HEALTH

GENERAL
CONDITIONS
EDITION - E22A01
 AGRUPACIÓN SANITARIA SEGUROS, S.A.

REGISTERED ADDRESS AND HEAD OFFICES

Av. Alfonso X El Sabio, 14 - Entlo. 03004 ALICANTE

Tel. 965 200 106 · Fax 965 144 239 · info@asssa.es · asssa.es

Registered in the Companies Register of Alicante, Volume 2.643, Book 0, Folio 119,
Section 8, Page A-76181. 2nd entry, CIF/VAT NR. A28005312

Registered in the Insurance Companies Register of the DGSFP with the code C-0437
 General
Conditions

HEALTH
 General Conditions · HEALTH

Index
1. Preliminary clause 1

2. Insurance purpose 1

3. Description of the cover. BASIC Programme 2

4. Exclusions 9

5. How services are provided 11

6. Payment of premiums 13

7. Liabilities of the Policy Holder and/or the Insured Person 15

8. Rights of the Policy Holder and/or Insured Person 16

9. Liabilities of the Insurer 17

10. Policy duration 17

11. Waiting periods 18

12. Loss of rights, cancellation and indisputability of the contract 19

13. Personal data handling 20

14. Notifications and jurisdiction 21

15. Limitation of action 22

16. Annual update of the policy’s economic conditions 22

17. Complaints and claims 23

18. Travel assistance 25

STANDARD Programme 34

PLUS Programme 36

MASTER Programme 39
1. Preliminary clause
This Insurance Contract is governed by the provisions of Spanish Law 50/1980 dated the 8th
of October, on Insurance Contracts (Spanish State Official Gazette- dated the 17th of October
1980), by other applicable Spanish regulations governing private insurance, and by that agreed
to in the General and Individual Terms and Conditions of this contract. Any limiting clauses on
the Insured Person’s rights that are not specifically accepted as an additional covenant to the
Private Conditions, by the Insured Persons themselves are not legally binding.

The mere transcriptions or references to principle legal requirements, or regulations on the

delimitation or definition of the covered risk shall not require such acceptance.

The Insurance Contract is made up of the General, Private and any possible Special Conditions
herein as well as all the annexes duly signed by the parties which may have modified the
original conditions.

According to the provisions of Articles 122 and 126 of the Royal Decree 1060/2015 dated
the 20th of November, on the Classification, Supervision and Solvency of Insurance and
Reinsurance Companies, it is stated that Agrupación Sanitaria Seguros, S.A. is a public limited
company with registered office at Avenida Alfonso X El Sabio, 14 in Alicante and subject to the
Spanish Law and under the supervision and control of the General Directorate for Insurance
and Pension funds of the Ministry of Economic Affairs and Digital Transformation, established
in Paseo de la Castellana 44, Madrid 28046 and with website www.dgsfp.mineco.es.

2. Insurance purpose
Within the terms and conditions stated in the policy and by means of the corresponding
premium and deductible payment, ASSSA shall provide the Insured Person, within Spain and
in the cities where ASSSA has a medical directory, with the medical, surgical and hospital
care that covers any illness or injury included in the description of the insurance policy cover
(Clause 3).

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 General Conditions · HEALTH

In any case and pursuant to section 103 of the Insurance Contract Act, ASSSA shall provide
the necessary emergency care, in accordance with the provisions in the General Conditions of
the Insurance Policy and within the services covered by this.

Under no circumstance shall it be possible to grant optional cash compensation as

a substitute for the provision of health care services.

3. Description of the cover · BASIC Programme

3.1. Primary care

• GENERAL MEDICINE.

The Insured Person shall be entitled to freely choose his/her own family doctor among
those that appear in the medical directory. The assistance shall be provided at the
doctor’s surgery or at the Insured Person’s address.

House calls shall only be carried out when, due to the type of illness, the
Insured Person cannot physically come to the doctor’s surgery.

• LOCAL PAEDIATRICS AND CHILDCARE (up to 14 years old).

The Insured Person shall be entitled to freely choose his/her own paediatrician
among those who appear in the medical directory. The assistance shall be provided
at the doctor’s surgery.

• NURSING SERVICE.

At the surgery and at the Policy Holder’s personal address (if the patient is bed
ridden) subject to an ASSSA doctor’s prescription.

3.2. Emergencies

Medical emergency care shall be provided at the permanent emergency centres that
appear in the medical directory. Assistance shall be given at home whenever the
patient’s condition requires it.

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3.3. Specialised medicine

The Insured Person shall be entitled to freely choose the specialist doctor among
those listed in the medical practitioner’s directory. Medical assistance will always be
given in the private surgery or clinic if the patient is hospitalised.

The guaranteed specialities are the following:

• ALLERGOLOGY.

• ANAESTHESIOLOGY / REANIMATION. In surgical operations and childbirth.

• ANGIOLOGY AND VASCULAR SURGERY.

• DIGESTIVE SYSTEM.

• CARDIOLOGY.

• GENERAL SURGERY (including Arthroscopic Surgery and Laparoscopic Surgery):

- General and Digestive System Surgery. ASSSA shall cover the costs and fitting of
synthetic mesh prostheses in hernias and incisional hernia operations.
- Thoracic Surgery.
- Paediatric Surgery.

• SPECIALISED SURGERY (HIGHLY SPECIALISED SURGERY):

- Cardiovascular Surgery.
- Maxillofacial Surgery.
- Plastic and Reconstructive Surgery.
- Lung and Mediastinum Surgery.
- Ear Microsurgery.
- Neurosurgery.

To apply for Highly Specialised Surgery, it is necessary to obtain authorisation from

Entity’s Offices. This must be accompanied with the medical history issued by a
specialist belonging to the ASSSA’s team of medical practitioners.

• DERMATOLOGY.

• ENDOCRINOLOGY AND NUTRITION.

• GERIATRICS.

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 General Conditions · HEALTH

• HAEMATOLOGY.

• INTERNAL MEDICINE.

• NEPHROLOGY.

• NEONATOLOGY.

• NEUMOLOGY.

• NEUROLOGY.

• OBSTETRICS AND GYNAECOLOGY. Including:

- Control of anovulatory treatment.

- IUD fitting and observation (the device shall be paid for by the Insured Person).
- Pregnancy supervision by an obstetrician and childbirth assistance by the said
specialist.
- Tubal ligation.

• ODONTOLOGY – STOMATOLOGY. Including:

- Extractions.
- Stomatological cures.
- Annual tooth cleaning prescribed by an ASSSA odontologist.

• OPHTHALMOLOGY.

This includes biometry and monofocal intraocular lenses in cataract operations.

• MEDICAL ONCOLOGY.

Diagnosis, planning and follow- up of the treatment provided by the oncologist.

• OTORRHINOLARYNGOLOGY.

• PROCTOLOGY.

• PSYCHIATRY.

• RHEUMATOLOGY.

• TRAUMATOLOGY.

• UROLOGY. Including vasectomy.

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3.4. Diagnosis methods

They shall always be prescribed in advance by doctors belonging to the ASSSA medical
directory and authorised by Entity’s Offices. Contrasts are included in outpatient
diagnoses.

• CLINIC ANALYSIS:

- Biochemistry.
- Haematology.
- Microbiology.
- Parasitology.
- Pathology:
• Surgical Pathological Anatomy.
• Cytopathology. Includes the Papanicolaou test for HPV.
• Detection of sentinel node in breast pathologies.
• Immunohistochemistry for the detection of tumour markers and diagnosis of
neoplasias.

• SIMPLE RADIOLOGY:

- Radioscopy and radiographies.

- Orthodiagram.
- Ultrasounds.
- Urography.
- Cystography.

• OTHER DIAGNOSIS METHODS:

- Allergology: Spirometry, Allergy Tests (SKIN-PRICK TEST), Bronchodilation Tests,

Epicutaneous Tests (PATCH TEST), Rhinomanometry.

- Angiology and Vascular Surgery: Arterial and Venous Doppler Ultrasound of

Upper or Lower Limbs, Doppler Ultrasound of Visceral Arteries, Doppler Ultrasound
of Supra-aortic Trunks.

- Digestive system: Esophagoscopy, Gastroscopy, Colonoscopy, Sigmoidoscopy,

Anoscopy, Oesophageal Manometry and PH monitoring. Includes conscious
sedation for guaranteed digestive endoscopies.

- Cardiology: Electrocardiogram, Echocardiogram, Cardiac Doppler.

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 General Conditions · HEALTH

- Nuclear Medicine: Bone, Thyroid, Renal and Pulmonary perfusion scintigraphy.

Partial or focalised Bone Densitometry, Isotopic Renogram and Cerebral, Bone and
Cardiac SPECT.

- Pulmonology: Spirometry, Arterial Gasometry, Pulse Oximetry, Bronchoscopy

(Bronchial Fibreoptic Endoscopy).

- Clinical Neurophysiology: Electroencephalogram, Electromyography, Evoked

Potentials: Auditory, Somatosensory, Visual and Cognitive.

- Gynaecology and Obstetrics: Colposcopy, Mammography, Diagnostic

Laparoscopy, Monitoring. Amniocentesis when there are circumstances of direct
family history or high risk pregnancy according to the medical judgement of the
ASSSA specialist. Triple Screening.

- Ophthalmology: Angiography, Retinography, Computerized Campimetry,

Biometrics, Gonioscopy, Pachymetry.

- ENT: Audiometry, Rhinofibrolaryngoscopy (Nasal fibroendoscopy),

Electronystagmography.

- Urology: Flowmetry, Urethrocystoscopy, Cystoscopy, Urodynamic Studies.

• HIGH TECH DIAGNOSIS METHODS:

- Digital Angiography of the Upper or Lower Limbs, Cerebral, Carotid, Supra-aortic

Trunks, Pulmonary, Renal and Abdominal.
- Ergometry.
- Vascular Hemodynamics: Coronary angiography.
- Holter.
- Polysomnography.
- NMR (Nuclear Magnetic Resonance).
- CT (Computed Axial Tomography).

3.5. Hospitalisation

At the medical centre appointed by the Entity and always subject to prior written
prescription from a Company doctor and within the following terms:

• MEDICAL EMERGENCY HOSPITALISATION.

In an individual room with an additional bed for the accompanying person. The
expenses of the room, board for the patient and the necessary tests carried out to obtain
a diagnosis shall be covered by ASSSA for a maximum period of 3 days per process.

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 Having obtained the diagnosis, the hospitalisation will be governed by provisions
stated hereinafter.

• SURGICAL HOSPITALISATION.

In an individual room with an additional bed for the accompanying person. The
expenses of the room and board for the patient, operation theatre, anesthetic
products, medical dressings and medication from the moment of the operation until
the discharge of the patient shall be covered by ASSSA.

• MEDICAL HOSPITALISATION.

In an individual room with an additional bed for the accompanying person for the
treatment of any of the following illnesses: myocardial infarctions or coronary
failures, acute comatose conditions, internal haemorrhages and acute respiratory
insufficiencies. The expenses of the room and board for the patient shall be covered
by ASSSA for a maximum period of 7 days per year and per Insured Person.

• PAEDIACTRIC HOSPITALISATION.

In an individual room with an additional bed for the accompanying person for the
treatment of any of the following illnesses: dehydration, acute respiratory conditions
and acute comatose conditions. The expenses of the room and board for the patient
shall be covered by ASSSA for a maximum period of 7 days per year and per
Insured Person.

• OBSTETRICS HOSPITALISATION (Childbirth).

In an individual room with an additional bed for the accompanying person. ASSSA
will cover the expenses of room and board given to the mother, operation theatre
or delivery room, anesthesia (epidural anesthesia included), medical dressings,
medication and incubator.

• POST-SURGERY HOSPITALISATION IN THE ICU UNIT (Intensive Care Unit).

For surgical operations that require post-operative care in the ICU. The expenses of
the room and board given to the patient, medical dressings and medication shall be
covered by ASSSA for a maximum period of 3 days per process.

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 General Conditions · HEALTH

3.6. Special treatments (therapeutical methods)

They shall be carried out by the services appointed by the Entity, always subject
to prior prescription written by a specialist medical practitioner from the Entity and
previously authorised by the Entity’s offices.

• VASCULAR HEMODYNAMICS.

Coronary angioplasty (including stents).

• LASERTHERAPY.

It will be carried out in the locomotor system and ophthalmologic treatments (Yag and
argon laser), and for a maximum of 20 sessions per treatment.

• RENAL LITHOTRIPSY.

Treatment of the renal calculi located in the urinary system by using shock waves.

• OXYGENOTHERAPY.

In case of hospital admission, provided that the Insured Person is entitled to

hospitalisation.

• RADIOTHERAPY.

Conventional radiotherapy using an Electron Linear Accelerator.

• REHABILITATION AND PHYSIOTHERAPY OF THE LOCOMOTOR SYSTEM.

This will be supplied to outpatients by the services appointed by the Entity provided
the original injury for which such services are required was acquired by the Insured
after the commencement date of cover. There is a maximum of 30 sessions per
year and per Insured Person.

• BLOOD TRANSFUSIONS.

ASSSA will cover the expenses of the medical transfusion procedure, blood, plasma
or product transfused during medical, surgical or childbirth hospitalisation, provided
that the Policy Holder is entitled to hospitalisation.

• VENTILATION THERAPY AND AEROSOLTHERAPY.

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 3.7. Other services

• AMBULANCE.

To transfer patients who need urgent medical assistance and hospitalisation by land
ambulance. The insurance covers transportation from the personal address to the
emergency centre corresponding to the insurance branch where the Insured Person
is registered.

• MIDWIFE.

For hospital assistance during childbirth.

• PRENATAL CLASSES.

For pregnant women who are in the last three months of pregnancy, provided that
they have childbirth coverage.

These shall be carried out by the services appointed by the Entity and previous
authorisation from ASSSA offices is required.

• PODOLOGIST.

Exclusively at the doctor’s surgery and there is a maximum of 6 sessions per

year and per Insured Person.

4. Exclusions

Without prejudice to any other exclusion or limitation contained in the conditions of

this policy, the following are expressly excluded from coverage:

a) Health care for diseases or injuries received as a result of civil, international

or colonial wars, riots, uprisings, repressions, military operations, revolutions
and acts of terrorism as well as care needed to treat ailments resulting from
officially declared epidemic outbreaks.

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 General Conditions · HEALTH

b) Health care for illnesses or accidents that are directly or indirectly related to
radiation, nuclear reactions or radioactive pollution, as well as those resulting
from cataclysms such as earthquakes, volcanic eruptions, floods and other
meteorological phenomena.

c) 
Health care for industrial or professional illnesses or accidents as well as
those resulting from sport competitions. Assistance needed for motor vehicle
accidents shall be provided by the compulsory motor vehicle insurance policy.
Furthermore this policy does not cover the expenses incurred when receiving
health care at Social Security centres that belong to the State Administration
or to the Autonomous Communities.

d) Health care for all types of congenital illnesses, signs and symptoms, injuries,
physical defects or deformities or those pre-existent on the date of entry of
each Insured Person, as well as their consequences. The only exceptions are
those declared by the Policy Holder or the Insured Person when filling in the
health questionnaire and which have been clearly accepted by the Insurer in
the Private Conditions.

e) Health care for chronic alcoholism, drug addiction, inebriation, intoxication with
psychoactive drugs, narcotics or hallucinogens, attempted suicide, self-inflicted
injuries, injuries as a result of fights (unless in self-defense), as well as care for
illnesses or accidents caused by willful misconduct of the Insured Person.

f) Diagnosis, treatment and operations merely for aesthetic purposes.

g) Sterility or infertility studies or treatment.

h) Health care for infections caused by the Human Immunodeficiency Virus (HIV),
AIDS and related diseases.

i) Organs, tissues and cell transplants, as well as corrective surgery for myopia,
astigmatism and hypermetropia and sex change and obesity surgery.

j) A
 ny type of prostheses, osteosynthesis material, biological or synthetic
material as well as anatomic and orthopaedic devices, which shall always
be paid by the Insured Person, except for the provisions in Clause 3 of this
contract. Under no circumstances shall prostheses be covered if the surgical
operation required for their fitting is not eligible for cover either.

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 k) Vaccines and radiopharmaceuticals.

l) Psychology, psychoanalysis, hypnosis, individual or group psychotherapy and

psychological tests.

m) 
Voluntary termination of pregnancy, the required tests for this and its
consequences.

n) Health care for social reasons.

o) Payment of medical practitioners fees that are not included in ASSSA’s medical
directory, as well as the expenses for hospitalisation, diagnosis methods or
treatment that these aforementioned doctors may prescribe.

p) Any type of medication, with the exception of that clearly specified as

being covered in clause 3 of this policy contract.

q) Diagnostic and therapeutic procedures and surgical techniques and medical

treatments that are not expressly detailed as being covered in this contract.

r) Genetic tests or any method of treatment or genetic and/or molecular

diagnosis except those expressly detailed as being covered in Clause 3.

5. How services are provided

5.1. 
Covered medical care shall be provided in all towns where ASSSA has a medical
directory. If any of the services covered by this contract is not available in a particular
town, they shall be provided in any other city where the service is available and the
transport expenses will be assumed by the Insured Person.

5.2. The Insured Person may freely choose any of the doctors listed in the current medical
directory to receive the assistance required in agreement with the coverage stipulated
in this present policy. Data which appears in the medical directory should be confirmed
and an appointment should be requested by telephone. The Insured Person should
always identify himself/herself as being an ASSSA Insured.

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 General Conditions · HEALTH

On receiving health care the Insured Person must present his/her ASSSA health card
and, if so required, an identity document.

5.3. Home visits are only made when the patient, due to his/her condition cannot
physically come to the doctor’s surgery. Morning visits have to be requested
before 09:00 hours and afternoon visits before 16:00 hours. Those calls received after
such time shall be attended the following day, except emergencies. In this case the
Insured Person should request this emergency assistance at the designated clinic
which appears listed in the Company’s medical directory.

The Nursing service always requires a written prescription from an ASSSA doctor. The
provision of this service at the patient’s home is governed by the same rules as the
aforementioned home visits.

The Insurance Company is only obliged to provide home assistance at the address
that appears in the Insured Person’s policy. The Company must be notified of any
change of address by whatever reliable means possible at least eight days prior to
request any of the home services offered.

Home services will be provided in those towns in which the Insurer has
arranged this type of service. Services provided at home are those related
to General Medicine, Nursing, Emergency and Ambulance.

5.4. The provision of some services must be prescribed by a Company doctor and the
Insured Person should also obtain authorization from the ASSSA offices. Once
authorized, the expenses will be assumed by the Company, except when it is clearly
stated that such assistance is not covered by the policy.

Hospitalisation, diagnosis methods, special treatments, medical check-ups and some

specialities listed in the medical directory in force also require such authorization.

In emergencies, a Company doctor’s order or prescription shall be sufficient, although

the Insured Person has to get this confirmed by the Company within
seventy-two hours from when he/she is admitted to hospital. In this last case,
the Company shall be economically liable for the expenses incurred until the moment
it raises objections against the doctor’s prescription, on the understanding that the
policy does not cover such medical assistance or hospitalisation.

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 The Insured Person must request emergency assistance either by telephone or in person¸
accordingly, at the nearest emergency centre listed in the ASSSA medical directory.

5.5. ASSSA is obliged to provide the guaranteed coverage in the terms established
in the policy, not being bound by the decisions that the professionals,
whether they belong or not to its medical staff, may adopt and that are not
covered under this contract.

6. Payment of premiums

6.1. Pursuant to section 14 of the Insurance Contracts Act, the Policy Holder is obliged
to pay the premium, which shall be verified at the Policy Holder’s address, unless
otherwise established in the Private Conditions.

Such payment obligation is a single obligation for the time the policy is in
force. The Policyholder may request the payment of the annual premium in
monthly, quarterly or semi-annual instalments that may be agreed in the
Special Conditions. Splitting the premium into instalments does not relieve
the Policyholder of their obligation to pay the full annual premium.

In the event of early termination of the contract attributable to the

Policyholder, the part of the annual premium not consumed will correspond
to the Insurer, since the premium is unique for the contractual period
regardless of whether its fractionation is permitted.

6.2. The first premium or instalment shall be claimed once the contract has been signed; if
it has not been paid by the Policy Holder, the Insurer is entitled to cancel the contract
or to demand payment through legal action based on the terms of the policy. If the
premium remains unpaid at the time of an incident or accident, the Insurer will be free
from any type of responsibility, unless otherwise agreed.

6.3. In case of failure in payment of second or subsequent premiums or instalments, cover
shall be withdrawn a month after the due date of the unpaid instalment and, if the
Insurer does not claim payment within the six-month period following such due date, the
contract shall be deemed terminated. If the contract has not been terminated or expired

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 General Conditions · HEALTH

according to the previous conditions, cover shall be back in force twenty-four hours after
the payment of premium by the Holder. If the payment of the premium is pending when
an incident occurs, the Insurer is free from all responsibilities, except otherwise agreed.

When paying by instalments, failure in payment of any premium part shall give the
Insurer, in accordance with the above conditions, the right to claim the total amount of
the annual premium that the Holder has not yet satisfied.

6.4. The Insurer shall only be bound by those receipts issued by its own Management or by
its legally authorized representatives.

Premium payment to an exclusive Insurer’s Agent shall have the same effects as if done
directly to the Company.

6.5. The following regulations shall apply if payment by standing order is agreed in the
Private Conditions.

a) The Policyholder will hand over to the Company a duly signed direct debit or
SEPA debit order, authorising the payment of receipts issued by the Company
from the effective date of the policy.

b) The premium shall be considered satisfied on its due date, unless there is not
enough cash in the Policy Holder’s account when tried its charging within thirty
calendar days. In such a case, the Insurer shall notify the Holder that the receipt
is at his or her disposal at the Company’s address and the Holder shall have to
satisfy the premium at the said address.

c) If the period of thirty calendar days set in the previous paragraph goes by without
the Insurer presenting the receipt for collection or when doing so, there is not
enough cash in the Policy Holder’s account, the Insurer shall have to notify the
Insured Person about this fact by letter or using any other reliable means, giving
him/her a new period of thirty calendar days to let the Insurer know about how he/
she shall satisfy the amount. Such period shall begin to count from the reception of
the letter or notice at the last address given by the Insured to the Insurer.

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7. Liabilities of the Policy Holder and/or the
Insured Person

The Policy Holder and, when appropriate, the Insured Person, has the following liabilities:

7.1. Before the contract is concluded, pursuant to the health questionnaire that has to be
answered, any and all the factors that might affect the risk assessment have to be
communicated to the Insurer. The Insured person or Policy Holder is only exempt of
this when the Insurer does not submit them to any questionnaire or when the exact
circumstances are not mentioned in the aforementioned questionnaire, even though
they might affect the risk assessment.

The Insurer shall have the right to cancel the contract by

 means of an
statement addressed to the Policy Holder which is issued within the period of
one month after discovering the Policy Holder’s non-disclosure or inaccuracy
of information. The premiums related to the period when this cancellation statement is
issued, shall correspond to the Insurer, unless willful misconduct or gross negligence has
been committed by this party.

If an incident occurs before the Insurer has issued the aforementioned
statement, the Insurer’s assistance shall be proportionally reduced to the
difference between the agreed premium and the premium that would have
been applied if the real extent of the risk had been known. In the event of willful
misconduct or gross negligence on the part of the Policy Holder, the Insurer shall
be released from payment of benefits (section 10 of the Insurance Contracts Act).

7.2. Any change in address has to be communicated to the Insurer as soon as possible.

7.3. The Insurer has to be notified as soon as possible of any new membership or
withdrawal by the Insured Persons that take place when this contract is still in force.
New memberships are considered valid on the first day of the month following the
Policy Holder’s notification and any withdrawal at the end of the annual period of the
current year. In either case the premium will be adapted to the new circumstances of
the policy.

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 General Conditions · HEALTH

Newborn children are entitled to be included in the mother’s policy from the moment
they are born. To that effect, the Policy Holder must notify the Insurer of this within 7
calendar days following the birth, by filling in an insurance application. New inclusions of
this kind will take effect on the date of birth, and waiting periods applied to the newborn
shall not be longer than the period the mother has still to wait to receive benefits.

If the newborn’s membership has started outside the stipulated time period,
a health questionnaire will have to be filled in and the Insurer can refuse
the membership request. If the new membership is accepted, waiting periods
established in the General Conditions of the scheme will be applied.

In any case, the Insurer shall cover health care expenses for the newborn

during the first 7 calendar days following the birth. This coverage will end,
however, after this said period if his/her entry is not requested within the time
period stipulated in this section.

7.4. To reduce the consequences of the incident, using all the means possible for a
speedy recovery. Non fulfilment of this duty will free the Insurer from all
responsabilities to provide the assistance needed.

7.5. If any healthcare action excluded from the cover is found by the Insurer, it will be entitled
to claim the amount to the Insured Person or the Insurance Company responsible for
the coverage of such actions on the basis of a civil liability or health insurance. The
Insured Person is obliged to collaborate so that subrogation to the Insurance is fully
effective and the recovery of the medical costs excluded from coverage is successfully
done. In case of breach of duty of collaboration, the costs of the healthcare
assistance will be chargeable to the Insured Person.

8. Rights of the Policy Holder and/or Insured Person

8.1. Those listed in Clause 3 under the Description of Insurance Coverage.

8.2. On receiving the policy and within a period of one month, the Policy Holder and/or
Insured Person is entitled to request that the Insurer rectify any divergence found
between this policy and the original insurance application or the agreed clauses.

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 8.3. Moreover, the Policy Holder and/or Insured Person is entitled to have the policy written
in any of the official Spanish languages of the place where the policy is concluded
or in a different language if so required in accordance with Directive 92/96 of the
European Community and section 8 of the Insurance Contracts Act.

9. Liabilities of the Insurer

9.1. In addition to providing the contracted health assistance, the Insurer shall give the
Policy Holder the policy or, if this is not possible, the provisional coverage document,
as well as a copy of the health questionnaire and any other documents signed by the
Policy Holder.

9.2. Furthermore, the Insurer shall make available to the Policy Holder the health card
and make available the list of approved medical services specifying the permanent
emergency centre or centres, hospitals, clinics and the addresses of the different
medical specialists.

10. Policy duration

The Insurance is valid for the time period that is stipulated in the Private Conditions and
which comes into effect as from the date when the contract is signed until the thirty- first of
December of that current year. On expiry, the policy shall be automatically renewed for annual
periods.

However, the Policy Holder may inform the Insurer of his/her wish not to renew the
contract in writing. This notification must be made and received at least one month
before the expiry date of the current period in order to be effective.

The Insurer may only cancel the contract in the case of willful misconduct or bad faith on the
part of the Policy Holder and/or the Insured Person.

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 General Conditions · HEALTH

11. Waiting periods

11.1. All services undertaken by ASSSA in accordance with the policy shall be provided from
the effective entry date of each Insured Person in the policy. The following services are
excluded from this general principle:

a) 
Surgical operations and hospitalisation, which require a six-month
waiting period.

b) Birth assistance, which shall have a waiting period of 8 months.

c) High technology diagnosis methods (digital arteriography, ergometry,

vascular hemodynamic, holter, polysomnography, nuclear magnetic
resonance and CAT Scans), which all require a six-month waiting period.

d) Special treatments like radiotherapy, chemotherapy, laser therapy, renal

lithotripsy, artificial kidney and peritoneal dialysis shall require a six-month
waiting period.

e) Prostheses shall require a twelve-month waiting period.


Waiting periods shall not be applied to surgical operations and dystocial labours that
take place in an extreme emergency situation.

11.2. Waiting periods may be eliminated or reduced, subject to the Company’s authorization,
if the person to be insured is submitted to a medical examination beforehand. In
this case, the examination shall be carried out by ASSSA medical services and the
applicant shall pay for the expenses incurred.

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12. Loss of rights, cancellation and indisputability of
the contract

12.1. The Insured Person loses the right to the guaranteed provision of services:

a) In the case of non-disclosure or inaccuracy of data when filling in the

health questionnaire, the Insurer is entitled to cancel the contract
through a statement addressed to the Policy Holder and which is issued
within the period of one month starting from when the aforesaid non-
disclosure or inaccuracy was discovered. The premiums related to when
this statement is issued, shall correspond to the Insurer, unless willful
misconduct or gross negligence has been committed on its part.

If an incident occurs before the Insurer has issued the aforementioned
statement, the assistance provided shall be reduced proportionally to the
difference between the agreed premium and the premium that would
have been applied if the real extent of risk had been known. In the event
of willful misconduct or gross negligence on the part of the Policy Holder,
the Insurer shall be released from the responsibility to cover the expenses
of the assistance provided (Section 10 of the Insurance Contracts Act).

b) When the incident is caused by the Insured Person in bad faith (section
19 of the Insurance Contracts Act).

c) Unless otherwise agreed, if the premium has not been paid before the
incident occurs (section 15 of the Insurance Contracts Act).

12.2. The Insured Person shall have the right to cancel the contract on the grounds of
changes in the medical directory and provided that these changes affect 50% of the
specialists listed. The Insurer must be notified about this decision in a reliable way.
This rule shall not apply in case of a justified temporary substitution, or
when it refers to doctors administering special surgical techniques, as well
as odontologists, analysts and electro- radiologists.

19
 General Conditions · HEALTH

12.3.On having carried out a medical examination or having acknowledged full rights, the
policy shall be indisputable in terms of the Insured Person or persons’ health and the
Company shall not be able to deny its services on the grounds of previous existing
illnesses, unless, as a consequence of the said examination, it is expressly set down
as an exception in the Private Conditions.

If neither the medical examination had been performed nor had full rights
been acknowledged, the policy shall be deemed indisputable one year from
the conclusion of the contract, unless the Policy Holder and/or the Insured
Person had shown a willful misconduct.

12.4. If, on applying for the Insurance, the Policy Holder had wrongly stated the age of any
of the Insured Persons, the Insurer shall only have the right to cancel the contract
if the true ages of such Insured Persons on the date that the policy takes effect
exceed the admission limits established by the Insurer.

In the event that inaccurate information concerning the date of birth was

given, and as a direct consequence of this the paid premium is lower than what
would really have had to be paid, the Policy Holder is obliged to pay the Insurer
the difference in such premiums. On the contrary, if the amount already paid was
superior, the Insurer shall be obliged to reimburse the Holder the excess amount paid.

13. Personal data handling

13.1. 
In accordance with current European and Spanish legislation on personal data
protection, the Insurer is obliged to confidentially store data received from the
Policyholder and/or Insured. The Insurer will apply all the technical and organisational
means required to fulfil the obligations set out in current legislation.

13.2. The Insurer is expressly authorised by the Policyholder and/or the Insured to handle
the personal data for the legitimate purpose of executing the signed contract or
policy, and that are included in the questionnaires or are known as a result of claims,
and to produce the necessary files containing personal information for the sole
purpose of maintaining, developing and monitoring the legal relationship between
the Policyholder and the Insurer. The data will be stored by the Insurer during the
period required in order to fulfil the purpose for which they were collected and to
determine the possible responsibilities that may derive from this purpose and from
the data handling.

20
 13.3. The body responsible for data handling is Agrupación Sanitaria Seguros, S.A., with
the address at which the rights of access, rectification, suppression, limitation of data
handling and portability and of any other information described in Regulation (EU)
679/2016 General Data Protection may be exercised being Av. Alfonso X El Sabio, 14 –
Entlo. 03004 Alicante. A complaint may also be made before the controlling authority
(Spanish Data Protection Agency - www.aepd.es).

14. Notifications and jurisdiction

14.1. The Policy Holder and/or the Insured Person shall always send written correspondence
to the Insurance Company’s registered address that appears in the policy or to the
telematics address expressly designated by the Insurer for certain communications.

Communications made by the Policyholder and/or Insured to an ASSSA insurance

agent will have the same effects as if they had been made directly to the Insurer.

Communications made by a Broker or Insurance Broker to the Insurer on behalf of

the Policyholder and/or Insured shall have the same effects as if made directly by
the Policyholder and/or Insured, unless otherwise indicated by the latter. However,
communications made by the Policyholder and/or Insured to the Broker or Insurance
Broker are not understood to be made to the Insurer until they are received by the
same. In any case, the express consent of the Policyholder will be required to sign a
new contract or to modify or terminate the insurance contract in force.

14.2. Communications from the Insurer to the Policy Holder and/or Insured Person may be
sent to the address that appears in the policy, unless they had informed the Insurer
of a change of address and/or via electronic mail provided by the Policy Holder and/
or Insured Person at the time the insurance was contracted, provided they have not
notified of any change. The Policy Holder authorises ASSSA to use their electronic
mail to send them communications and notifications related to their policy.

14.3. This contract is hereby subject to the Spanish Jurisdiction, and relevant cases will be
heard by the competent judge who corresponds to the specific district or area where
the Insured Person resides (section 24 of the Insurance Contracts Act).

21
 General Conditions · HEALTH

15. Limitation of action

In accordance to section 23 of the Insurance Contracts Act, no party to this
contract shall have the right to bring actions related to or arising from the present
insurance contract once the period of five years has elapsed from the moment such
actions could be brought.

16. Annual update of the policy’s economic

conditions

The Insurer may annually update the amount of the premiums and the amount corresponding
to the excess.

Such updates shall take place upon each renewal and shall include the adjustments needed
to guarantee that the premium coverage fee is sufficient. These will be based on the technical-
actuarial calculations performed, on the increase in the costs of medical care services, the
increase of the assistances covered by the policy, the incorporation of new technology used in
the guaranteed coverage and which arise or are used following the conclusion of the contract
and other similar factors.

Upon receiving notification about the updating of the premiums and/or deductibles for the
following year from the Insurer, the Policy Holder is entitled to choose between the Insurance
Contract renewal, which involves accepting new economic conditions or its cancellation at the
end of the current year. If the latter is chosen, the Policy Holder has to notify the Insurer about
his/her decision in writing.

The Insurer shall inform the Policyholder of any change in the contract with two
month notice before the end of the current period.

22
17. Complaints and claims
ASSSA has a Customer Service and Customer Ombudsman located in the ASSSA offices at
the disposal of the Insured and for the purpose of attending and resolving complaints and
claims in accordance with the procedure outlined in Order ECO 734/2004, of March 11 and in the
ASSSA Customer Ombudsman Regulation.

The policyholders, insured, beneficiaries and rights holders thereof may submit their complaints
and claims to:

- Customer Services, by writing to Av. Alfonso X el Sabio, 14, 03004 Alicante or by email
to the address sacquejasyreclamaciones@asssa.es.

- Customer Ombudsman, by writing to C / Velázquez 80, 28001 Madrid, or by email to

the address reclamaciones@da-defensor.org.

The Insured or legitimate persons who prove that they have made their claim to any of the
aforementioned addresses and are not satisfied with their resolution, or that, after a period
of one month from the presentation of the same, it has not been resolved, may send their
complaint or claim to the Claims Service of the General Directorate of Insurance and Pension
Funds, by writing to the address at Paseo de la Castellana, 44, 28046 Madrid, or through the
web www.dgsfp.mineco.es.

In addition to the claim channels indicated above, they may also be raised in court before the
competent judges and courts.

23
Travel

assistance
18. Travel assistance
The Insured, resident in Spain and travelling in Spain or abroad will have the right to the
guarantees established in point 18.1 provided that the required assistance occurs within
90 consecutive days from the start of the trip and, when the Insured is more than
30km from their usual address.

18.1. Description of coverage

Medical and health care

The expenses corresponding to the intervention of professionals and health establishments

required for the care of the Insured if they are sick or injured, with a limit of €15,000
per person when the required Assistance occurs abroad and a limit of €900 per
person when this Assistance occurs in Spain.

This expressly includes but is not limited to the following services:

a) Attention by emergency medical teams and specialists.

b) Complementary medical examinations.

c) Hospitalisations, treatments and surgical interventions.

d) Medication supplied while being in hospital, or refund of its cost in injuries or illnesses
not requiring hospitalisation.

In the event of a life-threatening emergency as a consequence of an unforeseeable

complication from a chronic or pre-existing disease, only the expenses of first-response
medical care carried out as an emergency will be covered and within the first 24
hours from your admission to the hospital. The expenses covered for this cause
may in no case exceed 10% of the sum insured for the guarantee of Medical
Assistance.

25
 General Conditions · HEALTH

The costs of professional treatment for acute dental problems, understood as those that
due to infection, pain or trauma require emergency treatment with a limit of €120 per
person per year.

Repatriation or medical transportation of the injured or sick

In the event of an accident or illness of the Insured, the following will be covered:

a) Cost of ambulance to the nearest clinic or hospital.

b) Control by the medical team in contact with the doctor treating the injured or sick
Insured person to determine the most appropriate measures, the best treatment
and the most suitable means for possible transfer to another more suitable hospital
or to his or her home.

c) The costs of transferring the injured or sick person, by the most appropriate means
of transport, to the prescribed hospital centre or to their home address. The means
of transport used will be decided based on the urgency and severity of the case.
Exclusively in Europe, a specially equipped medical aircraft may be used.

If the Insured is admitted to a hospital not close to their home, the subsequent transfer to
it will be covered at the time.

In the event that the Insured does not normally reside in Spain, they will be
repatriated to the place where their trip began in Spain.

Repatriation or transportation of other Insured Persons

When in application of the guarantee of "Repatriation or medical transport of the injured or

sick" or "Repatriation or transport of the deceased Insured", one of the Insured has been
repatriated or transferred, due to illness, accident or death and this prevents their spouse,
forbears or descendants in the first degree, siblings, or a companion continuing the trip by
the initially foreseen means, cover will include transporting them to their home or to the
place of hospitalisation.

26
In the event that the persons referred to in the preceding paragraph do not
normally reside in Spain, they will be repatriated to the place where their trip
began in Spain.

Repatriation or transportation of under age or disabled children

If the Insured repatriated or transferred, in application of the guarantee of "Repatriation or

medical transport of the injured or sick", is travelling in the sole company of children with
disabilities or children under fifteen years, the round trip travel costs for a hostess or a
person designated by the Insured to accompany the children on their return home will be
covered.

In the event that the persons referred to in the preceding paragraph do not
normally reside in Spain, they will be repatriated to the place where their trip
began in Spain.

Travel of a relative in the event of hospitalisation

a) If the condition of the sick or injured Insured Person requires their hospitalisation
for a period of more than five days, the insurance will cover a round ticket by plane
(tourist class) or train (1st class) available for a relative of the Insured Person or a
person delegated by them, to accompany them.

b) 
Upon presentation of the corresponding invoices, an amount equivalent to the
companion's expenses will be paid, up to a limit of €100 per day with a maximum
of 10 days in the case of travel abroad and a limit of €50 per day with a
maximum of 10 days when the travel takes place in Spain.

c) If the Insured travels in the company of children with disabilities or those under 18
years of age and the hospitalisation is expected to exceed one day, a round trip
ticket will be made available to a relative of the Insured, or the person designated
by the latter, by plane (tourist class) or train (1st class), so they may accompany
the children. However, and pending the arrival of the family member or person
designated by the Insured, whenever possible, the arrangements and cost of hiring
a caregiver in order to take charge of the custody of the children with disability or
under 18 years of age will be covered.

27
 General Conditions · HEALTH

Convalescence in a hotel

If the sick or injured Insured cannot return home due to medical prescription, the hotel
expenses caused by the extension of stay will be covered, up to a limit of €100 per day
with a maximum of 10 days in the case of travel abroad and up to a limit of €50 per
day with a maximum of 10 days for travel in Spain.

Repatriation or transportation of a deceased Insured Person

In the event of the death of an Insured, the organisation of the transfer of the body to
the place of burial in Spain and the expenses incurred will be covered. These expenses
will be understood to include those for post-mortem handling in accordance with legal
requirements.

Burial and ceremony expenses will not be included.

The return to their home of the other Insured will be covered when they cannot do so by
the means initially foreseen.

In the event that the Insured does not normally reside in Spain, they will be
repatriated to the place where their trip began in Spain.

Travel of a relative in the event of death

a) In the event of the death of an Insured, the organisation and travel of a relative to
the place of death will be covered so that they can accompany the body on the
repatriation journey.

b) An amount equivalent to the companion's expenses will be paid against the
presentation of the corresponding invoices, up to a limit of €100 per day with a
maximum of 10 days in the case of travel abroad and up to a limit of €50 per
day with a maximum of 10 days when the travel takes place in Spain.

28
Early return due to the death of a relative

If any of the Insured has to interrupt their trip due to the death of a family member as defined
in this policy, transportation will be covered, as a round trip, by plane (economy class) or train
(1st class), to the place in which the burial in Spain takes place.

Alternatively, at their choice, the Insured may opt for two airline (tourist class) or train (1st
class) tickets, to their usual address.

Early return due to a serious loss in the home or professional

premises of the Insured

A transport ticket will be made available to the Insured to return to their home in Spain,
in the event that the Insured has to cut their trip short due to serious damage to the
main residence or professional premises of the Insured, provided that the Insured is
the person carrying out a direct activity in the premises or exercises a liberal
profession in the aforementioned premises, caused by fire, provided that this
has led to the intervention of the fire brigade, consummated theft that has been
reported to the police, or serious flooding, which makes their presence essential,
providing these situations cannot be resolved by direct family members or people they
trust, and provided the event occurred after the start date of the trip.

Likewise, the Insured will have a second ticket for the transport of the person who
accompanied the Insured and who brought forward their journey, provided this second
person is also insured by this policy.

Search, location and shipment of lost luggage

In the event of loss of luggage on a regular flight, all possible measures will be taken to
ascertain its location, inform the Insured of any news that may occur in this regard and,
where appropriate, have it reach the beneficiary without any charge for the same.

Transmission of urgent messages

Urgent messages ordered by the Insured will be transmitted, as a result of the claims
covered by these guarantees.

29
 General Conditions · HEALTH

Sending medicines abroad

In the event that the Insured, while abroad, needs a medicine that cannot be acquired in
that place, it will be located and sent through the fastest channel and subject to local laws.

Cases in which a drug is no longer manufactured or unavailable via the usual

distribution channels in Spain are excluded.

The Insured will have to reimburse the cost of the medicine, upon presentation of the
purchase invoice for the aforementioned medicine.

Interpreter Service

If, due to any of the assistance guarantees covered by this Travel Assistance policy, the Insured
requires the presence of an interpreter in a first intervention, a person will be made available to
enable a correct translation of circumstances and situations to the Insured.

Legal information abroad

In the event that the Insured has a legal problem with third parties, related to an accident
that occurred in their private life, they will be put in contact with a Lawyer, if there is one in
the locality, to arrange an interview with the Insured at their expense.

This service will be provided only in countries that maintain diplomatic relations
with Spain, except in cases of force majeure or in the case of an event beyond the
control of the Insurer. The Insurer is not responsible for the outcome of the legal
consultation.

18.2. Exclusions

The guarantees contracted do not include:

a) Acts voluntarily caused by the Insured party or those involving dishonesty or

gross negligence by them.

30
b) Chronic, congenital and/or pre-existing ailments and diseases, as well as their
consequences, suffered by the Insured prior to the start of the trip or at the
time of signing the insurance, except those expressly covered.

c) Death by suicide or injuries or diseases arising from an attempt or intentionally

caused by the Insured Person themselves, and those arising from the criminal
enterprise of the Insured Person.

d) Diseases or pathological conditions caused by the ingestion of alcohol,

psychotropic drugs, hallucinogens or any drug or substance with similar
characteristics.

e) Cosmetic treatments and the provision or replacement of hearing aids, contact

lenses, glasses, orthoses and prostheses in general, as well as any cost
resulting from childbirth or pregnancy and any type of mental illness.

f) Injuries or illnesses derived from the Insured's participation in sporting bets,

competitions or events, and the practice of sports and/or adventure activities
not expressly covered.

g) Circumstances that arise, directly or indirectly, from events caused by nuclear

energy, radioactive radiation, natural catastrophes, war, disturbances or
terrorist acts.

h) Claims that occur in those countries which, at the time of the Insured's travel
or transfer, are in a state of war or siege, insurrection or warfare of any kind or
nature, even when they have not been officially declared. These areas can be
identified when the Ministry of Foreign Affairs has issued a recommendation
not to travel for security reasons.

i) Injuries caused by the professional practice of any type of sport.

j) The rescue of people in the desert and/or at sea.

k) Any type of medical or pharmaceutical expense of less than €9.

l) The use of a medical aircraft except in Europe and always at the discretion of
the Medical Team.

31
 General Conditions · HEALTH

18.3. Notice of a claim

When making a claim that may give rise to the covered benefits, the Insured must, without
fail, contact the emergency telephone service established by the Insurer, indicating the
name of the Insured person, policy number, their location, contact telephone number and
type of assistance required. This communication may be made on reversed charges, in the
event that this is impossible the Insured may request reimbursement of the cost of the
calls made to the Company, provided they are duly documented and justified.

18.4. Additional provisions

No obligation will be assumed in connection with services that have not been
requested or that have not been carried out with a prior agreement, except in duly
justified cases of force majeure.

When a direct intervention is not possible in the provision of services, the Insured will be
reimbursed for duly accredited expenses derived from such services, within a maximum
period of 40 days from the presentation thereof.

32
 Other

Programmes
 General Conditions · HEALTH

STANDARD Programme

Standard
Clause 3 of the General Conditions of this programme concerning the “DESCRIPTION OF THE
INSURANCE COVERAGE” has been extended and modified in regard to the following services:

• MEDICAL HOSPITALISATION. In an individual room with an additional bed for the

accompanying person in a medical centre appointed by the Company and subject
to written prescription issued by a Company’s doctor for the treatment of any of
the following illnesses: myocardial infarctions or coronary failures, acute comatose
conditions, internal haemorrhages and acute respiratory insufficiencies. The
expenses of the room and board for the patient shall be covered by ASSSA for a
maximum period of 30 days per year and per Insured Person.

• PAEDIATRIC HOSPITALISATION. In an individual room with an additional bed for

the accompanying person in a medical centre appointed by the Company and subject
to written prescription issued by a Company’s doctor for the treatment of any of the
following illnesses: dehydration, acute respiratory conditions and acute comatose
conditions. The expenses of the room and board for the patient shall be covered by
ASSSA for a maximum period of 30 days per year and per Insured Person.

• ICU HOSPITALISATION (Intensive Care Unit). For the treatment of non surgical
cardio-vascular illnesses. The expenses of the room and board for the patient shall be
covered by ASSSA for a maximum period of 15 days per year and per Insured
Person.

• PSYCHIATRIC HOSPITALISATION. In a room without an additional bed for

the accompanying person, in a psychiatric hospital appointed by the Company and
subject to written prescription issued by a Company’s doctor for the treatment of
acute outbreaks. A maximum of 30 days is covered per year and per Insured
Person.

• CLINICAL ONCOLOGY AND CHEMOTHERAPY. Chemotherapy counselling and

treatment including, where appropriate, outpatient anti-tumour medication as
required, as long as the medication is covered by the present policy and is prescribed
by a Specialist ASSSA Oncology doctor. As regards medication, ASSSA will pay the
cost of hospital use medication for parenteral administration, when this is available
nationally, authorized by the Dirección General de Sanidad and listed in Group L01

34
 of the ATC medicine classification, in accordance with the anatomic classification of
medications in the State of Spain, described in Royal Decree 1348/2003 of 31st October
and successive updates, up to the Order of the Ministry of Health and Consumer
Affairs 78/2008, of 17th January, in which those medications of Subgroup L01X
were specifically excluded from said classification.

• ARTIFICIAL KIDNEY AND PERITONEAL DIALYSIS. In an individual room with

an additional bed for the accompanying person, in a medical centre appointed by
the Company and subject to written prescription issued by an ASSSA doctor for
the treatment of acute but reversible renal insufficiencies and for the time
needed.

35
 General Conditions · HEALTH

PLUS Programme

Clause 3 of the General Conditions of this programme concerning the “DESCRIPTION OF THE
INSURANCE COVERAGE” has been extended and modified in regard to the following services:

• MEDICAL HOSPITALISATION. In an individual room with an additional bed for the

accompanying person, in a medical centre appointed by the Company and subject
to written prescription issued by a Company’s doctor for the treatment of any of the
following illnesses: renal lithiasis (nephritic syndrome), biliary lithiasis (biliary colic),
cholecystitis, diverticulitis, acute pyelonephritis, acute gastroenteritis, dehydration,
acute pancreatitis, arterial and venous thrombosis –either superficial or deep-, myocardial
infarctions or coronary failures, acute comatose conditions, internal haemorrhages

Plus
(haematemesis, haemoptysis, rectal bleeding, haematuria and brain haemorrhages
-CVA- cerebral vascular accident) and acute respiratory insufficiencies (acute bronchitis,
bronchial asthma, pneumonia). The expenses of the room and board for the patient shall
be covered by ASSSA for a maximum period of 60 days per year and per Insured
Person.

• PAEDIATRIC HOSPITALISATION. In an individual room with an additional bed for the

accompanying person, in a medical centre appointed by the Company and subject to
a written prescription issued by a Company’s doctor for the treatment of any of the
following illnesses: dehydration, acute respiratory conditions and acute comatose
conditions. The expenses of the room and board for the patient shall be covered by
ASSSA for a maximum period of 60 days per year and per Insured Person.

• ICU HOSPITALISATION (Intensive Care Unit). For the non-surgical treatment of

cardio-vascular diseases and conditions. The expenses of the room and board for the
patient shall be covered by ASSSA for a maximum period of 30 days per year
and per Insured Person.

• POST–SURGERY HOSPITALISATION IN THE ICU (Intensive Care Unit). For

surgical operations that require post-operative care in the ICU. The expenses of the
room and board for the patient shall be covered by ASSSA for a maximum period
of 5 days per process.

36
• PSYCHIATRIC HOSPITALISATION. A room without an additional bed in a
psychiatric hospital appointed by the Company and subject to a written prescription
issued by a Company’s doctor for the treatment of acute outbreaks. A maximum
period of 45 days is covered per year and per Insured Person.

• CLINIC ONCOLOGY AND CHEMOTHERAPY. Chemotherapy counselling and

treatment including, where appropriate, outpatient anti-tumour medication as
required, as long as the medication is covered by the present policy and is prescribed
by a Specialist ASSSA Oncology doctor. As regards medication, ASSSA will pay the
cost of hospital use medication for parenteral administration, when this is available
nationally, authorized by the Dirección General de Sanidad and listed in Group L01
of the ATC medicine classification, in accordance with the anatomic classification of
medications in the State of Spain, described in Royal Decree 1348/2003 of 31st October
and successive updates, up to the Order of the Ministry of Health and Consumer
Affairs 78/2008, of 17th January, in which those medications of Subgroup L01X
were specifically excluded from said classification.

• ARTIFICIAL KIDNEY AND PERITONEAL DIALYSIS. In an individual room with

an additional bed for the accompanying person, in a medical centre appointed by
the Company and subject to written prescription issued by an ASSSA doctor for
the treatment of acute but reversible renal insufficiencies and for the time
needed.

• ANNUAL MEDICAL CHECK-UP. Carried out by the services appointed by the

Company and previously authorized. The following services are covered in this
programme:

- Women. For prevention and early diagnosis of:

1. 
Breast and/or gynaecologic diseases. This includes: consultation and
clinical examination by the specialist doctor, smear test and mammography,
breast and gynaecologic ecographies.

2. Osteoporosis. Bone density scan.

37
 General Conditions · HEALTH

- Men. For prevention and early diagnosis of:

1. Urologic diseases. This includes: Consultation and clinical examination by

the specialist doctor, urologic ecography and analytical test to control the
PSA (Prostate Specific Antigen).

2. Coronary diseases. This includes: Consultation and clinical examination by

the specialist doctor and electrocardiogram.

Should any problem be detected as a result of such examinations, the necessary

additional tests shall be carried out subject to written prescription issued by the
ASSSA’s specialist doctor.

• HIGH TECH DIAGNOSIS METHODS.

- Transoesophageal Echocardiography.

- Multiparametric MRI (prostate pathologies).

- CT angiography.

- MR angiography.

• REHABILITATION.

- Lymphatic Drainage Rehabilitation.

- Pelvic Floor Rehabilitation.

- Vestibular Rehabilitation (vertigo).

- Cardiac rehabilitation (post- surgical operation).

- Post-cerebral vascular accident rehabilitation (CVA).

This shall be an outpatient service, prescribed and treated by ASSSA’s specialist


doctors and previously authorized at the Company’s offices. Limit: 30 sessions per
year and per Insured Person.

• RADIOTHERAPY. Conventional radiotherapy using an Electron Linear Accelerator

and three-dimensional planning. These will be carried out by medical services as
designated by the Company and always on presentation of a prescription by a
specialist in the same discipline with the authorization of an ASSSA office.

38
 MASTER Programme

Clause 3 of the General Conditions of this programme concerning the “DESCRIPTION OF THE
INSURANCE COVERAGE” has been extended and modified in regard to the following services:

• EMERGENCY MEDICAL HOSPITALISATION. This includes the provision of

medication in the emergency medical hospital until the diagnosis is confirmed and
for a maximum period of 3 days per process.

• MEDICAL HOSPITALISATION. In an individual room with an additional bed for the

accompanying person, in a medical centre appointed by the Company and subject to
a written prescription issued by a Company’s doctor for the treatment of any of the
following illnesses: renal lithiasis (nephritic colic), biliary lithiasis (biliary colic), cholecystitis,
diverticulitis, acute pyelonephritis, acute gastroenteritis, dehydration, acute
pancreatitis, arterial and venous thrombosis –either superficial or deep-, myocardial
infarctions or coronary failures, acute comatose conditions, internal haemorrhages
(haematemesis, hemoptysis, rectal bleeding, haematuria and brain haemorrhages
-CVA- cerebral vascular accident) and acute respiratory insufficiencies (acute bronchitis,
bronchial asthma, pneumonia). The patient’s room and board expenses shall be paid
by ASSSA. Hospitalisation cover is UNLIMITED and the hospitalisation period shall
be decided by the ASSSA doctor who is in charge of attending the patient. Cost of
Master

medicines is included.

• PAEDIATRIC HOSPITALISATION. In an individual room with an additional bed

for the accompanying person, in a medical centre appointed by the Company and
subject to a written prescription issued by a Company’s doctor for the treatment
of any of the following illnesses: dehydration, acute respiratory conditions and
acute comatose conditions. The patient’s room and board expenses shall be paid
by ASSSA. Hospitalisation cover is UNLIMITED and the hospitalisation period shall
be decided by the ASSSA doctor who is in charge of attending the patient. Cost of
medicines is included.

• ICU HOSPITALISATION (Intensive Care Unit). For the medical, non-surgical

treatment of cardiovascular diseases and conditions, AF (Atrial Fibrillation), internal
bleeding and stroke (non-haemorrhagic stroke). The patient’s room and board
expenses shall be covered by ASSSA for a maximum period of 60 days per year
and per Insured Person.

39
 General Conditions · HEALTH

• POST–SURGERY HOSPITALISATION IN THE ICU (Intensive Care Unit). For

surgery that requires post-surgery care in the ICU. The expenses of the room and
board for the patient shall be covered by ASSSA for a maximum period of 7 days
per process.

• PSYCHIATRIC HOSPITALISATION. A room without an additional bed in a

psychiatric hospital appointed by the Company and subject to written prescription
issued by a Company’s doctor for the treatment of acute outbreaks. The patient’s
room and board expenses shall be covered by ASSSA. A maximum period of 60
days is covered per year and per Insured Person.

• CLINICAL ONCOLOGY AND CHEMOTHERAPY. Chemotherapy counselling and

treatment including, where appropriate, outpatient anti-tumour medication as
required, as long as the medication is covered by the present policy and is prescribed
by a Specialist ASSSA Oncology doctor. As regards medication, ASSSA will pay the
cost of hospital use medication for parenteral administration, when this is available
nationally, authorized by the Dirección General de Sanidad and listed in Group L01
of the ATC medicine classification, in accordance with the anatomic classification of
medications in the State of Spain, described in Royal Decree 1348/2003 of 31st October
and successive updates, up to the Order of the Ministry of Health and Consumer
Affairs 78/2008, of 17th January, in which those medications of Subgroup L01X
were specifically excluded from said classification.

• ARTIFICIAL KIDNEY AND PERITONEAL DIALYSIS. In an individual room with

an additional bed for the accompanying person, in a medical centre appointed by
the Company and subject to a written prescription issued by an ASSSA doctor for
the treatment of acute but reversible renal insufficiencies and for the time
needed.

• ANNUAL MEDICAL CHECK-UPS. Carried out by the services appointed by the

Company and previously authorized. The following services are included in this
programme:

- Women. For the prevention or early diagnosis of:

1. 
 Breast and/or gynaecologic diseases. This includes: consultation and
clinical examination carried out by the specialist doctor, smear test and
mammography, breast and gynaecologic echographies.

2. Osteoporosis. Bone density scan.

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 - Men. For the prevention and early diagnosis of:

1. Urologic diseases. This includes: Consultation and clinical examination by

the specialist doctor, urologic echography and analytical tests to control the
PSA (Prostate Specific Antigen).

2. Coronary diseases. This includes: Consultation and clinical examination by

the specialist doctor and electrocardiogram.

- Women and Men:

1. Clinic Analysis. This includes: Complete haemogram with ESR, iron and
ferritin, glucose, urea, creatinine, uric acid, total cholesterol, HDL cholesterol,
LDL cholesterol, triglycerides, GOT, GPT, GGT, TSH (women), total PSA (men).

2. For the prevention or early diagnosis of colon cancer. This includes:

Consultation and clinical examination by the specialist doctor and
colonoscopy.

Should any problem be detected as a result of such examinations, the necessary

additional tests shall be carried out subject to a written prescription issued by the
ASSSA’s specialist doctor.

• HIGH TECH DIAGNOSIS METHODS.

- Transoesophageal Echocardiography.

- Multiparametric MRI (prostate pathologies).

- CT angiography.

- MR angiography.

• REHABILITATION.

- Lymphatic Drainage Rehabilitation.

- Pelvic Floor Rehabilitation.

- Vestibular Rehabilitation (vertigo).

- Cardiac rehabilitation (post- surgical operation).

- Post-cerebral vascular accident rehabilitation (CVA).

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 General Conditions · HEALTH

These shall be an outpatient service, prescribed and treated by ASSSA’s specialist

doctors and previously authorized at the Company’s offices. Limit: 40 sessions per
year and per Insured Person.

• SPECIAL TREATMENTS (therapeutic methods).

ANGIOPLASTIES:

- Carotid.

- Subclavian.

- Renal.

- Iliac.

- Femoral.

- Popliteal.

- Tibial.

They will be carried out by the services designated by the Insurer for Atherosclerosis
treatment. Prior to their performance, they will require a written prescription from an
ASSSA specialist doctor and authorisation issued by the Insurance Company's offices.

• PROSTHESES. ASSSA shall pay the cost of the prostheses up to a maximum of:

- 1.500 euros per year and Insured, for:

• Osteosynthesis material.
• Stent insertion in angioplasties (carotid, subclavian, renal, iliac, femoral, popliteal
and tibial).

- 3.000 euros per year and Insured, for:

• Traumatic internal hip and knee prostheses.
• Vascular By-pass prosthesis.
• Heart valves and pacemakers.

• RADIOTHERAPY. Conventional radiotherapy using an Electron Linear Accelerator

and three-dimensional planning. These will be carried out by medical services as
designated by the Company and always on presentation of a prescription by a
specialist in the same discipline with the authorization of an ASSSA office.

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• AMBULANCE. This includes the Insured Person’s return journey from the contracted
hospital to their home after surgery when there is a physical impossibility that
prevents them from using ordinary public transport services or private vehicles.
Under no circumstances shall a person be entitled to this cover if the
surgical intervention itself is not covered.

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 General Conditions · HEALTH

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 Customer
Service
Helpline

965 200 106

AGRUPACIÓN SANITARIA SEGUROS S.A.

Company founded in 1935