Generali Salud Opción Single Policy Conditions (English Translation)

Information Clause ↑ top

This clause fulfils the insurer's duty to inform under Article 96 of Law 20/2015 (on the regulation, supervision and solvency of insurers) and Article 122 of Royal Decree 1060/2015.

Insurer: GENERALI España de Seguros y Reaseguros S.A. (“Generali”, “the Company”, “the Insurer”), registered office Pl. de Manuel Gómez-Moreno 5, 28020 Madrid; NIF A48037642; Madrid Mercantile Registry, sheet M-377257. Supervisor: the Ministry of Economy, through 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 (Law 44/2002, Order ECO/734/2004), and its decisions bind the insurer; if not resolved in time or rejected, you may escalate to the DGSFP Claims Service (Pº de la Castellana 44, 28046 Madrid), without prejudice to going to the courts. Applicable law: Law 50/1980 on the Insurance Contract, Law 20/2015 and RD 1060/2015, plus the policy conditions, the application and the risk-assessment questionnaire signed by the policyholder.

Articles 1–3 — The parties & documents ↑ top

Policyholder: the person (individual or company) who, with the insurer, signs the contract and holds its rights and duties (except those that by nature fall to the Insured). Insured / Beneficiary: the person on whom the insurance is based, named in the Particular Conditions; may perform the policyholder's duties if they wish. Insurer: Generali, which assumes the agreed risk.

The policy is the set of documents recording the contract: these General & Specific General Conditions (governing birth, life and termination of the contract and the scope of each cover); the Particular Conditions (the individual agreements that complete, replace or amend the general conditions within the law); and any numbered, signed appendices. The insurer also issues an ID card per Insured; the up-to-date Cuadro Médico Premium (panel of doctors and services by specialty, with addresses and phone numbers) is on Generali's website. Limitative clauses are valid only if specifically accepted in writing alongside the Particular Conditions (mere transcriptions of mandatory legal rules need no such acceptance). The contract was issued on the basis of the policyholder's application and answers to the prior questionnaire, and the Insured's health declarations — hence the importance of exact and correct declarations.

Article 4 — Definitions ↑ top

• Accident: bodily injury during the policy from a violent, sudden, external cause beyond the Insured's intent.
• Calendar year: 1 January to 31 December.
• Social-type care: care not arising directly from objective, treatable medical conditions, or arising from the ailments of old age (not covered).
• Co-payment (Copago): the Insured's share in the cost of the medical act (or series of acts), by service, when received from the panel providers in the Guía Médica Premium.
• Illness: a health alteration of common or accidental cause, confirmed by a legally recognised doctor and requiring care.
• Congenital illness/defect: one existing at birth from hereditary factors or conditions acquired during gestation (may show at birth or later in life).
• Pre-existing illness: a health alteration giving evident symptoms or reasonable suspicion before the Insured's join date.
• Excess (Franquicia): a percentage of the total reimbursable expenses borne by the Insured, within the policy limits.
• Day hospital: an area of a hospital/clinic where medical or surgical care is given without admission, for no more than 24 hours.
• Hospitalisation: a stay in a clinic/hospital of over 24 hours for diagnosis or treatment. Medical / Psychiatric / Surgical hospitalisation are defined by the type of treatment received.
• Waiting period (Carencia): the time from the Insured's join date during which a given cover is not yet in force.
• Prosthesis: any part/appliance replacing an organ, a part of it, or its function.
• Operating theatre (Quirófano): a room equipped and accredited for surgical operations.
• Claim (Siniestro): any event whose consequences are covered by a guarantee of the policy.
• Vital emergency: an acute situation needing immediate care because the patient's life is imminently at risk (not the same as a serious illness).
• Compassionate / off-label / unauthorised medicines: use of an investigational medicine before its Spanish authorisation in seriously-ill patients; use outside the authorised data sheet; or use of medicines authorised abroad but not in Spain (each as defined by the regulations).

Article 5 — Start, duration & premiums ↑ top

The contract is perfected by both parties' consent and signature; cover starts on the date in the Particular Conditions once the first (or single) premium is paid. It runs for the stated period and then renews automatically for one year at a time. Either side may oppose renewal in writing — the policyholder with at least one month's notice, the insurer with two months' notice; the insurer must also notify any change to the cover at least two months before the period ends.

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 (unless a shorter period is contracted) and may be paid in instalments, all of which are then due. The first premium is paid when the contract is perfected; if it is unpaid through the policyholder's fault the insurer may treat the contract as void or claim payment, and if it is unpaid before a claim the insurer is released from all obligation. Successive premiums have a one-month grace period from the due date; thereafter cover is suspended until 24 hours after payment is made. The insurer may claim an unpaid premium within six months of its due date; if it does not, the contract is treated as extinguished. While suspended, the insurer may only require the current period's premium. Legally chargeable taxes are payable by the policyholder/Insured.

Article 6 — Waiting periods (Carencias) ↑ top

Cover begins on the policy's start date, except for the following waiting periods counted from the Insured's join date (unless agreed otherwise):

• Three months — surgery (with or without hospitalisation) and non-surgical hospitalisation.
• Three months — complementary diagnostic means (except simple analysis/radiology and abdominal/gynaecological ultrasound), i.e. radioactive isotopes, CT, scintigraphy, EEG, endoscopy, arthroscopy and similar.
• Three months — any special treatment (radiotherapy, chemotherapy, cobalt therapy, oxygen therapy, physiotherapy, functional rehabilitation, haemotherapy, etc.) and the daily-hospital-cash guarantee.
• Three months — preventive-medicine services.

All waiting periods are automatically waived in a vital emergency or where the claim results from an accident.

Articles 7–8 — Basis of contract, declarations & communications ↑ top

The contract is based on the policyholder's declarations in the application and the health questionnaire. Before signing, all known circumstances affecting the risk must be declared. If the policy differs from the application, the policyholder may ask for correction within one month of delivery.

During the contract the policyholder must declare circumstances that aggravate the risk: the insurer may then propose a change within two months, and if refused or ignored may rescind. If a reservation, inaccuracy or aggravation was not declared before a claim, the benefit is reduced proportionally (to the premium that would have applied) where the policyholder acted in good faith, or the insurer is released entirely in bad faith. Circumstances that reduce the risk are also declarable, entitling a future-premium reduction or contract resolution. The policyholder must declare any other insurance covering the same risks, and must enable the insurer's subrogation.

Communications between the parties must be in writing and take effect on receipt (postal/burofax on the first delivery attempt; email/SMS on arrival at the stated address/number). The insurer may communicate by post, burofax, fax, email or SMS to the contact details in the policy; the policyholder writes to the insurer's registered office or any public branch. Communications through the mediating agent or broker have the same effect as direct ones.

Article 9 — How the policy works (object of the insurance) ↑ top

Salud Opción Single is an individual, network-access health policy. The insurer covers the necessary medical, surgical and hospital care for the illnesses and injuries within the specialties of Article 10 by putting at your disposal its panel of providers — the Cuadro Médico Premium. When you need care you freely choose the provider from the panel and the insurer pays them directly, in line with the Particular Conditions. Urgent care is always assumed (Article 103 of the Insurance Contract Act).

Co-payment (Copago)

The policy may be taken with or without co-payment. If you contract with co-payment, using the network's services carries a small extra cost on top of the premium, set by the co-payment level chosen. If you contract without co-payment, there is no extra charge for using the network. Co-payment is the Insured's share in the cost of each medical act received from the panel providers (Art. 4).

Reimbursement option (limited)

Where the Reimbursement of Primary-Care & Gynaecology Fees guarantee has been contracted and shown in the Particular Conditions, the insurer also reimburses reasonable and customary fees for care given in Spain under guarantees 10.1 (Primary care), 10.2 and 10.4 but only in the gynaecology specialty (see Art. 10.5). Otherwise, the insurer does not reimburse where you used a network provider.

Article 10.1 — Primary care ↑ top

The cover is grouped into seven guarantees: Network care (1. Primary care · 2. Medical & surgical specialties · 3. Travel assistance · 4. Preventive medicine), Reimbursement (5. Primary-care & gynaecology fees) and Complementary care (6. Daily hospital cash · 7. Dental).

Primary care includes:

• General & family medicine (general consultations).
• Qualified nurse (ATS/DUE) — outpatient and, where illness prevents travel, at home, on medical prescription.
• Podiatry — limited to 6 chiropody sessions a year unless there is foot pathology.
• Home emergency medical service — for urgencies, only where the insurer has the service in that locality.
• Psychology — individual sessions prescribed only by a psychiatrist to treat psychological conditions, simple psychological diagnosis or psychometric tests (forms at the Insured's cost), with a maximum of 4 sessions a month and 20 a year. Psychoanalysis, psychoanalytic therapy, hypnosis, narcolepsy and psychosocial/neuropsychiatric rehabilitation are excluded.

Article 10.2 — Medical & surgical specialties ↑ top

The full range of specialties is covered through the network. Diagnostic tests must have therapeutic purpose; some items carry specific limits:

• Allergology & immunology (vaccines/autovaccines at the Insured's cost); clinical, anatomopathological, biological & biochemical analyses (diagnostic only, not predictive/preventive; food-intolerance tests excluded); anaesthesiology & resuscitation; angiology & vascular surgery; digestive system (biliary lithotripsy excluded); cardiology.
• Surgery: cardiovascular/cardiac; general & digestive (incl. laparoscopy where proven); maxillofacial (excludes stomatology/odontology acts); plastic-reconstructive (only after accident/illness during the policy — breast reconstruction is implant after radical mastectomy only; breast reduction and all cosmetic surgery excluded, even on psychological grounds); thoracic.
• Dermatology & venereology (scalp treatments, actinic lesions and dermo-cosmetic laser excluded); endocrinology & nutrition (incl. morbid obesity; dietary/slimming cures excluded); stomatology (cures & extractions only — fillings, endodontics, prostheses, orthodontics and periodontics excluded).
• Geriatrics (excludes social-type care and residence costs); gynaecology (incl. laparoscopy); haematology & haemotherapy; internal medicine; nuclear medicine (radioisotope tests, PET/PET-CT/SPECT for oncology/neurology).
• Nephrology (chronic dialysis study/treatment excluded; haemodialysis only acute/reversible or acute flare-ups, max 15 sessions); pneumology; neurosurgery; clinical neurophysiology (EEG, EMG, evoked potentials, polysomnography); neurology.
• Ophthalmology (incl. photocoagulation laser and intra-ocular surgery for conditions other than refractive defects); medical oncology (incl. chemotherapy & authorised cytostatic medicines applied in a centre); radiotherapy oncology (cobalt therapy, radiotherapy, linear accelerator, radio-neurosurgery).
• ENT (hearing prostheses excluded); psychiatry (detox/de-addiction cures, sleep cures, psychotherapy and psychoanalysis excluded); radiodiagnosis (general/digestive radiology, orthopantomography, ultrasound, mammography, CT, MRI, special & interventional radiology, bone densitometry, contrast media; virtual colonoscopy and full-body check-up excluded); rheumatology; traumatology & orthopaedics (incl. arthroscopic surgery); urology (incl. renal lithotripsy).
• Ambulance — urgent transfer to the nearest centre, or from home to the surgical centre on prescription (transfers for rehab/physio, outpatient diagnostics, outpatient consultations, day-hospital and dialysis are excluded).
• Oxygen therapy and aerosol/ventilation therapy — acute/reversible or acute flare-ups only, max 30 days, in clinic or at home on prescription (medication at the Insured's cost).
• Blood transfusions — the transfusion act, blood and/or plasma, for admitted patients (donor-bank costs and traumatology-related blood products excluded).
• Rehabilitation — outpatient, to restore prior function (maintenance rehab excluded); for conditions arising after joining; laser as a musculoskeletal technique; lymphatic drainage/pressotherapy only for oedema from oncological complications. Phoniatrics — speech rehab only after larynx/vocal-cord surgery or oncology. Permanent emergency centre — where the insurer has it in that locality.

Article 10.2 (cont.) — Hospitalisation & prostheses ↑ top

• Medical hospitalisation — in a network centre, including room and board.
• Surgical hospitalisation — fees of doctors, assistants, anaesthetists and nurses, theatre use, medicines and any other in-stay medical service.
• ICU hospitalisation (UVI/UCI) — intensive-care stay costs.
• Psychiatric hospitalisation — capped at 60 days per Insured per year.
• Companion in clinic — lodging only, where the room offers it (excluded for psychiatric and intensive-care admissions).
• In-clinic medication — outside and inside theatre during the stay/operation. Telephone, TV, cafeteria, companion's meals and anything not directly related to the treatment are never included.
• Prostheses (on prescription and prior authorisation) — only: heart valves, pacemakers, vascular prostheses (coronary stent / by-pass), internal traumatological prostheses, osteosynthesis material, breast prostheses after a covered total mastectomy, monofocal intra-ocular lenses (cataract surgery) and abdominal meshes. Excluded: orthopaedic material, artificial heart, any defibrillator, aortic vascular prostheses, valved conduits, ENT prostheses and any prosthesis not listed.

Article 10.3 — Travel assistance abroad (Europ Assistance) ↑ top

Valid throughout Spanish territory beyond your province (more than 10 km from home in the Balearics/Canaries) and worldwide, provided you are domiciled and habitually resident in Spain and away for no more than 90 days per trip. Cover ceases on return home or after repatriation; prior authorisation from Europ Assistance is required. Key benefits (amounts for different scopes are not cumulative):

• Medical expenses outside your country of residence up to €35,000 (sudden illness/accident on a trip; fees, first-aid medicines, hospitalisation, local ambulance); in your country of residence up to €2,000 (excluded where the Insured is a Social Security beneficiary, save urgent transfer to a non-Social-Security hospital); emergency dental up to €2,000 (endodontics, cosmetic, prostheses, crowns and implants excluded). Trips to the passport country get the same cover as a trip in the country of residence.
• Hotel-stay extension by illness/accident up to €200/day, max 10 days; medical transfer of the sick/injured (special air ambulance within Europe/Mediterranean only, first-class train, helicopter, ambulance or scheduled flight); repatriation of mortal remains to the place of burial/cremation in Spain (incl. embalming, minimum coffin, urn transfer; funeral/burial costs excluded); return of accompanying insureds; resumption of the trip.
• Companion for a hospitalised Insured — travel where hospitalised >5 days with no direct relative present, plus stay up to €200/day, max 10 days; companion-stay extension up to €60/day, max 10 days; return on a relative's death (travel within 7 days) or hospitalisation (>5 days); escort of minors under 14 / dependants; escort of mortal remains.
• Medicine dispatch abroad; fund advance up to €5,000; criminal bail advance abroad up to €12,000 (after a traffic accident); legal-assistance fees abroad up to €600; hospital-admission advance up to €6,000 (advances repayable within 30 days); telephone interpreter (English/French/German); card-cancellation info; dispatch of forgotten/recovered personal objects (max 10 kg); urgent-message transmission; digital-legacy management after death.
• Search & rescue up to €1,500 (mountain/sea/desert rescue excluded); checked-baggage loss/theft/damage up to €1,000 (theft, simple loss, cash, jewellery, electronics and documents excluded); baggage delay (>12h) up to €300; trip delay (>6h on scheduled transport) up to €300; missed flight connection (>6h) up to €300; holiday interruption up to €60/day, max €600 for all Insureds (for listed causes such as death, serious illness/hospitalisation, major home damage, non-disciplinary dismissal or forced relocation, jury/witness summons).
• Private civil liability on the trip up to €30,000 (incl. court costs and bail; excludes motor/aircraft/boat and firearm liability, professional/union/political liability, fines, dangerous-sport liability and damage to entrusted objects).
• 24-hour services: information (health, leisure, travel, motoring, sports), telephone social guidance (9:00–19:00 Mon–Fri), at-home health staff / companion / cleaning / catering / hairdressing-podiatry services (fees and travel at the Insured's cost), pet information, telepharmacy (with or without prescription, including night/holiday), home-security guard for up to 24 hours after burglary/fire/flood/explosion, and a legal-assistance service — 24h urgent legal help, telephone legal advice, access to a lawyer network, consumer defence, drafting/review of listed contracts, free choice of lawyer/procurator (out-of-area travel costs at the Insured's cost) and the right to arbitration of disputes with the insurer.

Travel exclusions include: pre-existing/chronic conditions appearing on the trip; refusing the proposed medical transfer; mental illness, preventive check-ups, spa cures, cosmetic surgery, alternative medicine and physiotherapy/rehab, and trips taken to obtain treatment; pregnancy diagnosis/follow-up/birth and voluntary termination (except urgent care before the 6th month); bets, challenges, brawls; competition or motor sport and listed dangerous activities (boxing, weightlifting, wrestling, martial arts, glacier mountaineering, sledding, scuba with breathing apparatus, caving, ski-jumping, air sports, rafting, bungee, hydrospeed, canyoning and similar); suicide, attempted suicide and self-harm; mountain/sea/desert rescue; alcohol, drugs or non-prescribed medicines; wilful acts; sudden epidemics/infectious diseases and pollution; war, riot, terrorism, sabotage, strikes, nuclear reactions and natural catastrophes; and theft/simple loss of cash, jewellery and documents. Also excluded: in-situ-treatable transfers; glasses/contact lenses and any prosthesis (e.g. neck collar); and reimbursement of medical, surgical and pharmaceutical costs. Legal-defence cover also excludes uncommunicated or pre-contract matters, foreign-law disputes, bad-faith claims, unfounded or disproportionate claims, and fines/penalties.

Article 10.4 — Preventive medicine ↑ top

Adult prevention (ages 18–65)

General GP review (every two years to age 35, then annually): full history, blood pressure, height, weight, skin, cardio-respiratory and abdominal exam, health/risk assessment. General blood test on medical criteria (haemogram, ESR, glucose, cholesterol, urea, creatinine, uric acid, albumin, urine sediment, GOT/GPT). Prevention of obesity, hypertension and hyperlipidaemia. Coronary prevention (from age 30: baseline ECG in men + cardiology; ages 35–65 every 5 years per cardiovascular risk: stress ECG + cardiology). Annual gynaecological review with cytology and, from age 45, an annual mammography (on medical criteria). Family planning (gynaecology consult + IUD fitting — device/medication cost excluded; for men, urology; tubal ligation and vasectomy). Dental prevention (annual stomatology check + dental hygiene). Tetanus vaccine. Hearing prevention (audiometry). Eye prevention (visual acuity at 25 and 35; acuity + tonometry from 40, every two years).

Geriatric prevention (over 64, annually)

General GP review; general blood and urine test; annual gynaecological review with cytology; flu and tetanus vaccines; dental check + hygiene; hearing and eye prevention (ENT and ophthalmology reviews); cancer prevention — breast (mammography), gynaecological (cytology) and digestive (faecal occult blood), all on medical criteria.

Article 10.5 — Reimbursement of primary-care & gynaecology fees ↑ top

This optional guarantee (only if shown in your Particular Conditions) lets you use a doctor or centre outside the network for these services in Spain and claim them back:

• Primary-care fees — general-medicine consultations, plus nurse (ATS/DUE), podiatry, home emergency medical service and the psychiatrist-prescribed individual psychology sessions, up to the limits in Art. 10.1.
• Gynaecology fees — consultations and the professional fees (incl. anaesthetist) for gynaecology surgery.

The maximum capital per Insured per year is set in the Particular Conditions. Reimbursement is based on the amount you actually paid, less a 20% excess (franquicia), and capped per medical act per the Particular Conditions. Gynaecology operations are classified under the Spanish Medical Council's act/technique terminology, with the combined surgeon/assistant/anaesthetist fees not exceeding the figure for that operation (after the excess); for two different surgical approaches in one operation, the limit is the highest group plus 60% of the other, max two groups. Excluded from this guarantee: infertility treatment; services given by a network provider; and services given by the Insured's spouse or relatives up to the second degree.

Articles 10.6–10.7 — Daily hospital cash & dental ↑ top

10.6 Daily hospital cash (illness & accident)

The insurer pays the daily sum insured set in the Particular Conditions for each day of uninterrupted hospitalisation caused by illness or accident, accruing per complete 24 hours from admission. An additional equal sum is paid for each 24 hours in ICU (UVI/UCI). Successive stays for the same cause count as one period; nothing is paid for stays under 24 hours; and no Insured may accrue beyond the indemnity period for the same process/diagnosis (a coincident or consequent illness does not restart the clock; a genuinely new process does). For Insureds over 65, this guarantee is limited to surgical hospitalisation. Hospitalisation for pregnancy/birth and its complications is excluded.

10.7 Dental

Access to the coded acts listed in the Guía Dental (which forms part of the policy), provided only at network providers. No cash indemnity is paid in lieu, but you may freely choose any provider in the Guía Dental, in your province or any other where it is published, on showing your ID card.

Article 11 — Using the network & making a claim ↑ top

Network use & authorisations

The claim is deemed notified the moment you use a Guía Médica Premium provider. You may use the panel of your locality or of others within your cover. (The insurer is released where providing a benefit would breach UN/EU/UK/US sanctions.) Home visits are authorised only where illness prevents travel to the surgery. For urgencies you may go directly to the permanent emergency centre (address on the website) or call the home-emergency number. You may go directly to specialists, though seeing your GP first is recommended.

Prior authorisation is required for special diagnostic tests, hospitalisation, surgery (diagnostic or therapeutic) and special therapies (radiotherapy, chemotherapy, physiotherapy, functional rehabilitation, oxygen/aerosol therapy, haemotherapy, etc.): a network doctor prescribes it with a justifying report and you confirm at Generali's offices or website (Health Procedures / Medical Authorisation). In urgencies the doctor's order suffices, with confirmation obtained within 72 hours of admission. You must show your ID card, report its loss/theft within 48 hours, and return it when the contract ends.

Reimbursement claims (Art. 11.2)

Notify within: 48 hours after an urgent hospitalisation, 3 days before a planned one, or 7 days after any other claim. Send the completed “Solicitud de Reembolso de Gastos e Indemnización”, original itemised invoices/receipts (with the provider's name, NIF/CIF, college number, specialty, service, date and amount) and original prescriptions (with the doctor's name and college number, the patient's name and card number, and the diagnosis/cause). Reimbursement is paid within 20 days of receiving the full documentation (for processes over three months, send quarterly proof of payment). Non-EU services are valued in euros at the official buyer rate on the payment date; translation into Spanish is at the Insured's cost.

Daily-cash claims (Art. 11.3)

Notify within 7 days (Art. 16 of Law 50/1980). Send the reimbursement/indemnity form signed by the prescribing doctor (or a signed medical note with the Insured's and doctor's details, the centre, admission date/time, the reason and treatment, and probable discharge date), plus a discharge document signed by the doctor and the centre stating the exact admission period (day and hour of discharge). The insurer may make visits and, with consent, consult the attending doctors; refusal of a visit releases the insurer. Payment is made once the claim is established, with payments on account where it lasts over 40 days.

Article 13 — What is not covered ↑ top

In addition to the limits elsewhere in the Conditions, this insurance excludes:

• Pre-existing illnesses giving evident prior symptoms before the join date.
• Prostheses of any kind, anatomical/orthopaedic pieces and therapeutic appliances — except those listed in Art. 10.2.
• Any breast reconstruction other than implant after radical mastectomy, and any breast reduction.
• Nuclear/radioactive damage covered by nuclear-liability insurance.
• Claims caused directly by any contagious disease classed as a WHO Phase-5+ pandemic.
• War, riot, revolution, terrorism and cataclysms (earthquake, flood and other seismic/weather phenomena).
• Non-surgical treatment of obstructive sleep apnoea.
• Psychoanalysis, psychoanalytic therapy, hypnosis, narcolepsy, psychosocial/neuropsychiatric rehabilitation, group therapy, psychological tests, sleep cures, acupuncture, and experimental or scientifically-unrecognised treatments.
• Purely cosmetic treatment (plastic surgery, varicose sclerosis, cosmetic treatments, slimming/obesity treatment, and refractive surgery for myopia/hypermetropia/astigmatism) — but not reconstructive surgery after accident or burn.
• Transplants of any type.
• Treatment of any drug addiction or substance abuse (e.g. alcoholism).
• Care from suicide, attempted suicide or self-inflicted injury.
• Immunodeficiency illnesses.
• Medicines and vaccines (except those supplied during hospital admission per Art. 10).
• Genetic-map determinations (predisposition, or studies of the couple's infertility/sterility causes).
• Non-evidence-based diagnostics, holistic/biological medicine and other alternative therapies (homeopathy, reflexology, cosmetic lymphatic drainage, osteopathy, flower therapy, chiropractic, music therapy, organotherapy).
• For all covers: pregnancy monitoring and birth, and the basic study and any treatment of the couple's infertility/sterility.
• Voluntary medical/surgical acts not arising from accident or illness (except preventive medicine 10.4); medical exams, check-ups and stays in spas/rest-homes/asylums/geriatric homes under the daily-cash guarantee (10.6); dental services outside the Guía Dental coded list (10.7).
• Under the reimbursement guarantee (10.5): infertility-treatment acts, services given by a network provider, and services given by the Insured's spouse/relatives up to the second degree.
• Diagnostic/therapeutic techniques not in habitual, proven and accepted use in the National Health System; compassionate-use medicines; and any benefit not specifically included.

Articles 12, 14–15 — Other duties, indisputability, law & jurisdiction ↑ top

Other duties (Art. 12): the policyholder/Insured must notify any change of address by certified letter at least seven days before requesting any service; the insurer issues the corresponding endorsement.

Indisputability (Art. 14): if a medical examination was carried out (or full rights recognised), the policy is indisputable as to the Insured's health and the insurer cannot deny benefits by alleging prior illness, save any reservation expressly noted in the Particular Conditions. If no medical exam was done and the policy rested on the health questionnaire, the insurer may rescind within one month of discovering a reservation or inaccuracy; in any event the policy becomes indisputable one year after the start date, save wilful misconduct by the policyholder.

Law & jurisdiction (Art. 15): Spanish law applies unless the Particular Conditions say otherwise; the competent court is that of the Insured's domicile in Spain (an Insured living abroad must designate a Spanish domicile), and any contrary agreement is void.

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 Opción Single, Seguro de Protección Médica, ref. G50881 (edition G51218, 01/2026).