Description of services

MAIN FEATURES

If you are aged between 14 and 60, Assistència Sanitària offers you a benefit and compensation policy.

This policy's cover features:

  • Payment of a fixed sum for each day of medical hospitalisation.
  • Payment of a fixed sum for each day spent in a clinic or hospital when the insured person undergoes a surgical operation.
  • Payment of a lump-sum compensation when you undergo a surgical operation.


MEDICAL HOSPITALISATION

The organisation will pay the daily benefits subscribed during the time the insured person spends in a clinic or hospital for medical reasons for a maximum of 30 days.

Waiting period: TWELVE MONTHS.


SURGICAL HOSPITALISATION

The organisation will pay the daily benefit subscribed if the insured person undergoes surgery in a clinic or hospital as an in-patient from the day of admission to hospital until the day he/she is dismissed from the medical establishment where the operation took place.

Compensation is limited to a period of 120 days for each process. In the event that, after the first operation and while the insured person is hospitalised for this reason, a further operation is necessary, the maximum period for daily compensation will be extended by the number of days between the two operations.

The daily compensation sum will be the same whatever the number of operations the insured person undergoes during his stay in the healthcare establishment.
Delivery in a clinic or hospital brings with it the right to a compensation five times the daily compensation, so long as at least one year has passed since the policy came into effect, whether it is a normal or dystocic birth.

Waiting period: SIX MONTHS, except in the case of childbirth, when it will be ONE YEAR.


SURGICAL OPERATION

The company will pay the lump-sum compensation indicated in the table of compensations, according to the type of surgical operation carried out and the sum insured.

If the surgical operation does not appear in the table, the compensation will be decided by analogy or similarity with any of those listed.

Apart from surgical operations themselves, delivery assisted by the physician will be compensated with the amount indicated in the table of compensations, whether it is dystocic or normal.

Waiting period: TWELVE MONTHS.


CLAIMING FOR ACCIDENTS

In the case of an accident, it must be reported within a maximum of seven days.

The claim must include the following information:

  • Identification of the INSURED PERSON, including the age.
  • Address, if different from the one on the policy.
  • Hospital or clinic where the patient has been admitted.
  • Specialist's report specifying the nature and type of surgical or medical treatment.
  • Date when the surgical operation took place.
  • Date of admission to the healthcare establishment.

In the case of accidents covered by the Surgical Operation guarantee, this report must be made before the operation and must include the date and time it is to take place.

In vitally urgent cases when it is impossible to report beforehand, the report must be made as soon as possible afterwards and always within a maximum of seven days.

After discharge, Assistència Sanitària Col·legial must be notified by sending, if applicable, the following documents:

  • Doctor's certificate of the surgical or medical treatment applied.
  • Discharge signed by the doctor.
  • Confirmation from the hospital of the date the patient left.

Payment of compensations will be in keeping with the amounts and limits agreed.


EXCLUSIONS FROM THE POLICY

  • Constitutional and physical defects originating before the policy took effect.
  • Injuries produced as a result of riots or war.
  • Injuries arising from atomic or nuclear energy, unless it is a consequence of medical treatment.
  • Officially declared epidemics.
  • Illness or injury resulting from drunkenness, drug addiction or suicide attempts.
  • The practice of any kind of sport of a professional nature.
  • Psychiatric hospitalisation.