Health insurance arrangement conditions

PDF arrangement conditions

 

OPEN INDIVIDUAL/COLLECTIVE 

Dental contracts (Dental MAX)

No age limit to take out the policy. No health questionnaires are required to take out the policy.

Outpatient contracts (GO)

Up to 70 years.
Those aged over 70 will be accepted when they form part of a family policy with a minimum of three insured parties under 60 years old. If two or more people over 70 have been included in the contract, a minimum of three insured parties aged less than 60 must be included for each insured party over 70 years old).
No health questionnaires are required to take out the policy.

Healthcare assistance – Plena range:

Up to 70 years.
Those aged over 70 will be accepted when they form part of a family policy with a minimum of three insured parties under 60 years old. (If two or more people over 70 have been included in the contract, a minimum of three insured parties aged less than 60 must be included for each insured party over 70 years old).
A health questionnaire is required to take out the policy.

Refund of expenses – individual:

Up to 64 years.
Those aged over 64 will be included when they form part of a family policy with a minimum of three insured parties under 60 years old. (If two or more people over 64 have been included in the contract, a minimum of three insured parties aged less than 60 must be included for each insured party over 64 years old). A health questionnaire is required to take out the policy.

Seniors – individual:

Up to 64 years.
Between the ages of 55 and 84 (both inclusive), insured parties aged between 50 and 54 will be admitted provided that they are accompanied in the policy by an insured party aged 55 or over. The applicable rate in these cases will be that relating to the tranche of 55-59 years.
Those aged over 84 years old will not be included in the policy. Those aged less than 50 years old will not be included in the policy. A senior health questionnaire is required to take out the policy.

BUSINESSES AND COMPANIES

Businesses Tax ID No. – Self-employed workers:

Up to 70 years.
Those aged over 70 will be accepted when they form part of a family policy with a minimum of three insured parties under 60 years old. If two or more people over 70 have been included in the contract, a minimum of three insured parties aged less than 60 must be included for each insured party over 70 years old).
No health questionnaires are required to take out the policy.

Businesses and companies (Tax ID No.):

The policyholders’ Tax ID Nos. have an ID preceded by letters: A,B,C,D,E,F,G,H,J,N,P,Q,R and S. Up to 67 years.

  • Businesses Tax ID No. (1-4):
  • Legal entities (small business) and their employees. Legal entities with less than five insured parties.
    Family members and direct descendants of the employee can be included. (by accrediting their relationship). Maximum age to take out the policy for legal entity 
    policyholders (Tax ID No.): 67 years.
    For people over 67 years, where appropriate, it will be necessary to have three insured parties under 60 years for each insured party that exceeds the maximum age.
    A health questionnaire is required to take out the policy.
  • Companies (Tax ID No.):Legal entities (companies of + five insured parties) and their employees. Legal entities of between 5 and 99 insured parties.
    Maximum age to take out the policy for legal entity 
    policyholders (Tax ID No.): 67 years.
    For people over 67 it will be necessary to have three insured parties under 60 years for each insured party that exceeds the maximum age. A health questionnaire is required to take out the policy.

Type

  • Closed: the Policyholder assumes the entire cost of the insurance policy for the whole insured group. The company pays the insurance of the whole workforce (direct family members can be included). Non-voluntary inclusion.

    • Number of insured parties, up to 49 insured parties: Obligatory health questionnaire in the initial and successive inclusions.

    • Number of insured parties: 50 or more: Only when the policyholder is A / B or P:

      • A.- Corporations

      • B.- Public limited liability companies

      • P.- Local corporationsThe initial inclusions will be exempt from the health questionnaire, provided that at least 50 insured parties are included from the beginning. So that the successive inclusions are exempt from the questionnaire, at least 50 insured parties must remain in the policy.

  • Mixed or e-flex closure: The policyholder pays the insurance of the workforce through the payroll (direct family members can be included). Inclusion is voluntary on the part of the insured parties.

    • Number of insured parties: 75 or more:elimination of the health questionnaire, in the cases in which the policyholder is A/B or P, provided that all of them are included together in the initial charge.
      The successive additions to this initial charge always require a health questionnaire.

    • The successive additions to this initial charge always require a health questionnaire.     

  • Open closed: the policyholder (with letters C,D,E,F,G,H, J,N,Q,R,S and excluding A,B or P) pays the insurance, but does not assume the full cost of the insurance policy. Associations that agree to broker the payment to associates that form part of them. Voluntary inclusion of the insured parties.
    The health questionnaire will always apply regardless of the number of insured parties.

In all of the previous cases, the insured parties over 67 years must always pass the health questionnaire, whatever the number of insured parties in the initial inclusion.

Important

  • No insured party can be hired that currently has a health contract in force at Adeslas through any of the sale channels (Adeslas/ CaixaBank).
  • No policyholder can be hired that currently has any policy that has been cancelled due to non-payment, with unpaid receipts
  • If any insured party is currently insured at Adeslas, they must consult whether it is possible to transfer/replace policies, based on term of the contract, coverage, etc. The company’s regulations will apply.
  • The acceptance of the contract will depend on compliance with the arrangement conditions of each of the products, together with the acceptance of the health questionnaire of each insured party.