Europ Assistance) covers unforeseen illness or accident on trips outside your country of residence, up to €35,000 per insured per period, for trips of up to 90 days. It includes medical fees, prescribed medicines for the first treatment, hospitalisation, medical transfer/repatriation and related travel-assistance services. You must be resident in Spain to use it.
Part 2 — Reimbursement, exclusions & claims
The reimbursement option (the add-on) ↑ top
When you use a provider outside the Cuadro Médico, the policy pays you back under a reimbursement special-conditions annex. The annex sets your annual sum insured and the percentage reimbursed (typically 80–90%, reducing to 50% from the year you turn 65), plus per-item sub-limits (hospital room, surgeon's fees, consultations, maternity, etc.). Reimbursement applies to care both in Spain and abroad.
Generali offers four tiers — 50, 150, 300 and 600 — differing only in those amounts. See and compare them on our Salud Elección Reembolso page.
Main exclusions ↑ top
As with all private health policies, the cover does not extend to, among others: pre-existing conditions not declared; purely cosmetic or aesthetic treatment; cures, spa treatments and rest-home stays; non-prescribed medicines and out-patient pharmacy; experimental or non-recognised treatments; assistance for purely social reasons or old-age care; self-inflicted injury and the effects of alcohol or drugs; and the consequences of war, riot, nuclear reaction and officially declared epidemics/pandemics. The full, binding list is in Article 12 of the Spanish conditions — ask us if you need any point clarified.
Claims, contract & renewal ↑ top
For network care you simply show your Generali card. For reimbursement you submit the original itemised invoices and the medical documentation; reimbursement is paid within 20 days of receiving everything needed. The contract runs for the term in the Particular Conditions and renews automatically each year (either side may decline renewal with the required notice). Cover for an insured ends on death or on moving abroad / not residing in Spain at least 180 days a year. The policy is based on the health questionnaire, so accurate disclosure matters.