mediaciÓn,operadordebanca … · 1 - 47 thebbvamassaludconcopagoisaproductmediatedbybbva...

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The BBVA Mas Salud Con Copago is a product mediated by BBVAMEDIACIÓN, OPERADOR DE BANCA-SEGUROS VINCULADO, S.A.,with corporate domicile in Madrid, Calle Azul nº 4, 28050, recorded inthe Madrid Companies Register under Volume 24602, Section 8, SheetM-62255 with Tax Code A/78581998, and the special administrativeregister of insurance agents at the Directorate General of Insurance andPension Funds, an organisation that reports to the Spanish Ministry ofEconomy and Competitiveness, code OV-0060. It is not obliged toperform insurance mediation activity exclusively for SANITAS, S.A. anddoes not give advice based on the obligation to provide a fair analysiswhich is imposed on insurance brokers. The advice provided is to takeout an insurance policy and it may seek information about the insurersfor which it mediates.

BBVA MEDIACIÓN, OPERADOR DE BANCA-SEGUROSVINCULADO, S.A. has taken out Civil Liability Insurance andestablished a financial surety. It belongs to the business group whoseparent company is Banco Bilbao Vizcaya Argentaria, S.A. whichowns100% of its share capital and to which group the insurerBBVASEGUROS, S.A., DE SEGUROS Y REASEGUROS also belongs.

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GENERAL TERMS ANDCONDITIONS

Sanitas Sociedad Anónima de Seguros

Recorded on 10 February 1958 in the Register of theDirectorate General for Insurance and Pension Funds,code C-320.

Organisation domiciled in Spain, Ribera del Loira, 52 -28042 Madrid.

Companies Register of Madrid, sheet 4,530, volume1,241, book 721, section 3, Entry 1.

ID NO. A-28037042

BBVA SEGUROS Sociedad Anónima de Seguros yReaseguros.

Entered in the Register of the Directorate General ofInsurance and Pension Funds, with code C-0502

Entity domiciled in Spain and recorded in the BiscayCompanies Register, volume 3,678, section 8, folio 38,sheet BI-854

Corporate address: Gran Vía Diego López de Haro, 12- 48001 Bilbao

ID NO. A-48051098

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CONTENTS

General terms and conditions

Preliminary clause........................................................................................................ 7

Glossary of terms..........................................................................................................8

Clause I: Purpose of the Insurance...........................................................................13

Clause II: Benefits.......................................................................................................13

PRINCIPAL BENEFITS......................................................................................................................................13

1. Primary care.................................................................................................................................................13

1.1. General Medicine....................................................................................................................................... 13

1.2. Paediatrics and Childcare...........................................................................................................................13

1.3. Nursing Service..........................................................................................................................................13

2. Emergencies................................................................................................................................................13

Sanitas 24 Hours...............................................................................................................................................13

3. Medical specialities.....................................................................................................................................13

3.1. Allergology..................................................................................................................................................13

3.2. Clinical Analysis..........................................................................................................................................14

3.2.1. Genetic Studies...................................................................................................................................14

3.3. Anatomic Pathology....................................................................................................................................14

3.4. Anaesthesiology.........................................................................................................................................14

3.5. Angiology and Vascular Surgery................................................................................................................14

3.6. Digestive System........................................................................................................................................14

3.7. Cardiology...................................................................................................................................................14

3.8. Cardiovascular Surgery..............................................................................................................................14

3.9. General and Gastrointestinal Surgery........................................................................................................14

3.10. Maxillofacial Surgery.................................................................................................................................14

3.11. Traumatology and Orthopaedic Surgery...................................................................................................15

3.12. Paediatric Surgery....................................................................................................................................15

3.13. Reconstructive Surgery............................................................................................................................15

3.14. Chest Surgery...........................................................................................................................................15

3.15. Dermatology.............................................................................................................................................15

3.16. Endocrinology...........................................................................................................................................15

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3.17. Geriatrics..................................................................................................................................................15

3.18. Haematology and Haemotherapy.............................................................................................................15

3.19. Internal Medicine......................................................................................................................................15

3.20. Nuclear Medicine......................................................................................................................................15

3.21. Nephrology...............................................................................................................................................16

3.22. Pneumology..............................................................................................................................................16

3.23. Neurosurgery............................................................................................................................................16

3.24. Clinical Neurophysiology..........................................................................................................................16

3.25. Neurology.................................................................................................................................................16

3.26. Obstetrics and Gynaecology.....................................................................................................................16

3.26.1. Breast Surgery....................................................................................................................................16

3.26.2. Neonatology Care.............................................................................................................................16

3.26.3. Newborn care....................................................................................................................................16

3.27. Ophthalmology......................................................................................................................................... 17

3.28. Medical Oncology.....................................................................................................................................17

3.29. Ear, Nose and Throat...............................................................................................................................17

3.30. Psychiatry.................................................................................................................................................17

3.31. Radiodiagnosis/Imaging Diagnosis..........................................................................................................17

3.32. Radiotherapy............................................................................................................................................18

3.33. Rehabilitation............................................................................................................................................18

3.34. Rheumatology.......................................................................................................................................... 18

3.35. Urology.....................................................................................................................................................18

4. Other care services.....................................................................................................................................18

4.1. Ambulance..................................................................................................................................................18

4.2. Special Care in the Home of the Insured....................................................................................................18

4.3. Obstetric-Gynaecological Nursing (Midwifery)............................................................................................18

4.4. Physiotherapy.............................................................................................................................................19

4.5. Speech and Language Therapy.................................................................................................................19

4.6. Nutrition......................................................................................................................................................19

4.7. Podiatry (Chiropody exclusively).................................................................................................................19

4.8. Prostheses..................................................................................................................................................19

4.9. Mother and Baby Programme.................................................................................................................... 20

4.10. Psychology...............................................................................................................................................20

4.11. Home-based respiratory therapy..............................................................................................................20

5. Hospital admission........................................................................................................................................20

6. Preventive medicine......................................................................................................................................21

ADDITIONAL COVERAGES OF YOUR INSURANCE......................................................................................22

Overseas emergency healthcare cover...........................................................................................................23

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Second medical opinion cover.........................................................................................................................25

Sanitas Dental 21 Cc.........................................................................................................................................25

Clause III: Exclusions from cover..............................................................................27

Clause IV: Qualification periods................................................................................30

Clause V: Form of service provision.........................................................................31

Clause VI: Other features of the insurance...............................................................34

1. Basis and loss of rights of the policy........................................................................................................34

2. Duration of insurance................................................................................................................................. 34

3. Insurance premiums...................................................................................................................................35

4. Registering newborns.................................................................................................................................36

5. Provision of reports.................................................................................................................................... 37

6. Complaints...................................................................................................................................................37

7. Other important legal points...................................................................................................................... 37

8. Data Protection clause................................................................................................................................38

9. Others...........................................................................................................................................................45

10. Jurisdiction................................................................................................................................................45

11. BBVA coinsurance clause........................................................................................................................45

7 - 47 Condiciones Generales

Preliminary clause

The present contract is bound by thematters set out in its general aspects,Act 50/1980 of 8 October on InsuranceContracts (Official State Bulletin of 17October 1980), Act 20/2015 of 14 Julyon the Management, Supervision andSolvency of Insurers and Reinsurers andits implementing regulation (RoyalDecree 1060/2015 of 20 November onthe Management, Supervision andSolvency of Insurers and Reinsurers),Act 22/2007 of 11 July on the DistanceMarketing of Financial Services forConsumers Act 26/2006 of 17 July onPrivate Insurance and ReinsuranceBrokerage and the matters agreed uponin the General and Particular Terms andConditions. For particular aspects thisPolicy is governed by what is specificallyestablished about coinsurance in article33 of the above mentioned InsuranceContract Act.

Clauses restricting the rights ofInsured shall be applicable whenhighlighted in bold letters andspecifically accepted.


Glossary of terms

For the purposes of this document of the BBVA Mas Salud Con Copago insurance product, thefollowing definitions apply:

INSURANCE TERMS

ACCIDENTBodily injury suffered while the policy is inforce, stemming from an external, sudden,violent cause beyond the Insured's control.

STANDING MEMBERSHIPThis involves recognition to the Insured ofcertain rights due to standing membership inthe Insurer, which will be specified in theParticular Terms and Conditions.

INSUREDEach person included in the policy andspecified in the Particular Terms andConditions, entitled to receive insurancebenefits and who may or may not be thesame as the Policyholder.

BENEFICIARYPerson to whom the insurance Policyholderacknowledges the right to receive thecompensation or benefit arising from thiscontract, to the corresponding sum.

CO-PAYMENTParticipation of the Insured in the sum of thecost of the medical action or series of actions,according to the medical service required,received from professionals or the healthcarecentres providing it and to be paid directly tothe Insurer.

HEALTH QUESTIONNAIREDeclaration that must be truthfully and fullycompleted and signed by the Policyholder orInsured before formalisation of the policy andused by the Insurer to assess the risk subjectto insurance.

FRAUDULENT INTENTAction or omission committed fraudulently ordeceivingly with the intention of producingdamage or obtaining a benefit that affects theinterests of a third party.

INSURED'S HOMEThe place where the Insured lives and whichspecifically appears on the policy's ParticularTerms and Conditions.

INSURER OR INSURANCE COMPANYSANITAS Sociedad Anónima de Seguros andBBVA Seguros Sociedad Anónima deSeguros y Reaseguros, bodies corporatetaking on the risk as agreed under thisAgreement in a coinsurance regime of 50%each.

DEDUCTIBLESum of medical and/or hospital expenses notincluded in the insurance cover that,according to the corresponding cover, ispayable by the Policyholder or the Insured tothe care provider.

PARTICIPATION IN COSTSPrior to access to certain cover, the Insuredmust pay a single payment to the Insurer,which is specified according to the degree ofdifficulty of the cover.

QUALIFICATION PERIODSPeriod of time (calculated by months elapsedfrom the effective date of the insurance)during which some of the covers included donot enter into force.

POLICYWritten document that contains the Termsand Conditions governing the insurance andthe rights and duties of the parties and that isused as proof of existence thereof. The policycomprises: the insurance application, healthquestionnaire, General, Particular and SpecialTerms and Conditions and the supplementsor appendices that are added to it either tocomplete or amend it.

PRE-EXISTING PATHOLOGIESState or condition of health (illness, injury ordefect), not necessarily pathological, suffered


by the Insured prior to the date of signing thehealth questionnaire.

BENEFITAcceptance of payment of the care service bythe Insurer of the guarantees committed to inthe policy.

PREMIUMThe premium is the price of the insurance, i.e.the amount that the Policyholder or Insuredmust pay the Insurer. The premium invoiceshall also contain any legally applicablesurcharges, duties and taxes.

CLAIMEvery occurrence of consequences which arepartly or wholly covered by the policy andforming part of the Insurance. The set ofservices arising from the same cause isconsidered to constitute a single claim.

EXTRA PREMIUMThis supplementary premium is establishedby way of express agreement shown in theParticular Terms and Conditions of the policy,in order to take on additional risk that wouldnot be the object of insured cover where suchagreement does not exist.

POLICYHOLDERThe physical person or body corporate that,together with the Insurer, signs this contractand who may be the same as or different tothe Insured and to whom the obligationsarising there from correspond, particularly thepayment of the premium, except those that,due to their nature, are the obligation of theInsured.

HEALTH TERMS

HEALTHCAREAct of assisting or caring for the health of aperson.

H O S P I T A L - B A S E DHEALTHCARE/WITH ADMISSION TOHOSPITALThis is the care provided at a medical orhospital centre when admitted to hospital,with a record of admission and stay by theInsured as a patient for a minimum of 24

hours for medical treatment, diagnosis,surgery or therapy.

H E A L T H C A R E I N A D A YHOSPITAL/ADMISSION TO A DAYHOSPITALThis is the medical, diagnostic, surgical ortherapeutic care provided in a medical orhospital centre which requires non-intensive,short-duration care that does not involve thepatient staying overnight in the centre.

In the case of surgical treatment at a dayhospital, it will be performed in the surgeryunder general, local or regional anaesthesiaor sedation and requires non-intensive,short-duration care that does not involve thepatient staying overnight in the centre.

H E A L T H C A R E W I T H O U THOSPITALISATION / OUTPATIENTHEALTHCAREThis is the medical, diagnostic, surgical ortherapeutic care provided in the hospital thatdoes not involve admission or a day hospital.In the case of an outpatient surgicaltreatment, it is performed in the consultingroom on surface tissues and generallyrequires local anaesthesia.

SOCIAL CAREMedical admission becomes social admissionwhen a patient with functional deterioration oraffected by age-related chronic processesand/or disorders have surpassed the acutephase of the disease and require healthcarebut not under admission to hospital.

CONSULTATIONAssistance and examination of a patient by adoctor, performing the necessaryexaminations and medical tests to obtain adiagnosis or prognosis and prescribetreatment.

DIAGNOSISMedical opinion on the nature of a patient'sdisease or injury, based on assessment ofhis/her signs and symptoms and on theperformance of additional diagnostic tests.


REGISTERED NURSEGraduate in Nursing legally qualified andauthorised to perform nursing activities.

ILLNESSAny alteration of the state of health of anindividual who suffers the action of apathology that is not the result of an accident,which is diagnosed and confirmed by a legallyrecognised doctor or dentist and whichrequires professional medical care.

CONGENITAL DISEASEA disease that exists at the time of birth as aresult of hereditary factors or disordersacquired during pregnancy up to the time ofbirth. A congenital disorder may becomemanifest and be recognised immediately afterbirth, or be discovered later, at any time of theindividual’s life.

USER GUIDE TO DOCTORS ANDSERVICESHealthcare professionals and centresbelonging to the medical network of this policyand recommended by the Insurer for theprovision of the services included in theinsurance. The Guide may undergomodifications during the validity period of thepolicy. There is a full, up-to-date list of thedoctors and centres forming the medicalnetwork of this policy available to the insuredat the the Insurer offices.

CONVENTIONAL ROOMSingle-unit room equipped with the necessaryhealth care systems. Suites or roomsprovided with an anteroom are not consideredconventional.

HOSPITALAny legally authorised public or privateestablishment for the care of diseases orbodily injuries, provided with the means forperforming diagnoses, medical treatmentsand surgical operations, and able to admitinpatients.

For the purposes of the policy, hotels, resthomes, spas, facilities intended primarily forthe treatment of chronic diseases and similarinstitutions are not regarded as hospitals.

SURGERYAny operation for diagnostic or therapeuticpurposes, performed by means of incision orany other path of internal approach by anappropriate medical specialist at anauthorised centre (inpatient or outpatient),which normally requires the use of anoperating theatre comprising aspecial-purpose room and equipped with thenecessary systems.

INJURYAny pathological change that takes place in atissue or in a healthy organ and which entailsanatomic or physiological damage, i.e., adisturbance of physical integrity or functionalbalance.

OSTEOSYNTHESIS MATERIALPieces or elements of metal or of any otherkind used for joining the ends of a fracturedbone or for welding joint ends.

ORTHOPAEDIC MATERIALExternal anatomical parts of any kind used toprevent or correct body deformities such as,for example, a back brace, harness orcrutches.

MEDICINAL PRODUCTSAny substance or combination of substancespresented as having properties of treating orpreventing disease in human beings or thatmay be used by or administered to humanbeings with a view to restoring, correcting ormodifying a physiological function by exertinga pharmacological, immunological ormetabolic action or making a medicaldiagnosis.

Coverage by the insurer will be contingentupon the prescription of the most efficienttherapy available at the time, by activeingredient and always using the generic drugor biosimilar if authorised by the SpanishAgency of Medicinal Products and MedicalDevices and marketed in Spain.

PHYSICIANDoctor or Bachelor in Medicine legally trainedand authorised for medical or surgical


treatment of the disease or injury that givesrise to a cover contained in the policy.

C O M P L E X T H E R A P E U T I CPROCEDURESA complex therapeutic method is any methodrequiring technical equipment, a speciallydesignated area and specialised healthprofessionals in a healthcare or hospitalsetting.

The healthcare facility where it is performedmust have adequate personnel and resourcesto deal with any complications that the patientmight experience as a direct or indirectconsequence of the method.

Indicate as an example that all lithotripsy,radiotherapy, chemotherapy, interventionalradiology, haemodynamic and endoscopyprocedures and procedures covered thatrequire laser will be included.

NEWBORNPerson in the life stage of the first four weeksafter birth.

CHILDBIRTHThe expulsion of one or more newbornchildren and the related placentas from theinterior of the uterine cavity to the exterior.Normal or ‘at term’ childbirth occurs betweenweek 37 and week 42 after the date of the lastmenstruation. Childbirth occurring earlier than37 weeks qualifies as premature; childbirthoccurring after 42 weeks qualifies aspost-term.

ORGAN DISEASEStructural injury to tissue or organs of thehuman body.

PROSTHESESAny element of any kind that temporarily orpermanently replaces the absence of anorgan, tissue, organic fluid, member or part ofany of these. By way of example, thisdefinition encompasses mechanical (jointsubstitutes) or biological elements (heartvalve replacement, ligaments), intraocularlenses, medication reservoirs, etc.

COMPLEX DIAGNOSIS METHOD

A complex diagnosis method is defined asany test that requires a healthcare or hospitalfacility with technical equipment andspecialised health professionals in order toperform it. Similarly, the healthcare facilitywhere it is performed must have appropriatepersonnel and resources to address anycomplications that the patient mightexperience as a direct or indirectconsequence of carrying out the test. Forexample, all CAT scans, MRI,neurophysiology, nuclear medicine, geneticand molecular biology, endoscopy,haemodynamic tests, etc. will be included.

PSYCHOLOGYPsychology is the science of practicalapplication of knowledge, skills andtechniques to diagnose, prevent and resolveindividual or social problems, especially asregards the individual’s interaction with his/herphysical and social environment.

HOME SERVICESVisit of a GP to the insured’s home at theInsured's request, by a general practitioner,paediatrician, or registered nurse, in thosecases in which the Insured is not in acondition to attend the doctor's or registerednurse's surgery because of his/her disease.

EMERGENCY CARE SERVICESAssistance in justified circumstances both atthe Insured's home or anywhere else withinthe national territory where the Insured is,always so long as the Insurer has anarrangement for the provision of the service inthis place. The service will be provided by aGP and/or registered nurse.

TREATMENTAll means (hygienic, pharmacological,surgical or physical) primarily directed to cureor relieve a disease after it has beendiagnosed.

EMERGENCYAn “Emergency” is a clinical situation thatdoes not entail a life-threatening situation orirreparable damage to the physical integrity ofthe patient, that requires immediate medicalcare.


LIFE-THREATENING EMERGENCYA life-threatening emergency is a situationthat requires immediate medical care as adelay could prove life-threatening or lead toirreparable harm to the patient's physicalintegrity which could involve the loss orsignificant deterioration of a function, memberor body organ.


Clause I: Purpose of theInsurance

Within the limits and conditions stipulated inthe policy and following payment by thePolicyholder of the corresponding premium,co-payments and deductibles that maycorrespond, the Insurer provides its insuredwith a wide range of professionals, clinics andhospitals for medical, surgical and hospitalcare, according to normal medical practice, inthe specialties and modalities included in thecover of this policy, their cost being assumedthrough direct payment to the professionals orcentres providing the insured provision.

Any diagnostic and therapeutic advancesarising in medical science after the effectivedate of this agreement may become part ofthe cover of this policy provided that they aresafe, effective and universal andconsolidated. Whenever this policy isrenewed, the Insurer shall inform of thetechniques or treatments to be included in thecover of the policy for the following period.

Clause II: Benefits

The benefits covered by this policy areconditional on compliance with thequalifying periods indicated below andalways when they are conditionssubsequent to the contracting of the policyand not known by the insured.

PRINCIPAL BENEFITS

In general, with the limitations andexclusions highlighted in the terms andconditions of this policy, the healthcarebenefits covered correspond to thefollowing specialties:

1. Primary care

1.1. General Medicine

This includes medical care in a healthcarecentre, indication and prescription of basicdiagnosis tests and procedures (analysis andgeneral radiology) during the days and times

established for this purpose by the doctor. Itincludes also home services when, forreasons attributable only to the Insurer’sillness, he/she is prevented from attending theconsulting room.

In emergencies the Insured shall go to thepermanent emergency services or elsecontact the Insurer's telephone service.

1.2. Paediatrics and Childcare

This includes the care of children until theyare 15 years old in consulting room and athome, the indication and prescription of testsand basic diagnosis procedures (analysis andgeneral radiology), being applicable all otherregulations mentioned for the benefit ofGeneral Medicine.

1.3. Nursing Service

Includes healthcare at the healthcare centreand at home.

2. Emergencies

These include emergency healthcareprovided in permanent emergency centres.

In justified circumstances, the Insured will betreated at the place where he or she is by theround-the-clock emergency services, only inthose towns in which the Insurer hasengaged such service.

Sanitas 24 Hours

Telephone service that provides informationfrom a medical team, which will advise theInsured about his/her questions of medicalcharacter, treatments, medication, analysisinterpretation, etc., 24 hours a day, 365 daysa year.

3. Medical specialities

3.1. Allergology

It includes determination of completeallergen-specific IgE (natural extracts) but


excludes specific IgE determinations forrecombinant allergens and IgG4.

3.2. Clinical Analysis

3.2.1. Genetic Studies

It comprises exclusively genetic studiesessential for diagnosis and/or to serve as aguideline for treatment in an affected,symptomatic patient and which also have ahigh diagnostic yield.

Includes the study of BRCA 1 and BRCA 2genes in the following indications:

A) patient without personal history of breast orovarian cancer who meets the followingrequirements:• with 2 or more 1st or 2nd degree relatives

aged under 50 years old affected by breastcancer

• with 2 or more 1st or 2nd degree relativesaffected by ovarian cancer at any age

• with 2 or more 1st or 2nd degree relativesaged under 50 years old affected by breastcancer and ovarian cancer at any age

B) patient aged over 50 years old with ahistory of breast cancer• with 2 or more 1st or 2nd degree relatives

aged under 50 years old affected by breastcancer

• with 2 or more 1st or 2nd degree relativesaffected by ovarian cancer at any age

• with 2 or more 1st or 2nd degree relativesaged under 50 years old affected by breastcancer and ovarian cancer at any age

C) male patient with breast cancerD) patient aged under 50 years with breastcancerE) patient with ovarian cancer (+/-) breastcancer

PCA3 molecular study and DNA typing ofHLA classes I and II excluded.

3.3. Anatomic Pathology

Includes the performance of therapeutictargets: BRAF, ALK, K-RAS, N-RAS,C-ERB2/HER2, EGFR, C-Kit, ROS-1 andPDL-1 prior to the administration of certain

pharmaceutical products, provided that thesummary of product characteristics asestablished by the Spanish Agency ofMedicinal Products and Medical Devicesrequires that such targets be determined.These criteria also apply to the speciality ofgenetic testing.

3.4. Anaesthesiology

3.5. Angiology and Vascular Surgery

Varicose vein treatments with foam ormicrofoam are excluded.

3.6. Digestive System

Liver elastographs are covered annually bythe Insured solely to evaluate theprogression in the degree of hepaticfibrosis in chronic liver diseases,excluding conditions related toalcoholism. Prior authorisation from theInsurer is required after assessment of themedical report.

The technique for submucous endoscopicdissection is only included for thetreatment of lesions of pre-malignant orincipient malignant colorectal/gastricmucosa in which conventionalpolypectomy has been ruled out andwhere surgical treatment is beingconsidered. Prior authorisation from theInsurer is required after assessment of themedical report.

MR-enterography is included.

3.7. Cardiology

3.8. Cardiovascular Surgery

The cryoablation technique andpercutaneous techniques for thereplacement of heart valves are excluded.

3.9. General and Gastrointestinal Surgery

Includes laparoscopic surgery.

3.10. Maxillofacial Surgery


Includes the diagnosis and surgical treatmentof diseases and trauma involving only thejawbone, maxilla and facial bones.

Dentistry treatments are excluded, as arecosmetic treatments and/or treatmentstargeting functional issues of the patient'smouth or teeth, such as orthognatic,pre-implant and pre-prosthesis surgery.

3.11. Traumatology and OrthopaedicSurgery

Includes arthroscopic surgery.

3.12. Paediatric Surgery

In the same terms and conditions as thosementioned for adult surgery.

3.13. Reconstructive Surgery

3.14. Chest Surgery

3.15. Dermatology

3.16. Endocrinology

3.17. Geriatrics

3.18. Haematology and Haemotherapy

Comprises autologous bone marrow andparentperipheral blood cell transplants solelyfor treatment of haematological tumours.

Leukocyte immunophenotypic study onlycovered in the study of leukaemias andlymphomas.

3.19. Internal Medicine

3.20. Nuclear Medicine

Contrast agents are paid for by the Insurer.

PET and PET/ CT scans exclusively with18-fludeoxyglucose (18 FDG) are coveredfor:

A) the diagnosis, staging, monitoring oftreatment response and detection in

reasonable case of relapse in cancerprocesses and

B) the following non-cancer indications(authorised by the Spanish Agency ofMedicinal Products and Medical Deviceson the 18-fludeoxyglucose (18 FDG) factsheet):

b.1- Cardiology• Evaluation of myocardial viability in patients

with serious left ventricle dysfunction andwho are candidates for revascularization,only when conventional imaging techniquesare not conclusive.

b.2- Neurology.• Localisation of epileptogenic foci in the

pre-surgical assessment of partialtemporary epilepsy.

b.3- Infectious or inflammatory diseasesLocalisation of abnormal foci to guideetiological diagnosis in the case of idiopathicfever.

Infection diagnosis in the case of:• Suspected chronic infection of bones or

adjacent structures: osteomyelitis,spondylitis, discitis or osteitis, includingwhen there are metallic implants

• Diabetic patients with a foot indicative ofCharcot foot and ankle, osteomyelitis or asoft tissue infection

• Painful hip prosthesis• Vascular graft• Detection of septic metastatic foci in the

case of bacteraemia or endocarditis (alsosee section 4.4)

Detection of extension of inflammation in thecase of:• Sarcoidosis• Inflammatory bowel disease• Large vessel vasculitis• Treatment monitoring:

Unresectable alveolar echinococcosis in thedetection of active outbreaks of the parasiteduring medical treatment and followingtreatment suspension.


Prior authorisation from the Insurer isrequired after assessment of the medicalreport.Any radiotracer other than 18FDG isexcluded.

MR-PET excluded.

3.21. Nephrology

Includes dialysis techniques only for thetreatment of acute processes. Chronictreatments of dialysis and haemodialysisare excluded.

3.22. Pneumology

3.23. Neurosurgery

Includes surgery with surgical navigationassistance and Intraoperat iveElectro-physiological Monitoring.

3.24. Clinical Neurophysiology

3.25. Neurology

3.26. Obstetrics and Gynaecology

Includes laparoscopic gynaecological surgeryand study and basic diagnosis of infertility andsterility.

It also includes family planning, tubal ligation,IUD implantation (the IUD is paid by theInsured), and follow up of treatment withanovulatories.

The following genetic tests are included:• Karyotype• Factor V Leiden and mutation 20210 of the

prothrombin gene, with these twodeterminations requiring prior authorisationfrom the Insurer following assessment ofthe medical report, being covered whenthere is a personal history of recurrentmiscarriage and/or thromboembolicprocesses.

Any other genetic test other than thosementioned shall be excluded.

Includes breast tomosynthesis and use ofgenome sequencing platforms for breastcancer prognosis (ONCOTYPE,MAMMAPRINT, PROSIGNA) prescribed by aspecialist on the medical chart and whenevernecessary for the treatment in accordancewith the recommendations set out for eachgenomic platform mentioned above.Requires prior authorisation from theInsurer after assessing the medical report.

Foetal DNA determination in mother’sblood (non-invasive pre-natal screening) isnot included.

3.26.1. Breast Surgery

Breast surgery is covered in the followingsituations:• Benign tumours. Excludes breast

reconstruction.• Malignant tumours: includes surgery on the

affected breast and prophylactic surgery onthe contralateral breast if considered atherapeutic option following the BRCA1 andBRCA2 result. Includes posterior breastreconstruction.

• Individuals not affected by breast cancer inwhich prophylactic breast surgery isconsidered a therapeutic option followingthe BRCA1 and BRCA2 result. Includessubsequent breast reconstruction.

Prior authorisation from the Insurer isrequired after assessment of the medicalreport.

3.26.2.Neonatology Care

It comprises the medical check, vaccineadministration and performance of all thosetests that systematically are performed tonewborns during his/her first 48 hours of life,according to the care delivery protocolapplicable in each autonomous region,excluding any medical provision that is aconsequence of a pathology orcomplication appearing at the moment ofbirth.

3.26.3.Newborn care


Covers the costs of a newborn's healthcare,provided that the child has been registeredwith the Insurer and has this cover.

3.27. Ophthalmology

Includes laser photocoagulation exclusivelyfor ischemic retinopathies, macularoedema, glaucoma and peripheral lesionsof the retina (holes or tears); cornealcross-linking for keratoconus treatment;and surgery for cornea transplant with thecornea to transplant being paid for by theInsurer.

Refractive surgery of any type (for myopia,hyperopia and astigmatism) is excluded.

3.28. Medical Oncology

The treatment prescription must always beperformed by the Medical Oncology specialistin charge of the patient's care. The Insurermust pay for treatment if conducted at ahealthcare site, whether on the basis of anoncology day unit or on an inpatient basis, ifnecessary.

The Insurer shall only pay for expensescorresponding to specifically cytostaticdrug products, the sale of which isauthorised in the local market andprovided they are used according to theinstructions of the product fact sheet andadministered parenterally in as manycycles as required and via vesicalinstillation in the case of MITOMYCIN ANDBCG.

Also includes drugs with no antitumor effectadministered simultaneously together withcytostatic agents during the chemotherapysession to prevent adverse or secondaryeffects.

3.29. Ear, Nose and Throat

Includes CO2 laser surgery andradiofrequency surgery.

3.30. Psychiatry

Psychiatric admission only covered as partof hospital admission and only includesthe treatment of acute outbreaks. It islimited to a maximum period of 50 daysper Insured/year.

3.31. Radiodiagnosis/Imaging Diagnosis

Comprises standard diagnostic techniques.Contrast agents shall be paid for by theInsurer.

It also includes:

A) The colonography performed bycomputerised tomography (CT) in thefollowing indications:

• Screening of colon cancer and colonpolyposis in patients without a knownclinical history of colon cancer, polyposisorinflammatory intestinal illness, as long asthey present family background of thesepathologies or are candidates to screeningfor age reasons (from the age of 50).

• Screening of colon cancer andcolonpolyposis in patients in which theconventional colonoscopy iscontraindicated due to their clinical situationor entails a higher risk.

• As a complement to conventionalcolonoscopy when this has been unable toreach the full length of the colon.


B) CAT coronography: included in theguarantee only for symptomatic patientspresenting a low or medium probability ofcoronary disease, in whom it is notpossible to perform an ischaemiadetection test or it is negative orinconclusive; asymptomatic patients butwith a positive or uncertain ischaemiadetection tests; for the coronary anomalystudy; suspected anomaly or identificationof the background of the diagnosedpatient; for evaluation of pulmonary veinsprior to atrial fibrillation ablation; for


coronary study prior to heart valve surgeryand for evaluation of stents or coronarygrafts.


Assessment of the calcium score isexcluded.

3.32. Radiotherapy

Includes radiotherapy exclusively for cancerprocesses.

Also includes stereotaxic radiosurgery fortumour treatment, principally malignanttumours, brain arteriovenous malformationsand as a final therapeutic step in trigeminalneuralgia.


3.33. Rehabilitation

It comprises the consultations which have thepurpose of diagnosis, evaluation andprescription of the physiotherapy treatmentsincluded in the cover of Physiotherapy.

3.34. Rheumatology

3.35. Urology

Includes Multiparametric MagneticResonance of the prostate in the followingindications:

• Local, regional or distance staging• Detection or guide for diagnostic biopsy

where there is a suspicion of clinical riskwith a negative result in previous biopsies

• Therapeutic monitoring


Also includes laser endourethral and vesicallithotripsy.

Fusion biopsy excluded.

4. Other care services

4.1. Ambulance

Transfers in ambulance from the place wherethe insured is located to the hospital wherehe/she will be admitted or to which he/shepresents for an emergency and under theInsurer coverage shall be covered. Alsocovered are return transfers of the insuredfrom the hospital to their home and thosemade between hospital centres on the theInsurer list of healthcare providers if the careresources at the hospital where the Insured isfound are not those that their medical carerequires. Transfers for chemotherapy andradiotherapy treatments at a Day Hospital arealso covered. In all these cases the servicewill be provided by land within the nationalterritory using the means agreed on by theInsurer and so long as the physical state ofthe Insured impedes his/her transfer by otherordinary means (taxi, private car, etc.) and isauthorised via the Sanitas 24-hour hotline.

This benefit does not include transfersrequired for physiotherapy treatments,diagnostic tests or to attend doctor's visitsnor generally any other type not covered inthe paragraph above. Service provisionsby providers not agreed with or by theSpanish regional or national public healthservice are therefore excluded.

4.2. Special Care in the Home of theInsured

This will be carried out by the healthcareteams designated by the Insurer, providedthat it is possible to arrange the service whenthe patient’s illness requires special care butdoes not require admission to hospital norspecialised equipment, always under theprescription of the doctor.

4.3. Obstetric-Gynaecological Nursing(Midwifery)


Care provided by a midwife will be availableonly for hospital-based child delivery.

4.4. Physiotherapy

It is provided solely on an outpatient basisand exclusively for conditions originatingin the musculoskeletal system, consideringas such exclusively those structures of thehuman body that perform the locomotive ormovement function and therefore not thosesuch as the temporomandibular joint whichdoes not perform this function and alwaysprovided it is not a chronic or degenerativeprocess, through to the greatest possiblefunctional recovery of the patient, determinedby his or her rehabilitation physician.

It includes shockwave therapy for chronicosteotendinous injuries (more than 6months’ evolution) of the musculoskeletalsystem.


Also includes lymphatic drainage following acancer process. It also includes themusculoskeletal physiotherapy as inpatient,secondary to orthopaedic surgery andheart rehabilitation under a hospitaladmission system following surgery withextra-corporeal circulation.

Neurological rehabilitation, pelvic floorrehabi l i tat ion , ou tpat ien t card iacrehabilitation, respiratory rehabilitation,temperomandibular joint rehabilitation andrehabilitation using robotic systems areexpressly excluded.

4.5. Speech and Language Therapy

It is included only when related with organicprocesses (larynx and vocal cords), to amaximum of 6 months a year per Insured.

They are dysphonia caused by damage to thevocal tract (congenital or acquired) not relatedto using the voice. Organic processes areconsidered to be:1. Inflammation: oedemas

2. Tumours:a) Benign: modules, polyps.b) Malignant: cancer of the larynx (partialor total)

3. Changes to the vocal cords:a) Paresis (reduction of cord movementbecause either the muscle or nerve areinjured)b) Paralysis (reduction of cord movementbecause either the muscle or nerve areinjured)

4. Congenital malformations

The insured cover includes only speechtherapy and language therapy forprocesses deriving from an acute stroke.

4.6. Nutrition

Access to this speciality must be prescribedby specialists in endocrinology, oncology,internal medicine, geriatrics or paediatricsauthorised by the Insurer. It is coveredwhen a medical condition exists (cancerpatients, diabetes, obesity with BMI >30 ora severe eating disorder).

4.7. Podiatry (Chiropody exclusively)

Limited to a maximum of 6 sessions perInsured and insurance annuity.

4.8. Prostheses

Only covers internal prostheses andinternal implantable materials expresslylisted below.

The Insured must provide the reports and/orquotations if the Insurer so requires.

1. Ophthalmology: Monofocal intraocularlens, excluding toric, used for cataractsurgery. Also includes corneal tissueexclusively from national tissue bank forcornea transplant.

2. Traumatology and Orthopaedic Surgery:Hip, knee and other joint prostheses;columnar fixation material; intervertebral disc;intersomatic or interspinal intervertebralmaterial; vertebroplasty/kyphoplasty material;biological bone ligament material obtained


from tissue banks in Spain; osteosynthesismaterial; bone substitutes - exclusively forcolumnar surgery and bone grafts aftertumour surgery.

3. Cardiovascular Area: the followingvascular prostheses: stents, peripheral orcoronary bypasses, medicalized ornon-medicalized, excluding those used inthe aorta in any of its sections and aorticvalvulated tubes; cardiac valves included inaortic valvulated tubes provided they areassociated with aortic valve surgery and anyother percutaneous or transapicalimplantation; pacemakers, excluding anykind of defibrillator or artificial heart; coilsand/or embolization materials.

4. Chemotherapy or Pain Treatment:reservoirs.

5. Other surgical materials: abdominalmeshes except biologic meshes, biliarystents; urological suspension systems;cerebrospinal (hydrocephalus) fluid shunts;breast prostheses and expanders, both in thebreast affected by prior tumour surgery and incases where a prophylactic mastectomy isconsidered a therapeutic option following theBCRA1 and BCRA2 result.

6. Bone fixing materials in cranialand/ormaxillofacial surgery

4.9. Mother and Baby Programme

Includes theoretical and practice classes forchild delivery preparation, child healthexaminations, as well as telephonicassessment by nursing professionals duringthe first six months of life of the child.

4.10. Psychology

This comprises individual psychological careprescribed by Psychiatrists, Family HealthAdvisors, Paediatricians or MedicalOncologists the purpose of which is to treatdisorders which could be treated viapsychological intervention. Also includessimple psychological diagnosis andpsychometric tests, the forms of which shallbe paid for by the Insured.

This comprises individual psychologicalcare prescribed by Psychiatrists, FamilyHealth Advisors, Paediatricians or MedicalOncologists the purpose of which is totreat disorders which could be treated viapsychological intervention.

It includes a maximum of 4 consultationsper month and with a limit of 15 sessionsper Insured and insurance annuity.

Cover excludes psychoanalysis,psychoanalytic therapy, hypnosis,narcolepsy and psychosocial andneuropsychiatric rehabilitation services.

4.11. Home-based respiratory therapy

Exclusively comprises the followingtreatments:

a) O x y g e n t h e r a p y : l i q u i d ,concentrator-based and gaseous.

Liquid oxygen therapy must be prescribedfor administration for at least 15 hours aday. The Insurer shall only pay for one typeof oxygen therapy treatment.

Portable oxygen concentrator is excluded.

b) Generation of positive airway pressurewith CPAP to treat obstructive sleep apnoea.Auto-CPAP machines for this treatment areexcluded.

c) Partial BiPAP ventilation therapy andaerosol therapy.

5. Hospital admission

Hospitalisation in a clinic or hospital.

In case of admission, the patient shall occupya conventional, individual room with a bed forrelatives, except in psychiatric hospitalisation,in ICU and in incubator and the Insurer shallpay for any expenses arising from theperforming of the diagnosis and therapeuticmethods, surgical treatments (includesoperating theatre and medication expenses,except medication that is not authorised


for sale in Spain) and accommodation withthe upkeep of the patient.

Excludes care for social reasons.

6. Preventive medicine

Includes programmes applied to healthypopulations covering different activities suchas medical consultations, physical exams andbasic diagnostic tests prescribed by thespecialist concerned for early diseasediagnosis:

6.1. Paediatrics: Provides for consultationwith a specialist, newborn health checks(including metabolic screening and earlyhearing impairment detection via OAEs orAEPs where necessary) and regular healthchecks to monitor child development (frombirth to 11 years of age).

6.2.Gastrointestinal Tract: Includesconsultation with a specialist and a physicalexamination as well as basic diagnostic tests(e.g., test for blood hidden in faeces orcolonoscopy).

6.3. Cardiology: Includes consultation with aspecialist and a physical examination as wellas basic diagnostic tests (e.g., ECG, basicblood and urine tests) and a stress test toestablish coronary risk.

6.4. Pneumology: Includes consultation witha specialist and a physical examination aswell as basic diagnostic tests (e.g., chestx-ray).

6.5. Gynaecology: Provides for an annualgynaecological check for cervical, endometrialand breast cancer prevention. Includesconsultation with a specialist and a physicalexamination as well as basic diagnostic tests(e.g., ultrasound scan, mammogram, papsmear test or gynaecological ultrasoundscan).

6.6. Urology: Provides for a medicalconsultation with a specialist and basic bloodtests (including PSA determination) and urinetests, along with other basic diagnostic tests(e.g., ultrasound scan and/or prostate biopsy).

The recommended frequency for theseexams varies in line with the characteristics ofeach case, which is why it is up to thespecialist to establish recommendations inaccordance with the risk.

ADDITIONALCOVERAGES OF YOURINSURANCE


Overseas emergencyhealthcare cover

What is it? Use of services and timelimit

This is a policy add-on which will coveremergencies abroad due to illness oraccident, provided that the care requiredoccurs within 90 consecutive days fromthe start of the trip.

For everything that does not expressly goagainst the provisions of this add-on, theprovisions of the policy terms and conditions,including its limitation clauses andexclusions, will apply to the urgent medicalcare abroad guarantee.

To cover this care, it is essential for theInsured to be up to date with payment and,before any medical service is provided(except in a life-threatening emergency),the Insurer must be contacted and priorauthorisation sought via the phone numberon the back of the card.In the event of alife-threatening emergency, the Insured shallvisit the nearest clinic or hospital and mustreport this to SANITAS within a maximum of7 days starting from the date of admission,supplying Sanitas with a copy of theemergency report. In any case, the call toSanitas must be made before the return tripto Spain.

For Sanitas to accept the care provision, allthe required documents must be supplied(travel receipts, medical report justifying theemergency and all other reports needed, billsand payment receipts).

What is not included?

• medical expenses abroad under €3.• costs arising from the diagnosis or

treatment of a physiological condition(e.g. pregnancy) or an illness that wasknown about before the trip began,unless it is a clear or unforeseeablecomplication; treatments arranged inSpain;

• pregnancy costs incurred after the first150 days.

• mental and chronic illnesses causingalterations in the Insured’s health.

What services are included?

1. Medical Costs

The Insurer guarantees the Insured,throughout the term of the policy, emergencyhealthcare abroad for medical costs (doctors,surgeons and hospitals/clinics) originatingoutside of Spain and provided bySanitas-designated centres.

Limits

€12.000 per person and year.

2. Transfer of sick and injured individualsto a care centre

What is included?

The Insurer ill pay for this transfer undermedical observation through to the carecentre where the patient can be treated.

The the Insurer medical service shall decideon and choose the means of transport andmedical centre/hospital the Insured mustattend, in accordance with the medical orderapplicable to the case.

3. Extension of a companion’s hotel stayfor hospitalisation of the Insured

When the Insured has to be admitted tohospital on a doctor’s orders and inaccordance with the medical service, theInsurer shall reimburse the costs arising fromthe necessary extended hotel stay for theircompanion - if also insured by Sanitas - upto a maximum of €60 per day and up to amaximum of 10 days.

4. Family member’s travel and stay toaccompany the Insured in hospital

If during the trip the Insured should behospitalised for more than five days and nodirect family member is with him or her,


SANITAS shall make a regular-flight, returnplane ticket (economy class) or train ticket(first class) available to a companion withregular place of residence in Spain. TheInsurer shall pay up to €60 per day for up to5 days in respect of hotel accommodation tocover this person’s costs.

5. Transport in the event of death

In the event of the death of the Insured, theInsurer shall organise and meet theexpenses for the transfer of the coffin to theplace of burial in the country of his or herusual place of residence, as well as theminimum compulsory coffin expenses,embalming costs and administrativeformalities. Where applicable and following arequest from the Beneficiaries, the Insurershall meet the costs of incineration in theplace of death and transportation of theashes to the place of burial in the country ofhis or her usual place of residence. TheInsurerwill not meet funeral or burialexpenses.

6. Early return of insured accompanyingrelatives

If the Insured is transferred by reason ofdeath under the cover “Transfer in Event ofDeath” and this circumstance preventsaccompanying insured family members fromreturning to their homes by the meansplanned originally, the Insurer will bear thecost of their travel to their permanent place ofresidence in Spain. Maximum two adultsand accompanied children under the ageof 14.

7. Accompanying children

If, during the term of the contract, Insuredpersons travelling with disabled persons orchildren under 14 years of age cannot lookafter them due to a sudden illness oraccident covered by the Policy, the Insurershall arrange and cover the costs ofoutbound and inbound travel of a personresiding in Spain named by the Insured orhis/her family to accompany children on theirreturn to their habitual residence in Spain asquickly as possible.

8. Search and retrieval of luggage andpersonal belongings

If the Insured has his/her luggage delayed orlost, the Insurer shall help in its search andretrieval, advising on how to file thecorresponding formal complaint. If theluggage is retrieved, the Insurer shall send itto the Insured’s habitual residence in Spain,providing the presence of the owner is notrequired for its recovery.

9. Dispatch of documents and personalbelongings overseas

The Insurer shall organise and take care ofessential items for the journey which havebeen left at home (contact lenses,prosthetics, spectacles, credit cards, drivinglicence, ID card and passport). This serviceextends to posting the same items home ifthey have been left behind on the journey orrecovered after theft.

The Insurer shall only organise the dispatchand postage for parcels weighing no morethan 10 kilogrammes.

10. Advance of funds

The Insurer shall advance funds of up to€1,500 to the Insured, when required.TheInsurer shall require some kind of specialguarantee ensuring the Insured repays theadvance. In any event, the amountsadvanced shall be returned to the Insurerwithin a maximum period of 30 days.

11. Legal advice

If the Insured is incarcerated or prosecutedas a result of a traffic accident, the Insurershall pay up to €1,500 for lawyer andattorney fees incurred for the legalassistance provided. If this service is coveredby the Motor Insurance Policy, it shall beconsidered an advance and the Insurer shallreserve the right to request a specialguarantee from the Insured to ensurepayment of the advance.

12. Advance of the amount for baildemanded abroad


If the Insured is prosecuted or incarcerated inthe country in which it arises, the Insurershall issue an advance equal to the amountof bail demanded by the local authorities upto a maximum of €10,000. The Insurerreserves the right to request a specialguarantee from the Insured to ensurerepayment of the advance. In any event, theamounts advanced shall be returned to theInsurer within a maximum period of twomonths.

13. Dispatch of medication

What is included?

If the Insured needs a medicine prescribedby a doctor and cannot acquire it in the placewhere he or she is holidaying, the Insurershall locate it and send it to him or her by thefastest means and in compliance with locallaws.

What is not included?

Cases where the medicine is no longermanufactured and is unavailable in theregular distribution channels in Spain areexcluded. The Insured shall repay theInsurer the price of the medicine uponpresentation of the bill.

14. Transmission of urgent messages

The Insurer shall, through a 24-hour service,accept and transmit urgent messages fromthe Insured, so long as they have no othermeans of making them reach theirdestination and so long as they are aconsequence of a guarantee covered by thecontract.

Second medical opinioncover

Includes a second opinion on medicaldiagnosis or treatment in the event of seriouschronic diseases requiring scheduled care ofwhich the course may require new diagnostictests or therapeutic measures and whereofthe life prognosis is seriously compromised.

This second opinion shall be issued by amedical report by leading specialists,healthcare centres, physicians or academicsin any country in the world, designated by theInsurer.

To use this service, the Insured can call 90219 97 24 or 93 25 40 538 for an explanationof the procedure to follow and thedocumentation to supply, which shall includewritten medical information, X-rays or otherimage diagnoses, excluding dispatch of anybiological or synthetic materials. The dossiershall be sent, with due confidentiality, to thespecialist or centre concerned, according tothe disease being treated.

When the process ends, the Insured will besent a second medical opinion report whichwill include:

• Summary of their clinical history.

• Opinion of the experts consulted.

• Curriculum vitae of these experts.

During the whole of this process the Insuredshall be accompanied by a consultantphysician responsible for managing the caseand advising the patient at all times.

Acute diseases or those requiring anurgent answer are excluded from thisservice.

Consultations, tests or treatments notperformed in accordance with the rules orcovers of the healthcare policy will not becovered.

Sanitas Dental 21 Cc

The benefits insured by this policy arespecified in the document Insured DentalBenefits, attached to the Particular Termsand Conditions and forming an integral andinseparable part of them and of theseGeneral Terms and Conditions. They areclassified as follows:


1. Without excess: The Insured does nothave to pay any amount to the dentist unlessthe policy provides for copayments, whichshall be specified in the Particular Terms andConditions.

2. With excess: The Insured must pay theexcess amount determined in the InsuredDental Benefits document, attached to theParticular Terms and Conditions of thispolicy, for the service performed.

If there is any change to the insured benefitsor the amount of excess, the Insurer shallnotify the Insured of the new amounts to paywith two months' notice of the date of effect.Payment of the premium implies acceptanceof such changes.


Clause III: Exclusions fromcover

Healthcare arising from the risks indicatedbelow is excluded from the cover of thispolicy, regardless of any other exclusion dulyhighlighted in the terms and conditions of thispolicy:

A. All types of disease, injury, pain,constitutional or congenital defect,deformity, medical condition or situation(such as pregnancy or gestation) existingprior to the registration date of eachInsured party in the policy and/or those asa result of accidents or diseases and theirconsequences arising prior to the date ofinclusion of each Insured party in thepolicy.

The Policyholder, on his/her own behalfor that of the Insured parties, mustinclude any type of injury, congenitalcondition, disease, diagnostic test,treatment and symptoms that may beconsidered the onset of a condition in thehealth questionnaire included in theinsurance application. Where notindicated, any insured cover directly orindirectly relating to the declaration notmade shall be excluded. The Insurer shallassess the information provided by thePolicyholder as a basis to accept or rejectthe arrangement of the insurance or toaccept it excluding certain insured cover.

B. Healthcare relating to diseases,accidents, injuries, deformities or defects:

• Arising as a result of civil wars, terroristaction and military manoeuvres.

• Directly or indirectly related to nuclearradiation or radioactive contaminationand those resulting from officially

declared catastrophes.

• Arising from working or professional

accidents.

• Arising from the use of motor vehiclesthat are the purpose of the AutomobileCompulsory Subscription Insurance.

• Arising while the Insured is involved, insports of risk, such as flying activities,speed trials in a motor vehicle, scubadiving, climbing, boxing, bull fighting,martial arts or rugby.

C. Healthcare provided at Social Securityclinics or services or those integrated inthe National Health System. Cross-borderhealthcare is also excluded.

D. Hospitalisation for problems of a socialnature.

E. Health care and/or inpatient treatmentprovided to the Insured by persons thatare related with the Policyholder or withthe Insured by conjugal relationship orkinship until the fourth grade ofconsanguinity or affinity, inclusive.

F. Healthcare derived from chronicalcoholism, drug addiction, intoxicationdue to the abuse of alcohol, psychotropicdrugs, narcotics or hallucinogens,attempted suicide and self-harm, diseasesor accidents due to negligence or grossnegligence of the Insured, infection byHuman Immunodeficiency Virus, AIDSand related diseases.

G. All diagnostic, surgical or therapeuticmethods, procedures or techniques thatappear after the date of taking out thepolicy except where the Insurer, incompliance with art 126.2 of Royal Decree1060/2015 of 20 November on theOrganisation, Supervision and Solvencyof Insurance and Reinsurance Companieshas communicated to the Policyholder inwriting that they have been included inthe insured covers under the terms andwithin the limits established in saidcommunication.

Also excluded are any therapeuticmethod, surgical technique or diagnostictest performed within a clinical trial or notused in regular clinical practice due to


lack of safety or efficacy, consideringthese to be those not approved by theEuropean Medicines Agency and/or theSpanish Agency of Medicinal Productsand Medical Devices, as well as by thehealth technology evaluation agencies ofSpain’s regional health services ornational Ministry of Health. Also excludedfrom coverage are therapeutic methods,surgical techniques and diagnostic teststhat have been clearly surpassed by otheravailable ones.

H. Any type of service relating to:

• Conditions or treatments that are notcovered or any other medical benefit witha direct relation to a treatment that wasnot done under the policy's insurancecoverage for not being covered by it.

• Specific diagnosis and treatments,including surgery, aimed at remedyingsterility or infertility in either sex (in vitrofertilization), artificial insemination, etc. orinvolving impotence and erectiledysfunction, including sex-changesurgery.

• Voluntary interruption of pregnancy.

• Transplants of organs, tissues, cells orcells components, except autologoustransplant of both bone marrow andprogenitor cells of peripheral blood dueto haematologic lineage tumours andcornea transplant.

• Any surgical procedure on unbornbabies.

• Any surgical technique using roboticsurgery equipment.

• Genetic map determinations toascertain the predisposition of theInsured or his ancestors or present orfuture offspring to all diseases related togenetic disorders. Except for thedetermination of BCRA1 and BCRA2 andgenetic tests for breast cancer(ONCOTYPE; MAMMAPRINT and

PROSIGNA) under the conditions detailedin previous sections. Genetic mapping oftumours and pharmacogenetics are alsoexpressly excluded.

• Prosthesis and implantable materialsexcept those mentioned in thecorresponding paragraph of the presentGeneral Terms and Conditions. Amongothers, any external prosthesis,customised prostheses, any orthopaedicmaterial, external fixing materials,synthetic or biological materials, grafts,o r o es o p h ag eal o r c o l o n i cendoprosthesis, aortic endoprosthesis,valved ducts, except those associatedwith aortic valve replacement surgery,implantable pumps for the infusion ofmedicaments, medullary stimulatingelectrodes, defibrillators and the artificialheart.

• Operations, infiltrations and treatments,as well as any other action that is purelyfor questions of appearance or of acosmetic nature. In terms of breastsurgery, only those caused by tumourdisease are included, the following beingexpressly excluded: prophylacticoperations, except those that meet thecriteria detailed in the breast cancersection; and those performed to correctbreast hypertrophy and/or gynecomastia.Any kind of disorder or complicationwhich may occur subsequently and whichis directly and/or mainly caused by theInsured’s undergoing an operation,infiltration or treatment of a purelyaesthetic or cosmetic nature are alsoexpressly excluded.

• Tr eat m en t w i th p l at el et - o rgrowth-factor-rich plasma.

• Educational therapy in all its forms,such as language education in processesunrelated to organic disease or specialeducation in patients with mental illness.

• General medical examinations forpreventive purposes, except the cover


mentioned in these General Terms andConditions.

• Alternative medicine, naturopathy,homeopathy, acupuncture, mesotherapy,hydrotherapy, pressotherapy, ozonetherapy, etc.

• Services or techniques that merelyconsist of leisure, rest, comfort orsporting activities, similarly treatments atspas and health farms.

I. All surgical techniques or therapeuticprocedures using laser, except:

• Op h t h al m i c p h o t o c o ag u l at i o nexclusively for ischaemic retinopathies,macular oedema, glaucoma andperipheral retinal lesions (holes or tears).

• Corneal cross-linking for keratoconustreatment.

• Haemorrhoid treatments.

• Clinical (not cosmetic) peripheralvascular surgery.

• Ear, nose and throat CO2 laser.

• In musculoskeletal physiotherapy.

• Laser endourethral and vesicallithotripsy.

J. Travel expenses except those coveredin the ambulance section of these GeneralTerms and Conditions.

K. Any kind of refractive surgery (formyopia, hypermetropia and astigmatism)is excluded.

L. The following human medicines:

• Any type of medication administered tothe insured outside of hospitalisation,except for chemotherapy administeredvia parenteral by a healthcareprofessional and via bladder instillationin the case of MITOMICINA and BCG

under outpatient care or withouthospitalisation; and medication inhome respiratory therapies that areexpressly included in the insured cover.

• Medicinal products not on the marketin Spain.

• The following special medicines:• Vaccines/autogenous vaccines and

other biological medicinal products• Medicines of human origin• Advanced therapy medicinal

products (gene and cell)• Medicinal plant products• Homeopathic medicinal products• OTC products

M. Water birth, homebirth and alternativechildbirth techniques are expresslyexcluded.

N. Bariatric surgery is excluded in obesityand metabolic surgery is excluded indiabetes.

Ñ Radiosurgery is excluded.

O. Parkinson surgery is excluded.

P. Epilepsy surgery is excluded.


Clause IV: Qualificationperiods

All benefits which under this policy areassumed by the Insurer, on the basis of theapproved medical network, will be providedfrom the time this contract becomes effective.HOWEVER, THE FOREGOING GENERALPRINCIPLE DOES NOT APPLY TOMEDICAL, SURGICAL AND/OR HOSPITALHEALTHCARE IN THE EVENTS DETAILEDBELOW, TO WHICH SHALL APPLY THESPECIFIED QUALIFICATION PERIODS:

The above qualification periods do not applyto accidents or illnesses that arelife-threatening, unexpected and diagnosedafter the date the corresponding cover takeseffect, provided the care is covered by the

Qualification Periods for the modality ofContracted Medical Network:

• Vasectomy and tubular ligation: 10 Months

• Psychology: 6 Months

• Complex diagnosis tests: 6 Months

• The following Complex Therapeutical Methods: interventional cardiology/ hemodynamics; in tervent ional rad io logy, radiotherapy and chemotherapy; and lithotripsy: 10 Months

• Outpatient surgical operations. For example: Group 0 to II procedures, as classified by the Spanish Medical Colleges Organisation: 3 Months

• Child delivery or caesarean except premature birth (less than 37 weeks): 8 Months

• Hosp i tal i sat i on and su rg i cal operations different from outpatient care and those performed as inpatient. For example: Group III to VIII procedures, as classified by the Spanish Medical Col leges Organisation: 10 Months

insurance policy. Including cases ofpremature childbirth (before 37 weeks).


Clause V: Form of serviceprovision

1. Through the contractedmedical network

Care shall be provided according tohealthcare regulations applicable, byprofessionals with sufficient qualifications foreach specific service and belonging to thecontracted medical network corresponding tothis insurance product. Where one of theservices included in the cover of this policydoes not exist in the town where the Insuredis located, it shall be provided in anotherregion through the healthcare provider thatthe Insured chooses in each case.

On receiving applicable services, the Insuredmust present his/her the Insurer card. Alsothe Insured must show his/her NationalIdentity Document, if such was required. Eachtime the Insured receives a service coveredby this policy, he/she must pay, in theconcept of participation in the cost of suchservice, the amount that is established in theParticular Terms and Conditions.

The Insurer must provide insured cover underthe terms established in the policy and is notbound by the decisions that professionalsmay make, whether or not they belong to itsmedical network or are included in thisinsured cover.

The care may be provided in different ways,depending on the service to be given:

1.1. Free access.

The Insured shall be able to attend freely inSpain the consulting rooms of consultants,general physicians and paediatrics, as well asthe emergency centres that belong to thecontracted medical network by the Insurer forthis product. Please check your User Guide toDoctors and Services for those consultantsf o r wh i c h y o u w i l l n e e dprescription/authorisation.

1.2. Prior prescription for theperformance of the service

Diagnosis tests, therapeutic methods, andcertain care services will require, for theirperformance, written prescription by aphysician belonging to the Insurer medicalnetwork.

Particularly, Psychology consultations mustbe prescribed by a Psychiatrist, GeneralPractitioner, Oncologist or Paediatrician.

1.3. Prior prescription and authorisationfor the performance of the service.

As a general rule, for surgical operations,inpatient treatment and counselorprofessionals, prior express authorisation bythe Insurer shall be needed, after the writtenprescription of the professionals belonging tothe Insurer network. Such authorisation shallbe also needed for certain therapeuticmethods, diagnosis tests and other careservices, whenever such is said in theGeneral Terms and Conditions of the policy.The authorisation voucher shall not be valid ifat the moment of receiving the service, theInsured is not fulfilling all the requirementsestablished in the General Terms andConditions of his/her policy to access to thefull insured coverage relating to the serviceindicated in such authorisation voucher (i.e.no being current on payments of thepremium, preexisting condition not declared,etc.).

1.4. Prior authorisation for the service tobe performed by expressly accreditedprofessionals

Any laparoscopic or arthroscopic surgicalprocedures and those involvingradiofrequency or laser techniques must beperformed by professionals specificallyarranged and accredited by the Insurer toperform this type of specific surgicaltechnique.

1.5. Prior authorisation and expressdesignation of the physician

More particularly, for surgical procedures ofgreat complexity, as indicated below:neurosurgery, heart surgery and backbonesurgery, surgery requiring robotic equipment,assisted navigation equipment or any other


restricted implementation technology, that arecovered by this policy, the Insurer shallappoint the healthcare centre and theprofessionals to perform the surgery in eachindividual case and prior to the specificsurgical procedure.

1.6. Services at the Insured's home.

The Insurer undertakes to provide homeservices in those localities where it has anarrangement for the provision of this service.Any change of the Insured's home addressmust be reliably notified with a minimum ofeight days' notice before requiring anyservice.

Services provided in the Insured's home arethose relating to the specialties of FamilyMedicine, Paediatric Medicine, EmergencyCare, Nursing, Special Home Care,Ambulance and Respiratory Therapies. All ofthese require a doctor's prescription exceptFamily Medicine and Paediatric Medicine. TheInsurer reserves the right not to provide theservice when in the doctor's opinion it is notnecessary.

Particularly, treatments involving home-basedrespiratory therapies, must be prescribed by apneumologist belonging to the Insurernetwork. In all chronic treatments, the Insuredhas to renew the pneumologist’s prescriptionand the service authorisation by the Insurereach month.

1.7. Care in case of temporarydisplacement to Cantabria and Navarra.

In case of temporary displacement of theInsured to the mentioned AutonomousRegions the service included in the coverageshall be performed through the medicalnetwork of the Entities expressly contractedby the Insurer for such performance. TheInsured must present his/her the Insurer cardin the Offices of the contracted Entities,accepting the administrative steps of theseEntities.

1.8. Emergencies

As specified in article 103 of the InsuranceContract Act, the Insurer provides the

necessary care of an emergency nature inaccordance with the policy Terms andConditions and that in all cases shall beprovided through the resources designated bythe Insurer, expressly indicated in the UserGuide to Doctors and Services for thisproduct.

In cases of life-threatening emergency,wherever the Insured needs to be admittedto a centre not included in the medicalnetwork, the Insurer must be reliablyinformed of this admission as soon aspossible so that it can transfer the insured toa partner centre, provided his/her medicalcondition allows as such.

1.9. Care in providers not recognised bythe Insurer.

Notwithstanding what is mentioned in theabove paragraph for cases oflife-threatening emergency, the Insurershall not pay for the fees of professionalsnot belonging to its medical network, norfor the expenses of internment or servicesthat such professionals could order. Also,the Insurer shall not pay, under thecontracted medical network modality thatis the object of insurance of this policy, forthe expenses originated in private orpublic centres not contracted for thisproduct, no matter who the prescribing orperforming professional is.

2. Video consultation

The insured can access the emergencydental video consultation service atweekends.

2.1. Description:

• The insured can receive personalisedmedical care from a dentist on the Sanitasmedical chart through remotecommunication techniques (videoconsultation).

• This service is suitable for treating thefollowing cases:- Cases related to pain- Discomfort


- Inflamed gums- Problems related to treatments in

progress (such as braces or implants)- Other problems like jaw pain or occasional

bleeding

• This service is always provided with anappointment and only at weekends.

• Subject to availability of the calendar ofspeciality and the working hours of thespecialist. The insured can check thesetimes at Mi Sanitas

2.2. Procedure:

• The insured will request this service via MiSanitas at www.sanitas.es or via the mobileapp.

• On the appointment day and time, theinsured must connect to the application inMi Sanitas to contact the professional andstart the video consultation following theinstructions provided by SANITAS at eachmoment.


Clause VI: Other features ofthe insurance

1. Basis and loss of rights of thepolicy

1.1. The present agreement has beenclosed on the basis of the declarations madeby the Policyholder and the Insured in thehealth questionnaire included in theinsurance application, where questionsare made referring to the state of health oftheir health, profession, Insured’s sportpractices and in general those habits oflife that can be of relevance for a correctassessment of the risk that is the object ofthe insurance by this policy being itessential that the Policyholder/Insuredprovides with complete truthful about thequestions posed since these constitutethe basis for the acceptance of the risk ofthe present agreement, being the mentionedInsurance Application a constituent part of it.

1.2. The Policyholder's duty, before theconclusion of the contract, to declare theInsurer, according to the questionnaire it willsubmit all the circumstances known to himthat might affect the valuation of risk. He isrelieved of this obligation if the Insurer did notsubmit questionnaire or even when theInsurer did, there are circumstances that mayinfluence the risk assessment and that arenot included in it.

The Insurer may terminate the contract bydeclaration addressed to the Policyholderwithin a month, as of knowledge or inaccuracyof the Policyholder. They correspond to theInsurer except willful misconduct or grossnegligence on its part, the premiums for thecurrent period to the time to make thisstatement.

If the incident occurs before the Insurermakes the statement to which the precedingparagraph refers, the provision will bereduced proportionally to the differencebetween the agreed premium and that whichwould have applied had the true risk beenknown. If there was fraud or gross fault on thepart of the Policyholder, the Insurer will be

released from payment of the benefit (Art. 10of the Insurance Contract Act).

1.3. Notwithstanding the foregoing, theInsured also loses the right to theguaranteed benefit, if the incident occursbefore the premium has been paid (or,where applicable, a single premium)unless otherwise agreed (Art. 15 of theInsurance Contract Act).

1.4. The Policyholder can terminate theagreement when the medical network ischanged, providing the change affects to50% of the consultants that are part of thenational medical network of the Insurer, whowill have available for the Insured, at all times,in the Insurer Offices, the complete andupdated list of such consultants, for theInsured’s information.

1.5. In the event of the Insured not statinghis/her correct date of birth, the Insurer mayonly contest the policy if the Insured's trueage exceeds the established limits for thiswhen the policy comes into force.

1.6. Remote subscription of Insurance: Asspecified in Article 10 of the DistanceMarketing of Financial Services Act 22/2007of 11 July, the Policyholder shall have a termof fourteen calendar days to terminate theremote subscribed contract, without having toindicate any reasons and incurring in no typeof penalty.

The term for exercising the right totermination shall begin on the date theInsured Contract is signed. However, wherethe Policyholder has not received the termsand conditions of the policy and the priorinformation note about the contracting of theInsurance policy, the term for exercising theright to terminate shall begin to count on thedate on which said information note isreceived.

2. Duration of insurance

2.1. The Insurance Contract expiry date shallbe established in its particular terms andconditions and, at its expiry, in accordancewith Article 22 of the Insurance Contract Act,it shall be extended tacitly for periods of one


year. Nevertheless, either of the parties mayrepudiate extension by giving the other partydue written notice not less than two (2)months before the date of expiration of thecurrent period, if it is SANITAS that gives thisnotice and one month if it is the Policyholderwho gives it.

2.2. If the insurance policy is terminatedunilaterally at the discretion of the Insurer,it may not suspend the provision of coverwhile the Insured is undergoing hospitaltreatment, until discharge, unless the Insuredwaives to continue the treatment.

If the insurance policy is terminated by theInsured, the covers will cease to have effecton the expiry date specified in the ParticularTerms and Conditions of the policy, and theprovisions of the preceding paragraph will notapply. Therefore, if the Insured is receivingsome kind of insured benefit at the time thepolicy expires, the cover insured by theInsurer shall cease on said expiration dateand it will not be obliged to pay for any costas of said date, even those arising from aclaim occurring during Insurance validityunless the policy is terminated due to fraud orgross negligence on the part of the insured.

2.3. With regards to each Insured person,the insurance lapses due

a) To death.

b) Transfer of residence abroad or notresiding a minimum of six (6) months innational territory. The premium shallcorrespond to the Insurer until the date onwhich the Insured communicates andcredits such circumnstance.

2.4. Persons under 14 years of age can onlybe included in the insurance if the personsthat hold their custody or guardianship arealso insured, unless the parties agreeotherwise.

3. Insurance premiums

3.1. The Insurance Policyholder must paythe premium when the contract isaccepted. The arranged covers shall not

take effect until the first premium has beenpaid.

3.2. The first premium shall be requestedonce the contract has been signed.Successive premiums shall be requestedon their respective due dates.

3.3. The Policyholder can apply for thedivision of the payment of the annualpremiums in biannual, quarterly or monthlyperiods.

In these cases, the correspondingsurcharge shall be applied. The division ofthe premium does not exempt thePolicyholder of his/her obligation to paythe complete annual premium.

3.4. If, due to the Policyholder’s fault, thefirst premium is not paid, the Insurer isentitled to terminate the contract or legallydemand payment based on the Policy. Wherepayment is not received before the claimarises, the Insurer shall be freed from itsobligation, except where otherwise agreedand duly indicated in the Particular Terms andConditions of the policy.

In the event of non-payment of the secondor successive premiums or their divisions,the Insurer coverage shall be suspendedone month after the due date of thepremium.

Where the Insurer does not claim paymentwithin the six months following said duedate, the contract shall be consideredterminated.

If the contract is not terminated ordischarged according to the abovementioned conditions, the cover shallonce again become effective twenty-fourhours following the day on which thePolicyholder pays the premium or, whereapplicable, suitable part payments thereof.

The Policyholder shall lose any agreedright to pay part of the premium in thecase of non-payment of any receipt andshall, from that moment, be required to


pay the full premium agreed to for theremaining Insurance period.

For premiums paid in installments, in theevent of a claim, the Insurer may deduct fromthe amount payable or reimbursable to thePolicyholder or Insured any premiuminstallments for the current annual period notyet collected by the Insurer.

3.5. Where the parties stipulate theapplication of co-payments for certain benefitsinsured by this policy, the amountscorresponding to said co-payments shall bespecifically established in the ParticularTerms and Conditions of the policy. Theiramount shall be established each year by theInsurer. The provisions of this Clause in theevent of non-payment of the second orsuccessive premiums or part paymentsthereof shall apply in the case ofnon-payment of the amount of co-payment.

3.6. Except where otherwise specified in theParticular Terms and Conditions, the place ofpayment of the premium and co-payments,where applicable, shall be as indicated in thebank debit account order form.

To this end, the Policyholder shall provide theInsurer with the details of his/her bankaccount where the payment of the receipts forthis Insurance are to be debited and shallauthorise the bank to pay them.

3.7. The Insurer is only bound by theinvoices issued by the Management or byits legally authorised representatives.

3.8. The Insurer may modify the premium andthe amount of participation of the Insured inthe cost of services with each renewal of theContract. This review is based ontechnical-actuarial criteria made and basedon the variation in the cost of healthcareservices, the type, the frequency of use of thebenefits covered and the inclusion oftechnological medical innovations that werenot covered on the initial effective date of thepolicy.

The premiums to be paid by the Policyholderwill vary according to the age achieved byeach of the Insured, the geographical zone

corresponding to the place of performance ofthe services, the tariffs established by theInsurer on the date of renewal of each policybeing applicable. Such variation of premiumsshall be communicated in writing by theInsurer to the Policyholder with at least twomonths’ notice with respect to the renewaldate.

3.9. The Policyholder, after receivingnotification from the Insurer about thevariation to the premium for the next yearcan choose to accept the InsuranceContract renewal for the premiumproposed by the Insurer or terminate itwhen the Insurance term in progress ends,in the latter case notifying the Insurer inwriting, at least one month before theexpiry date, of your wish to terminate it.

3.10. Payment of the amount of the premiummade by the Policyholder to the insurancebroker shall not be considered as made to theInsurer, unless the broker provides thePolicyholder with the aforesaid Insurer'spremium invoice in return.

4. Registering newborns

Newborn children can be included in thepolicy with all its rights since their date of birthif the care provided to the mother whilst thechild delivery has been provided by theInsurer within the coverage of the mother’spolicy and if the inclusion of the father as aninsured in the policy has taken place at least240 days prior to the child delivery. For this tobe effective, the Policyholder mustcommunicate to the Insurer suchcircumstance within the 30 natural daysfollowing the date of birth, by means ofcompleting an Insurance Application.

In any case, the Insurer will only cover thenewborn’s healthcare when and if he/sheis included as Insured in the Insurer. If theinclusion of the newborn is communicatedonce the term mentioned above has elapsedor without fulfilling all the requirementsindicated in the paragraph above this, theInsurer by virtue of the information providedby the Policyholder in the Insurance


Application can deny the inclusion of thenewborn as Insured member.

5. Provision of reports

The Policyholder and Insured must providethe Insurer, whenever expressly required soto do, medical reports and/or providers costestimates enabling the Insurer to determinewhether the requested care is covered by thepolicy. The Insurer is under no obligation tocover the requested care unless and until it issupplied with such reports and cost estimatesif the Insured is expressly required to supplythem.

6. Complaints

6.1. Complaints control and procedure

a) Supervision of the business activity of theInsurer lies with the Spanish State and isexercised through the Directorate General forInsurance and Pension Funds of the Ministryof the Economy and Competitiveness.

b) In case of any type of complaint in relationto the Insurance Policy, for the settlementthereof the Policyholder, Insured, Beneficiary,Aggrieved Third Party or Successor of any ofthese should proceed to address:

1. SANITAS Complaints ManagementDepartment, by means of a signed writtencomplaint with the claimant's NationalIdentification Document or a documentaccrediting their identity, addressed to calleRibera del Loira Nº 52 (28042 Madrid) orfax to 91 585 24 68 or to the email [email protected], which willacknowledge receipt in writing and issue areasoned written decision within thestatutory deadline of two months from thedate of filing the complaint, so long as itmeets all the requirements sought, pursuantto Order ECO /734/2004, of 11 March, on thecustomer care departments and services offinancial entities and the Customer ProtectionRegulation available at your disposal in ouroffices.

2. Once this internal process has beenexhausted or in the event of disagreement

with the decision of the Insurer, a signedwritten complaint, with the claimant’s NationalIdentification Document or a documentaccrediting their identity, may be lodged withComplaints Service of the DirectorateGeneral for Insurance and Pension Funds,Paseo de la Castellana, 44, 28046 Madrid.Accordingly, the claimant must prove that theestablished period for the settlement of thecomplaint by the SANITAS ComplaintsManagement Department has expired or thatthe complaint has been denied leave toproceed or has been dismissed.

3. Please be informed that the Insurer is notbound by any consumer arbitration board.The insured may initiate administrative andlegal proceedings as set down in thecomplaints procedure described in theGeneral Terms and Conditions of their policy.

4. In any case, action may be brought beforethe relevant Courts.

6.2. Actions in connection to this InsuranceAgreement shall be subject to a five-year timelimit (Article 23 of the Insurance Act).

7. Other important legal points

7.1. Subrogation

Once payment of the covered benefit hasbeen assumed, the Insurer may exercise therights and actions corresponding to theInsured due to the claim caused with regardsto the persons responsible for it, up to thelimit of compensation paid.

The Insured must sign the necessarydocuments for subrogation in favour of theInsurer.

7.2. Notifications

7.2.1. Notifications to SANITAS on the partof the Policyholder, the Insured or Beneficiaryshall be sent to the Insurer’s registeredoffice as stated in the policy.

7.2.2. Notifications from the Insurer to thePolicyholder, the Insured or Beneficiary shallbe sent to the physical or email address of the


Policyholder or to the telephone numberprovided by the Policyholder that at the timethe Insurance is arranged, except where achange has been notified to the Insurer. ThePolicyholder authorises the Insurer to sendany notifications by email as permitted by law.

8. Data Protection clause

The contract is entered into under acoinsurance arrangement pursuant to whichthe insurers are BBVASEGUROS, S.A. deSeguros y Reaseguros and SANITAS, S.A.de Seguros.

The Data Protection policy of the two entitiesis given below:

8.1 SANITAS, S.A., de Seguros

8.1.1 Personal data controller

SANITAS, SOCIEDAD ANONIMA DESEGUROS, whose registered address is C/Ribera delLoira, 52, 28042, Madrid,(hereinafter, “Sanitas").

8.1.2 Personal data processing

Personal data, including data referring toidentification and health (hereinafter,"Personal Data"), provided through insuranceapplications and during the term of thecontract will be processed. Personal data isconfidential and appropriately protected.

The Applicant, Policyholder and the InsuredParty undertake that the information relatingto the Policyholder and the Insured Party(ies)provided to Sanitas is true and no informationhas been omitted on each Insured Parties’state of health.

8.1.3 The purpose for which their PersonalData is processed

(a) Formalising, developing, andimplementing the insurance contract.Processing Personal Data is necessaryfor formalising the contract between thePolicyholder/Insured Party and Sanitas,as well as for the maintenance,

development and execution of thecontractual relationship.Sanitas willt h e r e f o r e p r o c e s s t h ePolicyholder’s/Insured Party’s PersonalData in order, among other reasons, toassess, select and price the risksassociated with insurance, manage therelationship with them, manage the policy,etc. Furthermore, it may, in certain casesmake automated decisions based only onthe analytical procedures carried out toimprove the service provided which is theaim of their contract with Sanitas. Duringexecution of the contract Sanitas willprocess theirPersonal Data to assesstheir financial solvency, carry outstatistical or quality reviews or technicalanalyses, even conducting satisfactionsurveys, as well as managingcoinsurance/reinsurance whereappropriate.

(b) Provision and coverage of the health careservice covered by the insurance contract,being in a position to request and obtaininformation about their health fromhealthcare professionals. Sanitas willprocess the Policyholder’s/Insured Party’sPersonal Data to provide the contractedservices.This involves, among otherthings, making appropriate payment tohealthcare providers or reimbursing healthcare costs to the Insured Party or theirbeneficiaries. To this end Personal Datamay be reciprocally shared with andtransmitted to the medical professionalsproviding the healthcare service, evenasking and obtaining from the healthcareprofessionals information concerning theirhealth to assess the cover and theappropriate payment for or reimbursementof the services provided. If they wish, aspart of the service Sanitas places at thedisposal of the Policyholder/Insured Partywe have a "Health Folder" (accessible via"MiSanitas") so that they can apply totransfer to and file Personal Data (e.g.medical reports or diagnostic tests)generated by Sanitas health providers in atool for the exclusive use of thePolicyholder/Insured Party.

(c) Research for designing health caremodels covered by the insurance contract.


Processing the Policyholder’s/InsuredParty’s Personal Data is necessary inorder for Sanitas to perform analysisallowing it to design healthcare models forthe purpose of healthcare prevention forthe Policyholder/Insured Party.

(d) Offering and managing the insurancecontract assistance and preventionprograms. As a consequence of theanalyses and profiling carried out, Sanitaswill design healthcare models that it mayoffer to the Policyholder/Insured Party,taking into account their characteristicsand specific needs. Sanitas thereforeneeds to process their Personal Data inorder to be able to deliver and managevarious healthcare models that arespec i f ica l l y sui ted to thePolicyholder/Insured Party.

(e) Providing the healthcare promotion servicewhich is the purpose of the insurancecontract. Sanitas needs to process thePolicyholder’s/Insured Party’s PersonalData in order to design and refine specifichealthcare management plans for eachPolicyholder/Insured Party. Forthispurpose, as result of processing thePolicyholder’s/Insured Party’s PersonalData, Sanitas will draw up personalisedhealthcare plans and proactive follow-upprograms to allow for the management ofcomplex cases (such as serious illness orprolonged hospitalisations), provideassistance to chronic patients and alsoemergency care.

(f) Managing access to and the use of the "MiSanitas" tool. Sanitas will process thePolicyholder’s/Insured Party’s PersonalData in order to manage and provideaccess to "Mi Sanitas" (an insurancemanagement portal), as well as ensuringits correct operation, either through thewebsite or the app developed for thispurpose. Sanitas, in the context of the useof "Mi Sanitas", will process their PersonalDatain order to, among other things, offerhealth recommendations or placeat thePolicyholder’s/Insured Party’s disposalreceipts and refunds, managetheirappointments, etc.

(g) Providing the Sanitas video-consultationservice. Sanitas will process thePolicyholder’s/Insured Party’s PersonalData, and where appropriate, outsource itto third parties designated by thePolicyholder/Insured Party, in order toprovide a video consultation, chat or otherservice made available by Sanitas insofaras thisservice forms part of thePolicyholder’s/Insured Party’s insuranceservice. In this way, through the programsand applications downloaded for thatpurpose, the Policyholder/Insured Partymay contact medical personnel remotelyand provide documentation in order toresolve any queries that may arise for thePolicyholder/Insured Party in the context ofthe healthcareservices provided bySanitas.

(h) Actuarial risk management. Sanitas willneed to process the Policyholder’s/InsuredParty’s Personal Data in order to carry outa statistical-actuarial analysis for thedetermination of associated risk as well asfor assigning tariffs for customers’andpotential customers’policies prior to thesigning of the insurance contract or duringthe term of the latter, taking into accountany new circumstances affecting theInsured Party or any changes to theactuarial grounds.

(i) Compliance with any mandatory legalobligations corresponding to Sanitas. Oncertain occasions, Sanitas will need toprocess the Policyholder’s/Insured Party’sPersonal Data to comply with certain legalobligations. Among other things, Sanitaswill process Personal Data in order tocomply with the obligations laid down in thelegislation on insurance, tax laws and theexisting Personal Data protectionregulations.

(j) Profiling. Sanitas processes thePolicyholder’s/Insured Party’s PersonalDataso that their experience with Sanitascan be as personalised as possible and sothat Sanitas can continue customising itwhile performing the service covered bythe insurancecontract. To do this,Sanitaswillconduct an analysis of theirinterests and needs in order offer


information tailored to the specificc h a r a c t e r i s t i c s o f e a c hPolicyholder/Insured Party, among otherthings. To conduct this analysis, in somecases,Sanitas may make decisions basedsolely on automated processing, includingdeveloping a profile. This means thatSanitas may use automated analysisprocedures to recognise their interests andneeds based on the type of interaction thePolicyholder/Insured Party may have withSanitas and thus enable them to receivepersonalised information with advice andtips, among other things.

Likewise, any processing that Sanitas maycarry out of the Policyholder’s/InsuredParty’s Personal Datawill be performed inorder to improve the services that weoffer,whereby Sanitas anticipates thePolicyholder’s/Insured Party’s healthrequirements and the necessary increasein resources to provide personal servicesto them. Sanitas will carry out PersonalData processing for scientific researchpurposes with the ultimate aim ofimprovingtheir health as much as possible.

(k) Profiling for offering new products andservices. Sanitas will process thePolicyholder’s/Insured Party’s generalPersonal Data in order to offer them newSanitas products and services adapted totheir needs and interests, improve suchproducts and services, provide anenhanced response to their expectationsand improve customer satisfaction levels.

(l) Sending commercial communications overany channel, including electronically. Asdescribed above, Sanitas will process thePolicyholder’s/Insured Party’s PersonalData to provide them with tailor-madeinformation and advice, taking into accounttheir particular interests and needs forSanitas’s products and services. Thus,Sanitas will process thePolicyholder’s/Insured Party’s PersonalData for sending commercialcommunications relating to financialproducts and services, insurance, healthand social services and/or healthcare orwelfare services by any means, includingelectronically on custom offerings

responding to their interests. In addition,Sanitas may send them commercialcommunications by any means, includingelectronically, from third parties with whomSanitas has cooperative links.

(m) Carry out Personal Data anonymisationand pseudonymisation procedures.Occasionally, Sanitas may apply certainprocedures to the Policyholder’s/InsuredParty’s Personal Data either to make itimpossible to find a relationship betweenan identified or identifiable natural personand the Personal Data processed or sothat the aforesaidPersonal Data cannot beattributed to a certain person without usingadditional information listed separately.

(n) Transferring their Personal Data to GroupCompanies. Sanitas may transfer thePolicyholder’s/Insured Party’s PersonalData to Group Companies for sendingcommercial communications by anymeans, including electronically, as well asfor scientific or statistical researchpurposes so that, among other things,Sanitas can ant ic ipate thePolicyholder’s/Insured Party’s healthcarerequirements.

(o) Transferring Personal Data to third-partycompanies. Sanitas may transfer theInsured Party’s Personal Data to any otherentity with which it has establishedcooperative links for the effectiveness ofthe contractual relationship with theInsured Party arising from risk reinsuranceas well as for sending commercialinformation relating to products andfinancial services, insurance, socialhealthcare services and/or any othersrelating to health and/or well-being. Inparticular, the categories of recipients whowill receive the Insured Party’s PersonalD a t a a r e i d e n t i f i e d i nwww.sanitas.es/RGPD (Sanitas Seguros)and these include other co/insurance andreinsurance entities, insurance brokers,entities with which a commercial link hasbeen established, health professionals,medical centres and hospitals.

Sanitas may merely share thePolicyholder’s/Insured Party’s identifying


data with social networks with the aim ofcross-checking them with the informationcontained on the aforementionedsocialnetworks to understand the way in whichthe Applicant or Policyholder/Insured Partyuses Sanitas’s websites and applications,i.e., which pages and information theyconsult, and therefore provide themwithpersonalised information regardingthecompanies of the Sanitas Group.

In addition, Sanitas may carry out otherPersonal Data processing activities, in whichcase the Appl icant and/orPolicyholder/Insured Party will receive thenecessary information in relation tothisprocessing and Sanitas will request theirconsent if necessary.

8.1.4 Legitimacy for processing thePolicyholder’s/Insured Party’s PersonalData

- The legal basis for processing data forpurposes (a), (b), (c), (d), (e), (f) and (g) isperforming the service provision contract.

- The legal basis for processing data forpurposes (h) and (i) is the requirement tofulfil a legal obligation applicable toSanitas.

- The legal basis for processing data forpurposes (j), (l), (n) and (o) is the consentrequested from the Applicantand/orPolicyholder/Insured Party, without withdrawalof the latteraffecting in any way theperformance of the service provision contract.

- The legal basis for processing data forpurpose (k) is satisfying the legitimateinterest pursued by Sanitas to be able toanticipate the Policyholder’s/Insured Party’sneeds and to offer the latter the products andservices best suited forthepurpose.

- The legal basis for processing data forpurpose (m) is the need toprocess forscientific research or statistical purposes.

The Policyholder is responsible forcommunicating to all the Insured Partiescovered by the policy all the information

contained in this clause on Personal Dataprocessing so that together with thePolicyholder themselves they can exercisethe rights described in the section"Policyholder’s/Insured Party’s rights".

Likewise, the Applicant/Policyholder declaresthat they are acting on their own behalfandthose of the Insured Parties when theyconsent to the processing described in thisclause. In addition, the Applicant/Policyholderdeclares that the Insured Parties understandand accept that they have provided or mayprovide their Personal Data to SANITAS,since SANITAS provides theApplicant/Policyholder with the identifyinginformation about the Insured Parties’ medicalservices covered by the policy, unless thePolicyholder, releases SANITAS in writingfrom its legal duty to inform them, or this isrequested by any of the Insured Parties.

8.1.5 Personal Data conservation period

Sanitas will retain the Policyholder and/or theInsured Party’s Personal Data for the durationof the contractual relationship betweenSanitas and the Policyholder and/or theInsured Party and, in any event, during theperiod that is necessary to formulate, exerciseor defend potential claims, to comply with theobligations for the conservation of clinicaldocumentation and/or in any case where theapplicable law permits. Once this deadlinehas ended, Sanitas agrees to ceaseprocessing all Personal Data, as well as toproperly block access to it. However,Personal Data may be retained for longerperiods when it is necessary whenever it isprocessed exclusively for healthcare, medical,scientific research or statistical purposes.

8.1.6 Accessing Personal Data

The optimal service delivery offered bySanitas may require that other Sanitasthird-party service providers may access thePolicyholder’s/Insured Party’s Personal Dataas data processors. The Policyholder/InsuredParty understands that some of these serviceproviders are in countries outside theEuropean Economic Area or which do notoffer security levels equivalent to those in


Spain. Such international transfers are madeunder the authorisation of the Director of theSpanish Data Protection Agency and/or arecovered by contractual clauses complyingwith appropriate security measures.International transfers can be checked usingthis link www.sanitas.es/RGPD (SanitasSeguros). To obtain a copy of thisdocumentation, please contact Sanitas usingthe contact details set out in paragraph"Policyholder’s/Insured Party’s rights".

In addition to the national orinternationalaccess third-party providers mayhave to the Personal Data for which Sanitasis responsible in their capacity as dataprocessors within the service provisionframework, Sanitas will transfer PersonalData to other entities, as specified inparagraph III. -The purpose for which yourPersonal Data is processed.

In addition to the above, thePolicyholder/Insured Party understands thatSanitas may transfer or communicatePersonal Data to meet its obligations withpublic administrative bodies in cases in whichit is required to do so in accordance with thelegislation in force at any giventime, and,where appropriate, also to other bodies suchas state security and the judiciary.

Likewise, the Policyholder/Insured Partyunderstands that Sanitas may request,require, and share personal and health datawith professionals or health centres, hospitalsand, on the other hand, entities with which ithas a co/reinsurance or co-operativerelationship. It is therefore understood that itwill be necessary to reciprocally provide theirPersonal Data, for the purpose of managingreinsurance, coinsurance, comprehensivecare program management, a betterunderstanding and assessment of the risks tobe covered, fraud prevention, thedetermination of healthcare, payments tohealthcare providers or reimbursement to theInsured Party of health care expenses and inorder to attend to claims filed by the InsuredParties themselves.

8.1.7 The Policyholder’s/ Insured Party’srights

Sanitas informs the Policyholder/InsuredParty about the possibility that they mayexercise the rights of access, rectification,objection, erasure, portability andlimitation of processing as well as rejectingautomated processing regarding thePersonal Data collected by Sanitas.

These rights may be exercised free of chargeby the Policyholder/Insured Party, and as thecase may be, by any person representingthem, by making a written and signedrequest, accompanied by a copy of theirNational ID or equivalent documentaccrediting their identity, to the followingaddress: Calle Ribera del Loira no. 52, 28042,Madrid, Spain Att. Personal Data ProtectionLaw insurance or through Mi Sanitas athttp://www.sanitas.es/misanitas/online/clientes/contacto/index.html. Representatives mustprove their powers of representation by awritten document accompanied by copy of theNational ID or equivalent document attestingto the identity of the represented party or anyother supporting documentation set out inwww.sanitas.es/RGPD (Sanitas insurance).

In addition to the above rights, thePolicyholder/Insured Party will have the rightto withdraw any consent granted at anytime by following the procedure describedabove, without the aforesaid withdrawal ofconsent affecting the lawfulness of anyprocessing prior to withdrawal of the latter.Sanitas may continue to process thePolicyholder’s/Insured Party’s Personal Datainsofar as permitted by applicable law.

Sanitas reminds the Policyholder/InsuredParty that it has the right to file a complaintwith the relevant supervisory authorities.

The Policyholder/Insured Party may contactthe Sanitas Group Data ProtectionRepresentative (hereinafter, "DPR") viaemail"[email protected]" or at the postaladdress: Calle Ribera de la Loira 52, 28042Madrid, Spain, for any query or requirementfalling within the field of data protection.

8.1.8 Unsubscribing from the commercialcommunications service

mailto:[email protected]


As mentioned in the previous section, thePolicyholder/Insured Party has the right at anytime to revoke their consent for receivingcommercial communications by notifyingSanitas that they do not wish to receive them.To do this, the Policyholder/Insured Partymay either revoke their consent as describedin the previous section or click on the linkprovided in each commercial communication,thereby cancelling the sending of electronicadvertising.

8.1.9 Minors

In General, Sanitas will only process thePersonal Data of children under eighteenwhen their parents or legal guardians havegiven their consent to such processing, and itis necessary for the execution of theinsurance contract or to comply with a legalobligation and/or to satisfy a legitimateinterest of Sanitas.

However, in accordance with the regulationscurrently in force, those over the age of 14 (orthe age which may be legally established forthese effects) will have the right to accesstheir own medical information andmayexercise those rights recognised for themby law.

8.1.10 Amending the privacy policy

Sanitas may amend its privacy policy inaccordance with the legislation applicable atany giventime. At allevents, thePolicyholder/Insured Party will be duly notifiedof any amendment of the privacy policy, sothey can be uptodate with any processingchanges affecting their Personal Data and,should the regulations require it, thePolicyholder/Insured Party can consent tothis.

8.2. BBVASEGUROS, S.A. deSeguros y Reaseguros

8.2.1 Controller

The data controller for the personal dataprovided in the taking out of this InsuranceContract is BBVASEGUROS, S.A. deSeguros y Reaseguros, with registered

address in calle Gran Vía de Don DiegoLópez de Haro, 12, 48001 Bilbao and with itsmain office in calle Azul, nº4 28050 Madrid.Email address: [email protected](hereinafter, “BBVA Seguros”).

8.2.2 Data Protection Officer

The Data Protection Officer of the BBVAGroup may be contacted at the followingemail address: [email protected]

8.2.3 Personal Data Categories

For the aforementioned contractualrelationship, BBVA Seguros can process thefollowing categories of personal data(hereinafter, the “Personal Data”):

• Identifying and contact details (includingpostal addresses and/or electronicaddresses)

• Data relating to the insured asset. Inaccident, illness and life insurance, andin the event of claims, BBVA Seguroswill collect health-related data, with yourprior informed consent.

• Sociodemographic data (such as age,family situation, residence, education andoccupation)

The Personal Data must be duly updated toensure that it is accurate at all times. Anymodification must be communicated to BBVASeguros so that the data corresponds to thecurrent situation.

8.2.4 Purposes

The Personal Data will be used to (i) managethe taking out of the insurance contractapplied for and the full development of theinsurance contract, (ii) administer commonfiles with other insurers and institutionscollaborating with the insurance sector forstatistical, actuarial and fraud preventionpurposes, as well as prepare insurancetechnique studies, (iii) manage reinsurancecontracts, where appropriate, and (iv) createstatistical profiles for actuarial and marketresearch purposes, with the aim of being ableto offer products that we consider fit the

mailto:dpogrupobbva@bbv


customer’s profile, as well as personalisedoffers at more affordable prices.

8.2.5 Legal Basis

The legal basis that allows BBVA Seguros toprocess the Personal Data for the purposesindicated in the previous paragraphs is:

(i) and (iii) fulfilment of the contract andadditionally fulfilment of the obligationsimposed by law, including the Organisation,Supervision and Solvency of Insurance andReinsurance Undertakings Act 20/2015, theInsurance Contract Act 50/1980, theInsurance Distribution regulations and thePrevention of Money Laundering andTerrorismFinancing Act 10/2010.

(ii) the legitimate interest of BBVA Seguros.The Organisation, Supervision and Solvencyof Insurance and Reinsurance UndertakingsAct 20/2015 permits insurance undertakingsto establish shared files for the settlement ofclaims and actuarial statistical cooperation,with the purpose of enabling fees to beprepared and risks to be selected. Act20/2015 also grants authority to createcommon files whose purpose is to preventfraudulent activities designed toobtain illicitenrichment from, principally, claims fordamages or losses that were not incurred.These files fulfil a social function as state lawenforcement agencies are allowed access tothem. Inclusion in this file will be duly notified.

(iv) the legitimate interest of BBVA Seguros inits ability to meet the expectations of ourcustomers better and thus enable us toincrease their degree of satisfaction, as wellas to obtain statistics for actuarial purposes,surveys or market research. The aforesaidlegitimate interest respects the right of thepolicyholder/insured party to protection oftheir personal data, honour, and personal andfamily privacy.BBVA Seguros considers thatcustomers have a reasonable expectation thattheir data will be used to be able to offer themproducts and services corresponding to theirprofile and enjoy a better customerexperience.

In both cases, based on legitimate interest (ii)and (iv), you can exercise your right to

objection at the following address:[email protected]

8.2.6 Conservation of Personal Data

The Personal Data will be kept for the term ofthe contractual relationship. Applications forinsurance which is not taken out will be keptby BBVA Seguros for a maximum period ofninety (90) days, unless a greater period isagreed in the application, to preventprocedures from being duplicated in the eventof new applications. Once the contractualrelationship has terminated, BBVA Seguroswill keep the Personal Data blocked for thelegal limitation periods, which in general arefor 10 years under the regulations on theprevention of money laundering and thefinancing of terrorism. On expiry of the legallimitation periods, the Personal Data will bedestroyed.

8.2.7 Communications of Data

We will not transfer the Personal Data to thirdparties, unless the law requires us to do so orexcept under the reinsurance agreements, asa result of the contractual relationship itself.

In order to be able to successfully provide aservice and manage the contractualrelationship, the link indicated in the finalsection of this clause provides a list bycategories of the companies that processPersonal Data on behalf of BBVA Seguros, aspart of the services we have contracted themto provide.

8.2.8 Rights of the Data Subject

The data subject to whom the Personal Datarelates can exercise certain rights at any timevis-à-vis BBVA Seguros. In this respect, datasubjects may access, rectify, erase, object to,limit the processing of or request theportability of their Personal Data by writing toBBVA Seguros.Their request should beaccompanied bya copy of their National ID orequivalent document accrediting their identityand they should statethe right they wish toexercise.The request should be sent to thefollowing address:

mailto

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- BBVA Seguros. Quality Department. CalleAzul, 4. 28050 Madrid

- O r b y e m a i l t [email protected]

The exercise of these rights is free of charge.

If the data subjects consider that theprocessing of their Personal Data has notcomplied with the regulations, they can writeto the Data Protection Officer (Delegado deProtección de Datos) of the BBVA Group att h e f o l l o w i n g a d d r e s s :[email protected]. They may also,where appropriate, file a complaint with theSpanish Data Protection Agency (AgenciaE s paño la de P ro tec c ión deDatos)(www.agpd.es).

Additional information about the BBVASeguros Data Protection Policy can be foundby following this link:www.bbvaseguros.com

9. Others

The Policyholder and/or Insured grant theInsurer their authorisation so that, ifconsidered necessary, it may record thetelephone conversations that take place inconnection with this policy and use them in itsquality control processes and, whenapplicable, as a means of evidence for anyclaim that might arise between both parties,but preserving the confidentiality of theconversations held in all circumstances.

The Policyholder and/or the Insured may askthe Insurer for a copy or written transcriptionof the contents of the conversations recordedbetween both.

10.Jurisdiction

The Court competent to hear actionsarising from the insurance contract shallbe the one corresponding to the Insured'saddress in Spain.

11. BBVA coinsurance clause

The benefits guaranteed by the present policyare covered under coinsurance, with thepercentages indicated, by the followingentities:

SANITAS S.A. de Seguros 50 %

BBVA SEGUROS S.A. deSeguros y Reaseguros

50 %

This coinsurance is established in a singlepolicy, made out by SANITAS S.A., hereafterSANITAS, and which shall be signed by thePolicyholder and/or insured and by all theCoinsurers, therefore being fully valid for themall. In the event of the issue of supplementsor appendices, SANITAS shall issue a singledocument which shall also be signed by allthe Coinsurers, except for premiumregularisation and those cases which do notmodify the contractual economic conditions,which shall be signed solely by SANITAS onbehalf of all of the coinsurers. Therefore, thePolicyholder and/or insured shall only sign thecontractual documents that have been issuedby SANITAS S.A.

For the effectiveness of the premiums,SANITAS S.A. shall issue and submit forcollection a single receipt for the totality of thestakes in the coinsurance.

Its payment shall have the effect of releasingthe Policyholder from responsibility beforeeach of the coinsurers, without prejudice toany settlements between said coinsurers thatmay subsequently take place.

In their relations with the Policyholder and/orinsured, the Coinsurers shall always berepresented by SANITAS S.A., includingwhen it involves declaring, processing orsettling any claims that may occur. ThePolicyholder and/or insured must onlyaddress SANITAS to report the contingenciesit must relay to its insurers and allcommunications from them to thePolicyholder and/or insured shall beperformed in the same fashion.

Furthermore, in the event of a claim, thedecisions which must be adopted for thecommon defence of the interests of the



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Insured and the Insurers, a previousagreement between the latter and SANITASS.A. shall be taken except in the event of itbeing delegated to another coinsurer inspecial circumstances and by mutual accord.

Without prejudice to SANITAS S.A.'s powers,when the technical complexity and economicimportance of a claim make itrecommendable, in its opinion, it shall consultwith the Coinsurers that represent at least50% of the stake in the coinsurance.

SANITAS's representation does not extend topossible court or arbitral proceedings thatmay arise by cause of this contract, andwhich are filed by the Policyholder and/orinsured or injured party, and therefore all theCoinsurers must be sued, for their respectivequotas, without prejudice to them being ableto subsequently commission the managementof the process to the leading insurer. Whenthe purpose of the lawsuit is exclusively todemand the quota of compensation thatcorresponds from one or more Coinsurers ,this having already been settled by the others,the suit shall be addressed exclusivelyagainst the provision's debtor companies.

The present contract may be terminated:

1. By SANITAS on behalf of all of theCoinsurers in all cases where the Law and thepresent contract award the power oftermination to the insurers.

2. By the insurance Policyholder in the casesprovided for under the Law and in thiscontract, addressing SANITAS S.A. solely.

The action of settling or not extending thecontract is indivisible and can only beexercised by the leading insurer on behalf ofall the Coinsurers. Consequently, separationor exclusion from the network of onecoinsurer may only take place by reason ofextending the contract, under the terms set inthe paragraph below:

The insurance Policyholder may oppose theextension of the present contract, whetherfully or in respect to one or more of thecoinsurers, in both cases addressingSANITAS S.A. and the affected Coinsurers.

SANITAS S.A. shall have the sameentitlement, and must notify the full or partialtermination of the contract to the Policyholderand the affected companies. Likewise, eachof the Coinsurers may oppose the extensionof its participation in the contract, notifying thePolicyholder and SANITAS with the twomonths' notice anticipated under the Law.

In all cases, communication of settlement orrefusal to extend must be made with thenotice provided for in this contract.

The Policyholder and/or insured and thecoinsurers of this risk, lend their consent tothe content of the present contract by signingit, understanding that the matters establishedin the foregoing clauses do not mean that theCoinsurers respond jointly to compliance withthe obligations assumed by this policy. Theresponsibility of each of them is their own andindependent of that of the other Coinsurers,and is determined in accordance with thepercentages set forth in the coinsurancenetwork and no party can, for any reason,demand the payment of compensation whichexceeds that which results from theapplication of said percentages.

This is part of the coinsurance framework.


Executed in duplicate in Madrid, 15 June 2018For the Insured / For the InsurerPolicyholder

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