When I first came to Spain, I just bought a basic private health insurance plan to get my residency permit. It was quite restrictive, as I could only go to designated hospitals and clinics. After I settled into my job, a colleague told me about the ‘reembolso’ insurance model, which they said allows you to visit any hospital and then get reimbursed by the insurance company. It sounded incredibly flexible! So I did some deep research, starting with understanding [Spanish medical bills], and today I’m sharing what I’ve learned as a reference for anyone interested.
What is the Reembolso Model?
Simply put, Reembolso is an insurance model that allows you to freely choose your doctors and hospitals, including private medical facilities that are not in your insurer’s network. When you see a doctor, you need to pay the full cost upfront yourself, and then submit the invoice and medical report to the insurance company to apply for reimbursement. Typically, the company will reimburse between 80% and 100% of your expenses, with the exact percentage depending on your policy terms. Therefore, while the idea of ‘full reimbursement’ mentioned in discussions about [Spanish medical reimbursement] is theoretically possible, in reality, it usually covers the vast majority of the cost.
Who is this type of insurance suitable for?
I think the Reembolso model is particularly suitable for the following types of people:
- Those who value freedom of choice in healthcare: People who want to see a top specialist in a specific field who isn’t part of a standard insurance network.
- Frequent travelers: If you have a sudden illness while traveling within Spain or abroad, you can go to any legitimate hospital nearby without having to search for an in-network clinic.
- Those with high standards for medical quality: You can access Spain’s top private hospitals, like the Clínica Universidad de Navarra, which often do not partner with basic insurance providers.
- Individuals with a sufficient budget: The monthly premium for this type of insurance is usually significantly higher than for the standard ‘cuadro médico’ (in-network) model.
When choosing a plan, it’s crucial to carefully read the contract terms regarding the reimbursement limit. Many companies claim to reimburse 90% or even 100%, but they will have an annual cap on the total reimbursement amount, for example, a maximum of €200,000 per year. For most routine medical visits, this is more than enough, but this limit becomes critical in the event of a major illness. I’ve put together a simple comparison table below to make it clearer:
| Feature | Cuadro Médico | Reembolso |
|---|
| Scope of Care | Only designated in-network hospitals/doctors | Any hospital/doctor, including out-of-network |
| Payment Method | Only a small copay (or no copay) is required | Pay in full upfront, then apply for reimbursement |
| Premium | Relatively lower | Relatively higher |
| Convenience | Hassle-free, no reimbursement process | Flexible, but requires managing receipts for claims |
The Reembolso model offers a ‘pay for freedom’ option. It’s not for everyone, especially those on a tight budget or who find the reimbursement process cumbersome. However, if you have higher expectations for flexibility and quality of care, spending a bit more on this model for [reimbursing medical expenses] can indeed provide a better experience and peace of mind. I ended up switching to an Adeslas Reembolso product. Although I haven’t had to claim any large expenses yet, just knowing I have this option gives me a sense of security. I no longer worry about not being able to find a good doctor. I’m curious if anyone in the forum has used this type of insurance? Feel free to discuss the reimbursement speed and service of different insurance companies.
