Your rights as a private health insurance patient

The rights that protect you

As a private health insurance customer in Spain, you're protected by Law 41/2002 on Patient Autonomy, the Insurance Contract Act and consumer legislation. Knowing your rights lets you assert them when it matters.

The right to information

Before you take out cover

You're entitled to clear, complete and understandable information about:

• Everything your plan covers.
• The exclusions and limitations.
• The waiting periods.
• Which copayments apply and how much they are.
• The medical network available.
• The terms for renewal, cancellation and minimum term.
• How premiums have moved historically.

The insurer has to give you this in writing before you sign. If someone offers you a policy without handing over the general and specific terms, be wary.

While the policy is in force

• You're entitled to see your up-to-date medical network at any time.
• They have to tell you in advance about any change to your policy terms.
• You're entitled to know the status of your authorisations and paperwork.

The right to the care you've paid for

• The insurer is obliged to provide every service included in your contract.
• They can't refuse cover that's included in your policy, unless an exclusion expressly set out in the contract applies.
• They're obliged to maintain a medical network sufficient to deliver the services you've contracted in your area.

The right to choose your professional

Within your policy's medical network, you're entitled to choose:

• Whichever GP you prefer.
• Which specialist you see.
• Which hospital you're admitted to or operated in.

If your plan includes cost reimbursement, you can also choose professionals outside the network.

The right to a second medical opinion

Many plans include the right to request a second opinion when a diagnosis is complex or an invasive treatment is proposed. Even where it isn't expressly included, you can always ask to see another specialist in the network.

The right to privacy and data protection

• Your medical records and health data are strictly confidential.
• The insurer can only access the medical information needed to administer your policy.
• Your data is protected by the General Data Protection Regulation (GDPR) and Spain's LOPDGDD.
• You have the right to access, rectify, erase and port your data.

The right to complain

If you believe the insurer isn't meeting its obligations, there are several routes:

1. Customer Service Department

The mandatory first step. Submit your complaint in writing; the insurer has 2 months to respond.

2. Policyholder's Ombudsman

If the Customer Service Department doesn't resolve things, you can go to the Defensor del Asegurado, an independent figure appointed by the company.

3. The Directorate-General for Insurance (DGSFP)

If neither of the above resolves the problem, you can complain to the Directorate-General for Insurance and Pension Funds at the Ministry of Economy.

4. The courts

As a last resort you can go to court. Consumer claims relating to insurance are heard in the courts of first instance.

The right to cancel

• You can cancel at the renewal date by respecting the notice period (usually 1-2 months beforehand).
• If the insurer changes your contract terms unilaterally, you can cancel without penalty.
• If you bought online, you have a 14-day cooling-off period from purchase.

The right not to be discriminated against

The insurer cannot:

• Refuse to renew simply because you've used the policy a lot.
• Raise your premium individually because you've had an expensive illness (increases have to apply to everyone in the same category).
• Discriminate against you on grounds of sex, origin or disability when granting cover.

What to do if a claim is refused

1. Ask for the refusal in writing, stating the reason and the contract clause that justifies it.
2. Go through your contract to check whether the refusal is justified.
3. Submit a formal complaint if you believe it isn't.
4. Get advice if you need it: consumer associations, solicitors specialising in insurance.