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Medical insurance for pre-existing conditions

Posted: Sun Feb 14, 2021 3:50pm
4 replies120 views2 members subscribed
Robbo10

Posts: 114

12 helpful points

Location: Orihuela Costa

Joined: 9 Jul 2018

Hiya

Can anybody tell me whether I am able to join the Covenio Special.

I have been here a year this month. Our residencia application is in but not accepted yet. Our Padron was applied for in November.

I have been told twice that we have to have had residencia for a year.

We are 64 and 65 and are not old enough to have an S1 form.

I have private medical insurance and I need an incisional hernia repair. Salus have refused to pay for it bcos I was not with them a year and bcos its has been caused by an a previous operation that I had in UK in September 2019.

I declared this operation to Salus before my application was excepted and there are no exemptions on my policy.

I am having the operation in a weeks time at a cost of €6100.

I do not want to have to pay for any more treatment.

Can anybody please help.

Kind regards

Chris

tebo53

Posted: Sun Feb 14, 2021 5:30pm

tebo53

Legendary helpful member

Posts: 4826

5023 helpful points

Location: Benidorm

Joined: 29 May 2018

Posted: Sun Feb 14, 2021 5:30pm

Robbo10 wrote on Sun Feb 14, 2021 3:50pm:

Hiya

Can anybody tell me whether I am able to join the Covenio Special.

I have been here a year this month. Our residencia application is in but not accepted yet. Our Padron was applied for in November.

I have been told twice that we have to have had residencia for a year.

We are 64 and 65 and are not old enough to have an S1 form.

I have private medical insurance and I need an incisional hernia repair. Salus have refused to pay for it bcos I was not with them a year and bcos its has been caused by an a previous operation that I had in UK in September 2019.

I declared this operation to Salus before my application was excepted and there are no exemptions on my policy.

I am having the operation in a weeks time at a cost of €6100.

I do not want to have to pay for any more treatment.

Can anybody please help.

Kind regards

Chris

Sorry but I'm afraid that you have to be a fully legal resident for a full year before you can apply for the Convenio especial. 

Steve 

Robbo10

Posted: Sun Feb 14, 2021 5:40pm

Robbo10

Original Poster

Posts: 114

12 helpful points

Location: Orihuela Costa

Joined: 9 Jul 2018

Posted: Sun Feb 14, 2021 5:40pm

tebo53 wrote on Sun Feb 14, 2021 5:30pm:

Sorry but I'm afraid that you have to be a fully legal resident for a full year before you can apply for the Convenio especial. 

Steve 

I thought as much. Thought we might have done it if we could prove we had been here a year.

Kind regards

Chris

Kimmy11

Posted: Sun Feb 14, 2021 11:36pm

Kimmy11

Legendary helpful member

Posts: 6870

12564 helpful points

Joined: 8 Aug 2017

Posted: Sun Feb 14, 2021 11:36pm

Hi Robbo,

You don't have to have formal residency for a minimum of 1 year, but you do need to have been registered on the Padron for that period.  This causes a lot of confusion, because non-residents are not supposed to register on the Padron, but you have to do so if your intention is to apply for residency.  This means that you will be eligible to apply for the Convenio Especial from November this year (the first anniversary of registering on the Padron), even though your residency has yet to be approved.  By the way, although you say that your Padron was "applied for in November" 2020, it must have been registered at that time, as you would not have been able to make your residency application without it.

Unfortunately, this does not help the current situation with your hernia operation.  If your PHI with Salus does not exclude pre-existing conditions, this is unlikely to be the reason for declining cover for your operation.  PHI companies usually have a qualifying period (I'm with ASSSA and couldn't claim within the first 6 months of cover), so this is more likely to be the reason.

Kind regards,

Kim

Robbo10

Posted: Mon Feb 15, 2021 9:09am

Robbo10

Original Poster

Posts: 114

12 helpful points

Location: Orihuela Costa

Joined: 9 Jul 2018

Posted: Mon Feb 15, 2021 9:09am

Kimmy11 wrote on Sun Feb 14, 2021 11:36pm:

Hi Robbo,

You don't have to have formal residency for a minimum of 1 year, but you do need to have been registered on the Padron for that period.  This causes a lot of confusion, because non-residents are not supposed to register on the Padron, but you have to do so if your intention is to apply for r...

...esidency.  This means that you will be eligible to apply for the Convenio Especial from November this year (the first anniversary of registering on the Padron), even though your residency has yet to be approved.  By the way, although you say that your Padron was "applied for in November" 2020, it must have been registered at that time, as you would not have been able to make your residency application without it.

Unfortunately, this does not help the current situation with your hernia operation.  If your PHI with Salus does not exclude pre-existing conditions, this is unlikely to be the reason for declining cover for your operation.  PHI companies usually have a qualifying period (I'm with ASSSA and couldn't claim within the first 6 months of cover), so this is more likely to be the reason.

Kind regards,

Kim

Hi

Thank you for your response. We have had bad advice from our solicitor.

A. He told us not to transfer bulk money into our Spanish account until we could get a residency appointment. If we had transferred it as soon as we got here we would have residency by now. Once we changed advisors we didnt transfer our money till August and then had to wait 3 months for it to be in the bank. Nightmare!!

That is why we are in this mess. Salus our medical insurance refused to pay for two reasons. We had only been with them 10 months when I needed to have it. Now, we have been with them 11 months. Also they blamed it on an operation that was carried out in the UK in September 2019. I might add that I told them about the operation, Sepsis and recovery before accepted the application. I have no exemptions on my policy. The consultant that diagnosed my hernia told Salus it was caused by that operation. I still find it hard to accept that they eont pay. I have argued that there is no exemptions on my policy, to no avail.

I am now looking at insurance called ASISA. These have been recommended by BREXPATS in Spain. 

Waiting for their offer.

Thanks for your help in clarifying things for me.

Regards

Chris

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