Network vs Reimbursement Health Insurance in Spain

How the two models work

Network policies (cuadro médico). The insurer contracts doctors, clinics and hospitals and publishes them in a directory. You book one, show your insurance card and the insurer pays the provider. On a sin copago (no co-payments) policy you pay nothing at the point of use. Most Spanish policies, including Adeslas Plena, DKV Integral and Sanitas Más Salud, work this way.

Reimbursement policies (reembolso or libre elección, free choice). You choose any doctor or hospital, pay the bill, then claim. The insurer repays a fixed percentage of the eligible cost, up to an annual cap. Many reimbursement products, such as Mapfre's and Sanitas Premium, also include the insurer's network, so you can use either route.

What reimbursement products actually repay

Comparison site Rastreator surveyed the main products in September 2026:

Rastreator notes that limit figures for Mapfre on third-party sites do not agree; Mapfre's own page for its standard reimbursement policy gives 80% to 90% (90% for hospital care) and up to €250,000 for hospital and outpatient reimbursement.

Prices

Reimbursement cover costs noticeably more than network cover. Rastreator's monthly prices for a 35-year-old, without co-payments, in the first year (Sanitas premiums in force since April 2026):

The same Sanitas Premium profile costs €274.56 a month in Ibiza and Formentera, which shows how much province matters. Add the 0.15% Consorcio de Compensación de Seguros surcharge. Premiums also rise with age; see how much private health insurance costs.

A closer look at two products

Sanitas Premium 500.000 (Sanitas):

• 90% of medical costs repaid, up to €500,000 per person per year, for doctors anywhere in the world
• Dental: 80% repaid up to €400, plus over 65 free services in the network
• Prescribed medicines: 50% repaid, up to €300 per person per year
• €100 a day if you are admitted outside the Sanitas network, up to 90 days a year
• Waiting periods: 3 months for minor surgery, 6 for high-tech tests and psychology, 8 for childbirth, 10 for major surgery and hospital stays
• Claims: pay, upload the invoice and medical report, and Sanitas says the refund arrives within five days

Mapfre Reembolso (Mapfre):

• 80% to 90% repaid; up to €250,000 for hospital and outpatient care
• Use Mapfre's network just by showing your card
• Some services are network-only: basic dental, preventive medicine, brief psychotherapy, assisted reproduction, podiatry and osteopathy
• Emergency assistance abroad up to €12,000
• Waiting periods: 8 months for surgery, hospital and childbirth; 6 months for oncology and rehabilitation

The hidden costs of reimbursement

The percentage is only part of the picture.

• You fund the bill first. You pay the provider and wait for the refund, so you need the cash or credit available.
• The 10% to 30% you pay adds up. On a €6,000 private birth, the figure Acierto gives as typical without insurance (Acierto), 10% is €600 and 30% is €1,800.
• Sublimits apply. Dental, medicines and other extras have their own caps, as the Sanitas list above shows.
• Waiting-period waivers can be narrower. Sanitas's switching waiver applies only to its own-network products, not to its reimbursement products.
• Paperwork. Every claim needs an itemised invoice and usually a medical report.

Cover outside Spain

This is where reimbursement earns its price. A standard network policy covers you abroad only for travel emergencies. Sanitas Premium repays 90% worldwide. Some network products sit in between: DKV Integral individual policies repay 80% of treatment abroad for serious illness, up to €16,000 a year.

If you live part of the year in another country, or want to be treated by a specific surgeon in the UK or US, compare reimbursement against an international expat plan; our best insurance for expats page covers both.

Which one works for a visa

The Unidad de Grandes Empresas, which decides digital nomad applications, does not accept "seguros basados únicamente en el reembolso de gastos médicos" (policies based only on reimbursement), nor policies with co-payments or waiting periods. Consulates word their requirements differently. London asks for a policy covering all the risks insured by the public system; São Paulo requires no waiting periods and no co-payments.

In practice, a network policy without co-payments or waiting periods is the straightforward route for the digital nomad and non-lucrative visas. A reimbursement product that also gives full network access may be accepted, but confirm the certificate wording first.

How to choose

1. Check the network where you will live. Search the directory for your postcode: GP, nearest hospital with emergency department, and any specialist you need. If it is good, a network policy usually gives the best value.
2. Decide whether you need doctors outside the network. A specific consultant, English-speaking specialists the network lacks, or treatment abroad are the usual reasons to pay for reimbursement.
3. Compare the real percentage and limit. 70% up to €90,000 is very different from 90% up to €500,000.
4. Check visa compatibility if you are applying for residence.

For the practical side, see how to get comparable quotes, including when a registered broker helps.