Find answers to your Health Insurance queries

Asking questions is wise. We are here to give you the answers.

For us, providing excellent service means anticipating your needs and providing your with the answers that you need before engaging in a contract.

Your contract

  • You need to hold residency in Spain and be of legal age.
  • If you are a minor, the mother, father or legal guardian must be the policyholder.

Medical insurance is an annual policy which renews automatically. If you do not wish to renew your policy, you need to advise us by providing one month’s notice ahead of its expiry date.

Of course you can, the more the better. You can save up to 35% discount on some of our products if you take out a family policy.

In the case of a new-born baby, if you have held a policy with us for longer than 8 months, don’t forget that you have 15 days to include him/her without any gaps in coverage or pre-existing conditions and without completing a health questionnaire.

Along with the application for medical insurance, a health questionnaire is included. This consists of a health declaration signed by each one of the insured persons who will be included in the policy prior to it being formalised. It includes relevant questions regarding the state of health of each person to be insured. This questionnaire must be completed for each person to be insured (except in the case of minors under the age of 18, whose declaration will be made by their father/mother or legal guardian), where you are obliged to answer each question truthfully, and note down all known circumstances in relation to your health (past and current). These answers will be considered by the insuring entity, in order to make an accurate risk assessment with regard to the insurance policy, reject the policy or establish any exclusions of coverage for any of the pre-existing illnesses that may be declared by the insured persons (prior acceptance of the insured person).

In the event of falsehood, inaccuracy or intentional omission of information in any of the declarations made in the questionnaire, the Company may cancel the insurance policy.

Yes, it is possible. Our intention is to always be able to offer you a quality medical insurance policy that is tailored to your needs.

However, there are some illnesses that we cannot insure given that the monthly premium would be excessively high, as well as the payment for use of the services.

Yes, of course. For that to happen, the contract has to have been taken out remotely and the maximum length of time to cancel it is 14 days following receipt of the policy.

However, you will be charged for a proportional part of the services that have already been provided.

Yes. However, you must remember that there are qualifying periods required for certain benefits, diagnostic tests, procedures, hospitalisation, etc., in this process. You should consult the contract terms and conditions.

The qualifying periods make reference to the minimum period of time that you have to fulfil following registration as an insured person in the policy, in order to be able to make a claim and use certain services. For example, for procedures, use of high tech diagnostic centres, prosthesis, etc.

Depending on the product, the age limit is currently set between the ages of 64 and 69 years. Please check the product’s terms and conditions.

Caser Salud does not have a maximum term limit. If you are happy with us, we will be delighted to renew your policy on an annual basis.

Caser will be able to amend the applicable premium for the following year’s coverage, in the event of co-payment amounts, taking as a base the technical actuarial calculations and RPI health insurance, the frequency of using the guaranteed coverage, the inclusion of medical advances or new coverage insured with each annual policy renewal, as well as updates from family or promotional discounts at the time of taking out the policy.

In the event that the premiums are amended, you will receive notification of this amendment for the following year’s policy two months prior to the policy’s expiry, where you may choose between renewing your medical insurance policy which assumes that you accept the new financial terms, or cancelling at the end of the current annuity, by means of a written notification directed to the insurance company.

The premiums to be paid will vary according to the annual increase in the healthcare system’s medical costs, as well as the increased age of each insured person, any variation in the number of people on the policy, customer loyalty, promotional conditions (if they were in your policy contract) and the geographical area corresponding to the provision address, by applying the rates that the insured person has in force on the date of each renewal.

The insurance is contracted for the period envisaged in the Particular Conditions. On its expiry, it shall be tacitly renewed annually. However, any of the parties may object to the renewal via written notification to the other party, when carried out in advance no less than one month prior to the conclusion of the current insurance period if the policyholder, and two months if it is the insurer.

In any event, the insurance company agrees to:

  • Not terminate the policy when the insured person is undergoing hospital treatment, until discharged thereof, except when the insured person declines to receive any continued treatment.

  • Not object to the renewal of medical insurance that the insured persons hold in certain situations of serious illness, as long as the initial diagnosis has been made during their policy’s effective period. The following diseases will be classed as ongoing treatment within the contract:

    • Active oncological processes.

    • Heart disease that requires surgical or interventionist treatment.

    • Organ transplant.

    • Complex orthopaedic surgery that is still ongoing.

    • Degenerative and demyelinating diseases of the nervous system.

    • Acute kidney failure.

    • Chronic respiratory failure.

    • Acute myocardial infarction with heart failure.

    • Macular degeneration.

    • Not oppose the policy renewal with regard to insurance policies that include insured persons over the age of 65, when their accredited presence with the entity (excluding non-payment) reaches a continuous length of service of 5 or more years.

    The previous agreements will not apply or will cease to have effect in those cases where:

    • The insured person has failed to meet their obligations or has failed to disclose information or has inaccurately provided information themselves at the time of declaring the risk.

    • This would happen in the event of any non-payment or refusal to pay the premium on accepting their renewal by the policyholder.

    • The Policyholder does not agree to the Renewal terms and conditions.

    This waiver on behalf of the Company, in their right to object to continue the policy, requires that the policyholder accepts the premium, without fail, and shares in the cost of their corresponding services (co-payments), and that the insurer may periodically modify them to accommodate any change in the insurance costs, while adhering to actuarial criteria and within the limits established by law and by the contract.

The premiums are subject to the application of legally recoverable taxes on the first invoice (0.15% L.E.A.) and the IPT for their part of the corresponding cover. The health insurance premiums are exempt from Insurance Premium Tax (IPT), except for the part of the premium intended to cover Travel Assistance, if included.

Yes. Age is one of the main factors for calculating the premium, as old age increases the risk of illness.

For medical healthcare insurance, and not dental healthcare, the premium can be paid monthly, quarterly or annually without any charge. This is paid via a current account direct debit, in the name of the policyholder, which is expressly indicated in the insurance application.

Questions about my insurance usage

Via a personally issued, non-transferable card from Caser. This will show your insurance number, personal details, and the type of insurance that you hold. When you visit a Health Centre, you just need to present the card.

In certain cases, due to safety reasons, you may be asked for another type of identification instead of your card.

In our range of products, there are insurance policies that require co-payment and those without co-payment, to allow the price to be tailored better depending on each person’s use.

The products that offer co-payment involve your co-participation for use of a service. For the products without co-payment, you only pay the cost of the premium.

Co-payment means that insured persons participate in the cost of the services that are included in the majority of medical insurance policies on the market.

This involves a payment of a small amount by the insured person to make use of certain services, and that way, avoiding an increase in the generic cost of the premium for all customers who hold the same insurance, by assigning these amounts according to the individual use of each person.

Each time that you attend an appointment or undergo a test, you show your card and, depending on the insurance product you hold, we will charge your account on a monthly or quarterly basis for your part of the co-payment.

In addition, so that you can always plan for the cost, you can always check it by accessing your personal customer area.

Remember that the Centre or doctor will notify us of your use, and Caser will invoice the assigned co-payment for each one of the services received.

On some of our products, we limit the co-payment to €295 so as to avoid penalising illness, and beyond this limit, the services will cost nothing further for the insured person.

We have designed a series of products adjusted to customers who make less use of their insurance, so that the customer pays a low fee and only pays for what they need via co-payment.

Reimbursement is a type of insurance where you decide at any time which doctor you want to consult, who you want to operate on you and which centre you want to be admitted to. If they are not in Caser’s medical directory, you will pay the costs and then we will subsequently reimburse you with a proportion of the charges, between 80 and 90% depending on the service, up to a limit of €210,000 per insured person, per year.

Once you have the invoice, you should complete the form and attach a copy of the invoice when you submit the form. Within 10 working days, we will reimburse you for the corresponding amount in accordance with the established reimbursement conditions in the policy. It’s very simple.

On our Medical Directory page, you can always check the up-to-date list of professionals who are at your disposal.

Yes, as long as they are in our extensive directory of renowned medical professionals.

In the event that you wish to visit a doctor who cannot be found in our approved medical directory, we recommend “Caser Salud Prestigio”, given that it offers the reimbursement payment method and you have complete freedom to choose a doctor.

You can start using it from the first date that appears on your contract. When you are taking out a policy online, we will ask you from which date you would like the policy to take effect.

You have to bear in mind that in order for us to register a policy, this needs to have been paid beforehand to cover the first month as a minimum. Remember that there are qualifying periods for certain services.

You can check in the General Conditions of your contract or in the conditions or good practice guide that can be found on our product pages online.

We would always recommend that you read the General and Individual [those that apply in your particular case] Terms and Conditions to be sure, and if you have any questions, get in touch with us so that we can answer them.

  • Via our Chat service.

  • Via email on our form.

  • Call us on +34 901 332 233.

As a general rule, you need to request authorisation for hospitalisation**, high tech diagnostic tests, special treatments and prosthesis. However, we will tell you about the tests that specifically require authorisation.

*You should have the Front and Backpages of the prescription receipt to hand

To request hospital admission, it is important to have your Medical Report. Digitalise it by scanning it or taking a photograph of it with your mobile.

You can do this in two ways:

  • By calling us on +34 901 332 233

  • By contacting us through your Customer Area, as long as you are the policyholder of the Medical Insurance policy.

Once requested, we will get in touch with you via text or via a phone call.

It’s simple:

  • 1. Make your purchase

  • Print out the Pharmacy Costs request form, attach the original invoices and the medical receipt that your doctor has given you. *The receiving patient’s full name must appear on them.

  • Send it to us at Caser, Avenida de Burgos, nº 109, 28050, Madrid

  • After 15 working days, we will reimburse you with a payment into the same account that you use to pay your insurance direct debits.

And that’s it.

It’s simple:

  • 1. Make your purchase

  • Print out the Optician Costs request form, attach the original invoices which must include the test and the concept of the products obtained and the medical prescription or sight test that authorised these services.

  • Send it to us at Caser, Avenida de Burgos, nº 109, 28050, Madrid

  • After 15 working days, we will reimburse you with a payment into the same account that you use to pay your insurance direct debits.

And that’s it.

Go to the Generic Nutrition Test webpage and it is all explained in detail there.

With Caser Salud, we guarantee that you can have a second medical opinion, meaning complimentary information and a medical opinion from an expert doctor about a serious illness, such as for a cancer case or a cardiovascular, dental, gynaecological case, etc. without it costing you anything extra.

Phone and administrative queries

If you lose your Caser card, don’t worry. You can request a new one in two ways.

  • Customer Area. Access your customer area to request it.

  • Call us on +34 901 332 233.

We have provided the following telephone numbers at your disposal, as well as online contacts so that you can find the solution to any of your needs.

Management service and telephone transactions +34 901 332 233

Online Medical and Paediatrics Advice. Telephone +34 902 190 191 (include link)

Caser offers the “Servicio de Defensa al Asegurado” [Insured Defence Service] (Complaints and Claims) for all their customers at Avenida de Burgos, no 109, 28050 Madrid, and at the email address defensa-asegurado@caser.es

If your claim is dismissed or more than two months have passed without you having received a response, you can also start an administrative claim process brought before the “Servicio de Reclamaciones de la Dirección General de Seguros y Fondos de Pensiones” [the General Insurance and Pension Funds Directorate Claims Service], Paseo de la Castellana, 44, 28046 Madrid. Likewise, you can go to the appropriate Courts and Tribunals service.

Call the plumber and check out the damage to your neighbour’s property. Don’t worry, damage to your belongings are Coverageed by the Water Damage Coverage and damage to your neighbour's property by the Civil Liability Coverage.

Medical insurance premiums are exempt from Insurance Premium Tax (IPT), except for the part of the premium intended to cover Travel Assistance.

In general, with Insurance for Individuals, the premiums paid for the current insurance do not confer any rights to any tax benefits. They are not deductible from Personal Income Tax (IRPF in Spanish), and do not confer any rights to deductions or allowances. However, there may be certain special cases in some Autonomous communities.

In the event that the policyholder is a business-owner or a professional who is subject to IRPF under the Direct Estimate Tax Regime, the maximum limit for deductions is 500 euros per person and calendar year, while considering in this sense solely their own cover, that of their spouse and their children aged under 25 years who live with the policyholder. If the policyholder were insuring their employees, the first payment will be tax deductible on their personal tax (Company Tax or Personal Income Tax, IRPF).

The premium will not constitute compensation in kind for the employee with the same quantitive limits per person insured and calendar year as indicated in the previous paragraph. The amount that exceeds these limits would be considered to be compensation in kind and would be subject to the corresponding on-account payment.

The provision of healthcare services does not constitute an income flow for the beneficiary. For this reason, these services are not taxed in the beneficiary’s Personal Income Tax or IRPF.

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