What to ask before you sign, and what a bad answer sounds like

Questions that decide whether you can be covered at all

These come first because a bad answer here makes every other question irrelevant.

“What exactly does the medical questionnaire ask, and what happens to what I declare?” Spanish insurance contract law puts a duty on you to declare the circumstances the insurer asks about in its questionnaire, and attaches consequences to reticence or inaccuracy. So the questionnaire is not a formality — it is the document your cover is built on, and it is the document an insurer will return to if a large claim arrives. Answer it fully and accurately, and answer it yourself rather than letting somebody summarise your history on your behalf. A bad answer: “Just put no to everything, it’s only a formality,” or a questionnaire completed for you over the phone that you never see in final form.

“What will you do with the conditions I declare — exclude, load, defer or accept?” These are four different outcomes with four different prices. You need to know which one applies to each declared condition before you commit, not when you claim. See pre-existing conditions for how each works. A bad answer: “That won’t be a problem.” Ask for it in the issued terms.

“If I have held cover before, what will you recognise, and how do I evidence it?” Continuity is worth asking about because it can shorten or remove waiting periods — but only if it is granted in writing. Continuous cover explains what to request. A bad answer: “Everything transfers.” Nothing transfers automatically.

Questions that decide when you can use it

“Which waiting periods apply, to which services, and for how long each?” A single headline figure is nearly always wrong, because waiting periods in Spain are set service by service — surgery, childbirth, complex diagnostics and some therapies typically sit on different clocks from ordinary consultations. If you are buying for a specific reason, that reason’s waiting period is the only one that matters to you. A bad answer: one number for the whole policy, or “there aren’t really any.” Ask for the schedule, and read waiting periods so you know what to look for.

“Is any waiver being granted, and does it name the services?” A waiver that says “waiting periods waived” and a waiver that lists which ones are waived are different documents in a dispute. A bad answer: a verbal assurance, or a waiver you are told will “be applied” without appearing in the terms.

“When does cover actually start, and what am I covered for on day one?” The start date and the date the cover becomes useful for your particular need are often not the same day. A bad answer: “It’s active immediately,” with no reference to the waiting-period schedule.

Questions that decide where you can use it

“Are these specific hospitals and these specific doctors in network, today?” Ask by name — your hospital, your paediatrician, the consultant you already see — and check the answer in the insurer’s current directory yourself. Networks change, and a hospital being listed does not mean every professional working inside it is. A bad answer: “We have excellent coverage in your area.” That is not an answer to the question you asked. See medical networks and hospitals.

“Is the network in my province as good as the network in the big cities?” Provincial coverage varies considerably, and a national brochure smooths that out. If you live somewhere rural, ask how far you would travel for the things you would actually use. A bad answer: a national figure for the number of centres.

“What happens if I move to another region of Spain, or travel abroad?” Moving province usually means a different network and sometimes a different price. Cover outside Spain, if any, is usually narrow and conditional. A bad answer: “You’re covered anywhere.” Ask what “covered” means, and where it is written.

“If I use a provider outside the network, does the policy pay anything?” This depends entirely on whether the product is network-based or reimbursement-based, which is the most consequential structural choice on the market. Reimbursement versus medical network sets out the difference; out-of-network doctors covers what happens when you go outside it. A bad answer: “You can go wherever you want,” on a network product.

Questions that decide what you pay beyond the premium

“What is the copayment schedule, per service, in euros?” On a copayment product the premium is only part of the price. Ask for the full table — GP, specialist, imaging, emergency, therapy sessions — and multiply it by how your household actually uses healthcare, not by how you imagine it will. Copayments versus no copayments covers the trade. A bad answer: “It’s only a few euros.” A few euros times a family times a winter is a real number.

“What annual limits and sublimits apply?” Sublimits are where policies quietly differ: a cap on physiotherapy sessions, on psychology sessions, on prostheses, on dental work, on a particular treatment. The headline may be generous while the thing you need is capped low. See dental care, physiotherapy and mental healthcare for the three where this bites most often. A bad answer: “There’s no limit.” There is nearly always a structure; ask where it is written.

“Which services need prior authorisation, and how long does it take?” Authorisation is where cover is decided for expensive treatment, and it is a process you will have to operate. Prior authorisations explains it. A bad answer: “The hospital handles all that.” Sometimes; not always.

“Does the policy pay for medication?” Outpatient prescription medicines are commonly outside Spanish private health cover, which surprises people from systems where the two travel together. Ask explicitly, and read prescriptions in Spain. A bad answer: silence, or a general assurance about “pharmacy cover” with nothing in writing.

Questions that decide what you will never be paid for

“What are the exclusions, and can I read them before I buy?” Exclusions are permanent; waiting periods expire. Confusing the two is the most common expensive misunderstanding in this market, and exclusions separates them properly. You are entitled to read the clause itself, plainly marked, before you are bound by it. A bad answer: “The usual ones.” Ask for the document.

Questions that decide what happens in year three

“How is the premium structured by age, and where are the band boundaries?” Age banding is the single biggest driver of long-run cost, and it is knowable in advance. Ask where the next boundary sits for each person on the policy. Renewal increases explains the mechanisms. A bad answer: “It goes up a bit each year.” That is not how banding behaves.

“What can change at renewal besides the price?” Limits, copayments, network and wording can all move. The law requires the insurer to notify any modification of the contract at least two months before the period ends, and to give two months if it opposes renewal, while you may oppose on at least one month’s written notice — and those terms must be highlighted in your policy. Ask where. A bad answer: “Nothing changes.”

“Is there any age at which you would stop renewing, or restrict the product?” Ask it directly, particularly if you are buying later in life. Cover over 60 deals with this. A bad answer: a reassurance rather than a clause.

Questions about what you will actually receive

“Which documents will I get, and when?” You should expect the condiciones generales, the condiciones particulares naming you and your cover, any special conditions applied to your history, the network directory or access to it, and your insurance card or its digital equivalent. The particular conditions are the ones that govern your case.

“Who do I contact for authorisations, claims and complaints, and what is the formal complaints route?” Ask before you need it.

A bad answer to either: “It’ll all come through.” Ask when, and check it against what you were promised.

If the answers arrive verbally and warmly and nothing is in writing, that is itself the answer. The errors these questions exist to prevent are collected in mistakes expats make; the quote they eventually produce is unpicked in how to read a health insurance quote.