When comparing private health insurance in Spain, one of the biggest differences is whether you normally use doctors and hospitals directly within an insurer's network, or whether you pay first and claim reimbursement later. Sanitas policies often work through the Sanitas cuadro médico, but exact access, reimbursement rules and payment responsibilities depend on the specific policy chosen.
Direct access
Direct access usually means using doctors, medical centres and hospitals in the insurer's network without paying the full private bill upfront, subject to policy terms and copayments if applicable.
Reimbursement
Reimbursement cover usually means the client may pay the provider first and then claim back according to policy rules, limits, percentages and exclusions.
Sanitas
Many Sanitas policies are designed around the Sanitas medical network and cuadro médico. However, exact access and any reimbursement element must be checked in the policy wording. Understand the cuadro médico.
Comparison
| Aspect | Direct-access (network) | Reimbursement |
|---|---|---|
| Payment at point of care | Usually none for covered services | Often pay first, claim later |
| Provider choice | Within the network | Potentially broader, per policy |
| Network restrictions | Use the cuadro médico | May be fewer, per policy |
| Claim paperwork | Usually minimal | Claims and receipts needed |
| Reimbursement risk | Low for covered services | Depends on limits and percentages |
| Visa suitability | Often expected | May not always be accepted |
| Predictable costs | Generally more predictable | Depends on the claim rules |
| Authorisation rules | May apply | May apply |
Useful for
It can reduce the need to pay large bills upfront where treatment is covered and within network, but policy rules still apply.
Useful for
It may offer broader provider choice in some policies, but the client must understand upfront payment, claim limits, exclusions and reimbursement percentages.
Visas
Some visa routes may require specific private medical insurance features. Reimbursement-style or international policies may not always be accepted depending on route and certificate wording. Verify before applying. See hospital access for visa applicants.
Residents Platinum
Do not assume exact reimbursement or network differences. See Sanitas Residents Platinum — subject to the current Sanitas policy terms and personal conditions.
Checklist
Talk to us
We can explain how Sanitas access works and which model suits you. We help expats compare Sanitas plans and request personalised quotes in English. We cannot provide medical advice, guarantee treatment or override Sanitas policy conditions.
We'll explain direct-access and reimbursement models and which may suit you, and request a personalised quote. Please check the actual current policy terms and your personal conditions before purchasing or using any Sanitas policy. Policies change and individual terms can vary.
We help expats compare Sanitas options in plain English before they decide.
FAQs
Common questions comparing direct-access and reimbursement health insurance. Always confirm the current policy wording.