What does health
insurance cover?
Cover, policy types, waiting periods and what to ask before you sign. An honest guide written by people who have been advising on insurance for 50 years.
What it is and what it's for
Private health insurance gives you access to medical care without depending on public-health waiting lists. You choose the doctor, you choose when and, in most cases, you choose where.
It doesn't replace the public system — it complements it. And in many cases it's the difference between waiting weeks for a diagnostic test or having it in days.
What health insurance
usually covers
General practice
No waiting times and no compulsory referrals to access specialists.
Specialists
Direct access to specialist doctors — cardiology, orthopaedics, gynaecology, dermatology, paediatrics and more — with no prior referral needed.
Diagnostic tests
Blood tests, X-rays, MRI scans, ultrasounds and other tests. Cover and waiting times vary by plan.
Hospitalisation and surgery
Admission, surgical procedures and hospital stays. Included in most policies.
Emergencies
24-hour emergency care at network centres. Some policies also include emergencies abroad.
Maternity
Pregnancy monitoring, birth and postnatal care. Subject to a waiting period — usually 8 months.
Mental health
Appointments with a psychologist or psychiatrist. Cover varies by company and plan.
Rehabilitation and physiotherapy
Treatment after an injury or surgery. The number of sessions varies by policy.
What it usually doesn't cover
Knowing the exclusions avoids surprises at the worst possible moment.
Pre-existing conditions
Medical conditions diagnosed before taking out the policy may be excluded or subject to special terms. It is essential to declare them correctly.
Cosmetic treatments
Surgery and treatments for purely cosmetic purposes are not covered unless medically justified.
Complex dentistry
Standard policies do not cover orthodontics, implants or dental prosthetics unless you have a specific dental policy.
Medication
The cost of medication prescribed in private consultations is usually not included.
Experimental treatments
Procedures not recognised as standard medical practice fall outside the cover.
Two ways to access
medical care
Network-only
You access a network of contracted doctors, specialists and hospitals. Care has no extra cost at the point of use.
- Wide network of professionals and centres
- No cost per consultation
- Direct access to specialists
With reimbursement
You can go to any doctor or clinic. You pay at the time and the company refunds you at the agreed percentage.
- Total freedom of choice
- Useful for expats and frequent travellers
- Requires managing invoices and receipts
Many policies combine both: a network for everyday care and reimbursement for specific situations or abroad.
Do you need insurance for a residency visa?
If you're a foreign national and need to prove health insurance coverage for a Spanish residency visa or permit — digital nomad, non-lucrative, family reunification or others —, your policy must meet specific requirements: no co-pays, no waiting periods and a certificate valid for the UGE or the consulate.
See health insurance for residency visasWhat waiting periods are and how they affect you
A waiting period is the time that must pass from taking out the policy until you can use certain cover. Emergencies are usually available from day one.
| Cover | Typical period |
|---|---|
| General practice and emergencies | No waiting period |
| Specialists and tests | 1 to 3 months |
| Scheduled surgery | 6 to 8 months |
| Maternity and birth | 8 months |
| Psychology | 3 to 6 months |
If you already have health insurance and switch company, in many cases the waiting periods can be removed or reduced. It's one of the things we handle when comparing options.
Lost in the jargon?
With most private health insurance you can go directly to the specialist without a referral. It is one of the main advantages over the public health system.
It depends on the plan. Some policies include emergency cover abroad. For frequent travel or living abroad, it is worth checking this cover specifically or complementing it with travel insurance.
Pre-existing conditions must be declared in the health questionnaire. The company may cover them, exclude them or apply special terms. It is essential to be honest when completing it, though it is worth knowing where the line falls: an honest oversight reduces the payout proportionally, but deliberately hiding something can leave you without cover.
It depends on age, the number of people insured, the plan and the cover chosen. The price varies significantly by profile. We prepare a comparison with no obligation.
Yes, but with a waiting period. Pregnancy monitoring and birth usually have an 8-month waiting period from the start date. If you are already pregnant when you take out the policy, the current birth will not be covered.
Yes. Most companies offer family group policies with better prices than insuring individually. The cost per person falls as you add more insured members.
Standard policies usually include check-ups and cleanings. For more comprehensive treatments — orthodontics, implants, root canals — you need a specific dental policy or insurance with an extended dental module.
Yes, provided you respect the notice periods: the law requires at least one month before expiry, and the policy must highlight them. When switching, it may be possible to remove the waiting periods if you have been insured for some time. We handle it for you hassle-free: the deadlines and their legal basis.
More and more policies include psychology in their standard cover, although the number of sessions and conditions vary. In some plans it is an add-on module. It is an important point to check before signing up, especially for families with children.
Chronic illnesses diagnosed before taking out the policy may be excluded or subject to special terms. Those that develop while the policy is in force are covered as normal.
Yes, but not just any policy. The authorities require insurance with no co-pays, no waiting periods and issued by an insurer authorised in Spain. You also need a specific certificate proving these conditions. See our guide on health insurance for a residency visa →
Not sure which health insurance suits you?
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