33 min read
Two quotes are lying on the terrace table. Both promise private doctors, short waiting times and hospital treatment throughout Spain. One is a little cheaper, the other carries a better-known name. Neither brochure says which is the better policy. That is in the small print: the condiciones generales.
There is no single best health insurance in Spain. There is, however, a handful of questions that every policy has to answer. The answers are in the policy wordings, which many insurers publish. We have reviewed those of DKV, Sanitas, AXA, Allianz and Cigna Global. Other large providers such as Adeslas, Asisa or Mapfre are not included in this comparison.
The clause that most surprises people moving to Spain is the insurer’s right not to renew the contract at the end of the insurance year.
- Spain has two basic models: the medical network (cuadro médico), where the insurer settles bills directly with doctors and clinics, and reimbursement (reembolso), with free choice of doctor and payment against invoices.
- Under the Spanish Insurance Contract Act, the insurer may object to the renewal of the contract by giving two months’ notice before the end of the insurance year. The law does not prohibit the insurer from doing so.
- Some policy wordings waive this right: DKV in the individual policy after three years, AXA in Óptima Plus under its general terms, with exceptions such as incorrect health information. Sanitas keeps the right in both wordings we reviewed, and for Allianz the information sheet describes the same rule.
- Typical waiting periods (carencias) at the Spanish insurers: six to ten months for hospital stays and major operations, eight to ten months for childbirth. DKV, Sanitas and AXA make exceptions for emergencies, Sanitas and AXA only for life-threatening ones.
- With DKV, Sanitas and AXA, known pre-existing conditions that you do not declare in the health questionnaire are excluded, and the insurer can expressly exclude declared ones. With Allianz and Cigna, pre-existing conditions are excluded as a rule unless cover has been expressly agreed. After one year, DKV also covers pre-existing conditions you did not know about yourself.
- Premiums rise with age. DKV states expressly in its terms that there is no upper limit on the annual adjustment.
- For EU citizens who live in Spain without working, the authorities require health insurance with cover that is equivalent to that of the public health system. For visas from non-EU countries, consulates often require a policy without co-payments, some also without waiting periods.
How to recognise the best health insurance
Online rankings usually sort insurers by how well known they are, by the number of contracted doctors or by price. If you want to live in Spain and grow old there, other points matter more. They decide whether the policy will still deliver in ten or twenty years what it promises today.
| Question | Why it matters | Where to find it |
|---|---|---|
| Network or free choice of doctor? | Determines which doctors you can see and whether you pay invoices up front | Description of benefits in the condiciones generales |
| Co-payments? | The copagos per visit add up if you see doctors often | condiciones particulares, co-payment table |
| Waiting periods? | Up to ten months without hospital cover for planned treatment | Section on carencias |
| Pre-existing conditions? | Whatever existed before the start of the contract is often excluded for good | Exclusions, health questionnaire |
| Maximum age at entry? | If you switch too late, you will not find a plan that accepts you | edad máxima de contratación |
| Insurer’s right not to renew? | Decides whether you stay insured in old age | Section on duration, oposición a la prórroga |
| Premium adjustment? | Age bands and rising costs determine your premium in twenty years | Section on the premium |
These seven questions run through the whole comparison. For a general introduction to the Spanish system, public and private, see our page on health insurance in Spain and our guide to health insurance in Spain for expats.
Medical network or reimbursement
The Spanish Insurance Contract Act, the Ley 50/1980 de Contrato de Seguro, allows two types of benefit in Article 105: the insurer pays money for the treatment, or it provides the medical care itself. In practice, these have become two models.
Medical network cuadro médico
You go to doctors and clinics that have a contract with the insurer and show your insurance card. The bill is settled directly. Depending on the plan, you pay a small co-payment per visit, the copago. You pay doctors outside the network yourself.
Reimbursement reembolso
You choose your doctor and clinic freely, also abroad, pay the invoice and submit it. Usually a fixed percentage is reimbursed up to maximum amounts, with some plans the full invoice. These plans usually also include a medical network that you can use as in the first model.
You may be used to reimbursement from private health insurance elsewhere. In Spain, the network model is the norm, and for most everyday treatment it is more convenient: you pay nothing up front, and the contracted clinics know the procedures. Reimbursement is worthwhile above all if you want to keep a particular doctor outside the network, travel a lot in other countries or value a free choice of clinic for major procedures.
A policyholder with a reimbursement plan that pays back 80 percent for outpatient and 90 percent for inpatient treatment is treated outside the network. For a series of outpatient specialist appointments with tests he pays 1,500 euros, for a planned procedure with a hospital stay 12,000 euros.
He is reimbursed 1,200 euros and 10,800 euros, provided the waiting periods have expired, the treatment is included in the plan and the invoices are within the maximum amounts. He bears 300 euros and 1,200 euros himself. If he sees a doctor from his plan’s network for the same treatment, the insurer settles the bill directly.
The example is an illustrative calculation with round figures, not a case from our advisory work. The rates match those AXA publishes for Óptima Plus. There, maximum amounts per benefit also apply, for example per specialist appointment, which can reduce the result.
The five insurers at a glance
DKV, Sanitas, AXA, Allianz and Cigna Global differ above all in model, co-payments, maximum age and the right to refuse renewal. We reviewed the general terms, for Allianz only the product information sheets, because we could not find the general terms for its health insurance publicly. Where a row says “not stated in the documents”, we searched and found nothing. That does not mean there is no rule.
| Plan | Model | Co-payment | Maximum age at entry | Insurer can refuse to renew |
|---|---|---|---|---|
| DKV Integral | Network | depends on the variant (table shows four of five), none in the Élite variant | up to 75 according to the product page | in the individual policy, after three years only for breach of obligations or incorrect information |
| DKV Top Health | Network and reimbursement | none in the network according to the terms, an excess (deductible) may be agreed outside it | not stated in the documents | in the individual policy, after three years only for breach of obligations or incorrect information |
| Sanitas Más Salud | Network | amount as per contract | accepted only below the age of 75 | yes, with two months’ notice |
| Sanitas Mundi | Network and reimbursement | none | accepted only below the age of 64 | yes, with two months’ notice |
| AXA Óptima Plus | Network and reimbursement | none | not stated in the documents | no, according to the terms; exceptions: undisclosed pre-existing condition, incorrect or incomplete information, and the contract also ends if you move away |
| Allianz Salud | Network or reimbursement | depends on the variant chosen | not stated in the documents | yes, with two months’ notice according to the product information |
| Cigna Global | International reimbursement | choice of deductible and co-insurance | from 18 with no maximum age according to the Cigna website | yes, but not because of your claims or illnesses |
The table does not replace a look at the individual plan. The sections on each insurer show where the information comes from and where the details lie. For a short overview in video form, see our short video on the best health insurance companies in Spain.
DKV
We reviewed the general terms of DKV Integral, DKV Top Health and DKV Mundisalud, edition January 2026.
DKV Integral: the network product
DKV Integral provides its benefits through DKV’s medical network and requires your habitual residence to be in Spain, unless DKV expressly allows otherwise. There are several variants that differ in the level of co-payment. In the published co-payment table, which shows four of the five variants, a GP appointment costs between 0 and 13.50 euros and a specialist appointment between 0 and 23 euros. In the Élite variant there is no co-payment. According to the table, co-payments are capped at 600 euros per person and year. DKV can change the amounts at each renewal.
When you travel, DKV Integral covers emergencies abroad for up to 180 days per trip, with treatment costs of up to 30,000 euros per claim and person. This is no substitute for a longer stay outside Spain.
More on the variants and benefits is on our page on DKV Integral.
DKV Top Health and Mundisalud: with free choice of doctor
Top Health and Mundisalud combine the network with reimbursement for doctors and clinics outside the network, also abroad. Under its terms, unless otherwise agreed, Top Health reimburses invoices in full, limited only by maximum amounts for individual benefits such as dental care or psychotherapy. In the network, according to the terms, you pay nothing per treatment. Outside the network an excess may be agreed, which does not apply to hospital stays. Mundisalud reimburses a percentage, the amount of which is set out in the contract.
Both plans require your life to be centred in Spain: Top Health reimburses invoices outside the network if you live in Spain for at least 183 days a year. Mundisalud requires nine months, unless DKV expressly allows otherwise. If you spend months of the year in your home country, this is the most important point to check. Details of the plans are on our pages on DKV Top Health and DKV Mundisalud.
Sanitas
We reviewed the general terms of Sanitas Más Salud and Sanitas Mundi, version October 2024, and Sanitas’ product pages. We did not find a more recent version of the terms.
Más Salud is a network plan. For each service you pay the share set out in your condiciones particulares, the policy schedule. You are accepted only below the age of 75, with exceptions only by express agreement. In the terms of Más Salud we found no age limit for staying insured. For its plans for foreign residents, Sanitas likewise states on its page for foreigners 75 years at entry and no limit for staying insured. Cover when travelling is an add-on: emergencies abroad in the first 90 days of a trip, up to 12,000 euros per person and year.
Mundi adds reimbursement to the network. According to Sanitas, the plan reimburses 90 percent of hospital costs and 80 percent of outpatient costs, in each case up to the agreed amounts, and it has no co-payments. You are accepted only below the age of 64. According to the product page, there is no age limit for staying insured.
Both wordings end if you move your residence abroad or live in Spain for less than six months a year. And in both, Sanitas keeps the right to object to the renewal with two months’ notice. According to Sanitas’ product pages, if you have already been insured with another insurer in Spain for at least one year when you switch to Sanitas, you can shorten or avoid the waiting periods altogether, except for childbirth. This rule is not in the terms, so ask for it to be confirmed in writing. More on the plans is on our page on Sanitas health insurance for expats.
AXA
We reviewed the general terms of AXA Óptima Plus, version January 2026, and AXA’s pre-contractual information. Óptima Plus combines the medical network with reimbursement: 80 percent for outpatient treatment, 90 percent in hospital and 80 percent abroad, up to an annual reimbursement limit that the pre-contractual information (retrieved October 2026) states as 806,362.04 euros. According to the terms, the limits are adjusted annually. This plan has no co-payments in the network.
According to the section on duration, AXA may only terminate the policy if a pre-existing condition was concealed in the health questionnaire or the information given was incomplete or incorrect. Regardless of this, the contract ends under the terms if you move your residence abroad or live in Spain for less than six months a year. If you fall behind with payment, cover is suspended after one month; this rule also appears with DKV and Sanitas. AXA’s pre-contractual information states the rule with the proviso “salvo pacto expreso”, meaning unless expressly agreed otherwise. Ask for confirmation that your condiciones particulares contain no deviating agreement.
According to the pre-contractual information, the six-month waiting periods do not apply when you switch if you provide the premium receipt from your previous health insurer for the month before the start of the contract. The eight-month waiting period for childbirth remains. When you travel, the travel cover in the terms pays treatment costs abroad of up to 15,000 euros per person if the trip lasts no longer than 90 days; known or chronic conditions are excluded. Under the terms, the 80 percent reimbursement abroad applies worldwide as long as your residence remains in Spain. AXA’s product information sheet sets a limit of 60 consecutive days of absence per trip for this. If you spend long periods in your home country, ask for the applicable limit to be confirmed in writing. Neither the terms nor the pre-contractual information state a maximum age at entry. More on the plan is on our page on AXA Óptima Plus.
Allianz
We did not find general terms for Allianz Seguros’ health insurance publicly available, only the statutory product information sheets. The information in this section therefore comes from these sheets and is less precise than for the other insurers.
Allianz Salud is available as a network plan with or without co-payments and as reimbursement in several variants. According to the product information sheet (as of February 2020), the Reembolso Completo variant reimburses 90 percent of paid invoices, with maximum amounts per benefit and up to 200,000 euros a year per insured person or policy. We were not able to review the other variants. Dental treatment is only available in the network. The waiting periods are six months for hospital stays, operations and complex diagnostics and ten months for childbirth.
On duration, the information sheet describes the statutory rule: the contract renews every year, and the insurer can object with two months’ notice. We found no waiver of this in the published documents. Before taking out a policy, ask for written confirmation of which waiting periods and exclusions apply to your plan. Advertising statements on product pages are no substitute for this. For an overview of the plans, see our page on Allianz health insurance.
Cigna Global
Cigna Global is not a Spanish plan but international health insurance for people who live outside their home country. The Policy Rules of the European company, Cigna Life Insurance Company of Europe, version February 2026, say so expressly: “This policy is only offered to beneficiaries who are expatriates”, meaning insured persons who live outside the country of their nationality. Check in advance which Cigna company issues your application from Spain, as its version may differ.
Cigna reimburses worldwide according to the area of cover chosen, with a choice of deductible and co-insurance. In the country of your nationality, cover applies only temporarily, for a maximum of 180 days per policy year. If you regularly return to your country of nationality for longer periods, you need to plan for this. According to its website, Cigna accepts policyholders from the age of 18 with no maximum age.
On renewal, Cigna sits between the Spanish wordings: the insurer can refuse to renew, but under clause 13.2, and subject to the policy’s rules on fraud, the decision “shall not be based on your claims history or any illness, injury or condition suffered by any beneficiaries”. Cigna can also terminate in cases of fraud, misrepresentation, late payment or if you are no longer an expatriate. For digital nomads, the law requires an insurer authorised to operate in Spain, and for other visas consulates can also impose stricter requirements. Before applying, check with the relevant consulate whether a Cigna policy will be accepted. More on the plan on our page on Cigna Global in Spain.
Waiting periods and pre-existing conditions
Waiting periods and the handling of pre-existing conditions decide what new health insurance in Spain actually pays for in the first months and years.
Waiting periods: what applies from when
DKV, Sanitas and AXA grant benefits from the start of the contract as a rule and then list exceptions, while Allianz states the periods in its information sheet. The most important ones compared:
| Benefit | DKV Integral | Sanitas Más Salud | AXA Óptima Plus | Allianz Salud |
|---|---|---|---|---|
| Hospital stay | 8 months | 10 months | 6 months | 6 months |
| Major operations | 8 months | 10 months | 6 months | 6 months |
| Minor outpatient procedures | 6 months | 3 months | 6 months | 6 months |
| CT and MRI scans | 6 months | 6 months | 6 months | 6 months |
| Childbirth | 8 months | 8 months | 8 months | 10 months |
Exceptions apply to emergencies: DKV exempts emergencies involving operations and hospital stays from the waiting periods, AXA exempts life-threatening emergencies from the six-month waiting periods, and Sanitas exempts life-threatening emergencies that occur and are diagnosed after the start of the contract. For Allianz, the information sheet states no exception. For childbirth, exceptions apply to premature births, in some cases only if the pregnancy began after the start of the contract. With Cigna, benefits for childbirth and pregnancy are only available in the Gold and Platinum levels, and only once the mother has been insured for at least twelve months.
The table shows the general terms. Your contract can waive or shorten waiting periods, especially if you switch from another Spanish insurer. More on this in our article on waiting periods in health insurance in Spain.
Pre-existing conditions and the health questionnaire
Before the contract is concluded, the insurer gives you a health questionnaire, the cuestionario de salud. Under Article 10 of the Insurance Contract Act, your duty of disclosure means you must state in it all circumstances known to you that you are asked about. If you conceal something, you risk a great deal: the insurer can terminate the contract within one month of finding out. If a claim arises before that, it reduces the benefit in proportion to the difference between the agreed and the correct premium, and in cases of intent or gross negligence it does not have to pay at all.
DKV, Sanitas and AXA exclude known pre-existing conditions that you have not declared. The insurer can accept declared conditions or expressly exclude them from cover. Allianz and Cigna exclude pre-existing conditions as a rule, unless cover has been expressly agreed. The differences in detail:
- DKV covers, after one year of the contract, pre-existing conditions that you did not know about yourself and did not deliberately conceal.
- AXA declares the policy incontestable after one year, except in cases of intent or a known pre-existing condition that was not declared.
- Sanitas excludes in Más Salud any cover connected with an undeclared pre-existing condition. We did not find a rule there under which this lapses after a certain time.
- Allianz lists pre-existing conditions as an exclusion in the information sheet and requires a truthfully completed health declaration. Ask for written confirmation of the exact scope before taking out the policy.
- Cigna excludes pre-existing conditions and everything related to them, unless cover has been expressly agreed. A pre-existing condition also includes symptoms you knew about without having seen a doctor.
Sanitas expressly asks in its questionnaire for symptoms that could be the start of an illness, and DKV also counts complaints without a diagnosis. A forgotten slipped disc or unmentioned high blood pressure can later cost you all cover for that condition. Fill in the questionnaire with your medical records to hand, not from memory.
Non-renewal and premiums in old age
Whether the insurer may end a health insurance contract in Spain is the most important question in the comparison for people moving to Spain. Comparisons that only list benefits and prices side by side usually leave it out.
Worth knowing before you compare
Do not assume cover for life
Some people assume that a private health insurer cannot simply decline to renew a policy as the policyholder grows older, and that the premium includes a reserve for old age. In Spain, neither can be taken for granted. What applies to your policy depends on its wording.
Spain
Objection to renewal with two months’ notice
Under Article 22 of the Insurance Contract Act, the contract renews for no more than one year at a time. Both parties can object to the renewal in writing, you with one month’s notice and the insurer with two months’ notice before the end of the insurance year. The law contains no prohibition for the insurer. It does, however, allow the contract to exclude the objection, and requires the rules on this to be highlighted in the policy.
Whether your insurer can still refuse to renew your policy when you are 78 is therefore not set by the law but by your policy wording. In the documents we reviewed, it looks like this:
AXA Óptima Plus no objection according to the terms
Under the terms (version January 2026), AXA may not terminate the policy, except for a concealed pre-existing condition or incomplete or incorrect information in the questionnaire. Age and treatment costs are expressly not grounds. This does not affect the end of the contract if you move away, and as with all insurers, cover is suspended if you fall behind with payment. The pre-contractual information contains the proviso “salvo pacto expreso”.
DKV after three years
In the individual policy for Integral, Top Health and Mundisalud, DKV waives its right to object after three full insurance years, provided the contract documents are signed and you accept the annual premium adjustment. In the event of a breach of obligations or incorrect information in the questionnaire, an objection remains possible. The waiver does not apply to group contracts.
Sanitas, Allianz objection possible
In Más Salud and Mundi, Sanitas keeps the statutory right to object with two months’ notice. For Allianz, the information sheet describes the same rule, and we found no waiver. If Sanitas ends the policy on its own initiative, ongoing hospital treatment continues until discharge, unless you waive this or the policy ends because of intent or gross negligence on your part.
The fact that an insurer may object to renewal does not mean that it regularly does so. But if you want to live in Spain permanently, you should choose your policy while you are healthy and can still be accepted, and pay attention to this clause. Switching in old age often fails because of the maximum age or new exclusions for conditions that have since become known.
Premiums in old age
In the terms of DKV, Sanitas and AXA, the premium depends on age and place of residence. When you move into a higher age band, you pay that band’s premium from the next renewal. On top of this come annual adjustments, which the insurer justifies with its costs.
DKV states expressly that there is no upper limit on the annual changes to the premium, and this also applies if DKV has already waived its right to object to renewal. In the terms we reviewed, we did not find any reserve built up from your premiums to cushion increases in old age.
If the premium goes up, you can end the contract at expiry; the terms of DKV and Sanitas expressly provide for this. Switching, however, means new waiting periods, a new health questionnaire and possibly new exclusions. That is why the choice at the start matters more than the cheapest premium in the first year.
A married couple, he 65, she 62, move from their home country to the Costa Blanca. Both want a free choice of doctor because they return home for a few weeks each year. Sanitas Mundi only accepts people below the age of 64, so the plan is no longer an option for him, but it is for her. Sanitas Más Salud would be possible for both, but it is a pure network plan.
With DKV Top Health, both would have to live in Spain for at least 183 days a year for invoices outside the network to be reimbursed. With AXA Óptima Plus, the insurer may only terminate the policy in the cases listed in the terms; the public documents state no maximum age at entry, which only the application will settle. Which solution fits depends on what matters more to the two of them: free choice of doctor, security in old age or one plan for both with the same insurer.
The example is entirely made up for illustration and is not a case from our advisory work.
Health insurance for registration and visas
If you live in Spain for longer than three months, you have to register, and health insurance plays a part in this. What is required depends on where you come from and what you live on.
EU citizens not working equivalent cover
Registration in the Registro Central de Extranjeros within three months of arrival. You need health insurance that covers all risks in Spain, with cover equivalent to the public health system.
Pensioners from the EU entitlement from home
If you are entitled to healthcare paid for by the state that pays your pension, you provide proof of this entitlement. A private policy can then add what the public system does not provide.
Visas for non-EU citizens consulate requirements
If you come from outside the EU, for example as a UK or US citizen, the law requires health insurance, for some types of stay with an insurer authorised to operate in Spain. Consulates often require more, such as no co-payments and no limit on cover.
For EU citizens who do not work in Spain, this is governed by Real Decreto 240/2007: in addition to sufficient resources, you need health insurance that covers all risks in Spain. The implementing order, Orden PRE/1490/2012, requires cover equivalent to that of the public health system. Whether a policy with co-payments or waiting periods is sufficient is decided by the relevant immigration office. A plan without either is the safer choice.
For residence without gainful activity, the new immigration regulation, Real Decreto 1155/2024, requires health insurance in Article 61, without further requirements as to its content. For student visas, by contrast, Article 35 requires an insurer authorised in Spain and benefits similar to those of the public system. For digital nomads and other stays under Ley 14/2013, Article 62 requires an insurer authorised to operate in Spain. Consulates often require more: the Consulate General of Spain in Washington, for example, requires on its website insurance without a deductible, without co-payments and without a limit on cover. Other consulates also state expressly that no waiting period may apply. What counts is what your consulate requires. Our article on health insurance for visa and residency in Spain covers this in detail.
Which health insurance suits whom?
Which health insurance in Spain suits you depends above all on your age, how long you stay and your visa. The terms we reviewed show where you should start, but they do not replace a personal comparison.
| Your situation | What matters | What the documents suggest |
|---|---|---|
| Living in Spain permanently, mid 50s to early 70s | Security in old age, maximum age | According to the documents we reviewed, plans that restrict the insurer’s right to object to renewal, i.e. AXA Óptima Plus (ask about the maximum age at entry beforehand) or a DKV individual policy. Take out cover early, before the maximum age and new diagnoses close the door |
| Half the year in Spain, half in your home country | Minimum stay in Spain, cover in your home country | Read the residence rules carefully: 183 days with DKV Top Health, nine months with Mundisalud, six months with Sanitas and AXA, with AXA also a limit on consecutive absence. For longer periods outside Spain, travel cover is not enough |
| Often on the move, several countries | Worldwide reimbursement | International plans such as Cigna Global or reimbursement plans with worldwide cover. For a visa, check recognition in advance |
| Family planning a child | Waiting period for childbirth | Eight to ten months with the Spanish insurers, twelve months with Cigna and only in the higher levels. Take out cover early and check whether fertility treatment is excluded |
| Visa from a non-EU country | No co-payments, depending on the consulate no waiting periods | Choose a plan according to the consulate’s requirements, for example a variant without copago, and get any waiver of waiting periods confirmed in writing |
If you already have private insurance in Spain and want to switch, you should have the new contract in hand before you cancel the old one. Several insurers waive waiting periods if you can prove previous cover, and the conditions for this differ.
Six mistakes when comparing health insurance in Spain
Most mistakes in comparing happen because only the first premium and the list of benefits are read, not the clauses on duration and health questions.
Our article 7 things you should never do while looking for health insurance in Spain describes further typical mistakes.
Frequently asked questions
The following answers sum up important questions about private health insurance for expats in Spain. They are based on the Spanish Insurance Contract Act, Spanish immigration law and the publicly available documents of DKV, Sanitas, AXA, Allianz and Cigna.
What is the best health insurance for expats in Spain?
There is no single best health insurance in Spain for everyone. Well-known providers include DKV, Sanitas, AXA and Allianz, plus international plans such as Cigna Global. What matters is the model, co-payments, waiting periods, pre-existing conditions, maximum age and whether the insurer may object to renewal.
Can a Spanish health insurer refuse to renew my policy in old age?
Under Article 22 of the Spanish Insurance Contract Act, the insurer may object to renewal with two months’ notice. Some policy wordings restrict this, for example DKV in the individual policy after three years and AXA in Óptima Plus, where under the terms the insurer may only terminate in listed cases such as incorrect health information. Sanitas keeps the right in the wordings we reviewed, and for Allianz the information sheet describes the same rule.
How much does private health insurance in Spain cost?
The premium depends on your age, where you live and the plan, and it is adjusted every year. Depending on the plan, co-payments are added, with DKV Integral between 0 and 23 euros for a specialist appointment in the four published variants. Only a quote for your situation gives a binding premium.
How long are the waiting periods in Spanish health insurance?
With the Spanish insurers we reviewed, six to ten months for hospital stays and major operations, six months for CT and MRI scans and eight to ten months for childbirth. DKV, Sanitas and AXA make exceptions for emergencies, in some cases only for life-threatening ones. If you switch and can prove previous cover, waiting periods may be waived.
Are pre-existing conditions covered in Spain?
With DKV, Sanitas and AXA, known pre-existing conditions that you do not declare in the health questionnaire are excluded, and the insurer can accept declared ones or expressly exclude them. With Allianz and Cigna, pre-existing conditions are excluded as a rule unless cover has been expressly agreed. After one year, DKV covers pre-existing conditions that you did not know about yourself and did not deliberately conceal.
Up to what age can I take out private health insurance in Spain?
Each plan sets this itself. Sanitas accepts people only below the age of 75 in Más Salud and below 64 in Mundi, and DKV states 75 years for Integral on its product page. AXA and Allianz state no maximum age in the documents we reviewed, which the application will settle. Cigna states on its website that it has no maximum age for applicants aged 18 and over.
Do premiums rise with age?
Yes. In the terms of DKV, Sanitas and AXA, the premium depends on age and place of residence and is adjusted every year. DKV states expressly that there is no upper limit on the annual change. In the terms we reviewed, we did not find any reserve built up from your premiums to cushion increases in old age.
What health insurance do I need as an EU citizen to register in Spain?
If you live in Spain without working, Real Decreto 240/2007 requires health insurance that covers all risks in Spain. Orden PRE/1490/2012 requires cover equivalent to that of the public health system. Pensioners can instead prove their entitlement to healthcare funded by the country that pays their pension.
Does health insurance for a Spanish visa have to be without co-payments?
For residence without gainful activity, Spanish immigration law only requires health insurance, but consulates often require more. Several consulates require a policy without co-payments and without a limit on cover, some also without waiting periods. What counts is your consulate’s requirement, so check it before you take out a policy.
Does Spanish health insurance cover me during stays in my home country?
Network plans usually only cover emergencies abroad while travelling, with DKV Integral up to 180 days per trip and 30,000 euros, with Sanitas Más Salud as an add-on up to 90 days and 12,000 euros. Reimbursement plans such as AXA Óptima Plus also reimburse treatment abroad, with limits on the length of absence. Cigna Global covers your country of nationality only for up to 180 days per policy year, and some Spanish wordings end if you live in Spain for less than six months a year.
Our advice as an independent broker
The best health insurance for your life in Spain is the one that fits your age, your health and your plans and still covers you in twenty years. You cannot tell this from a price, only from the terms.
As an independent insurance broker, we are not tied to any insurer. We compare the plans of several insurers for you, go through the clauses on waiting periods, pre-existing conditions and duration with you and support you with the health questionnaire. We advise you in English, and when a claim arises we support our clients in dealing with the Spanish insurer. We present the plans we work with on our page on private health insurance in Spain.
We compare plans from DKV, Sanitas, AXA, Allianz, Cigna and other insurers for you by model, waiting periods, maximum age and renewal rules, and make you an offer. In English and with no obligation.
Phone: +34 922 94 16 10 or via our contact form.
We advise you on Tenerife, La Palma, Gran Canaria, the Costa Blanca and Mallorca.
Note: This guide is for general information only and does not replace legal advice or a review of your specific insurance contract. The information reflects the position as of October 2026 and is based on the linked versions of the Ley 50/1980 de Contrato de Seguro, Real Decreto 240/2007, Orden PRE/1490/2012, Real Decreto 1155/2024 and Ley 14/2013. The statements on the insurers are based on publicly available documents: DKV Integral, Top Health and Mundisalud (general terms, edition January 2026, and co-payment table), Sanitas Más Salud and Mundi (general terms, version October 2024, and product pages), AXA Óptima Plus (general terms, version January 2026, pre-contractual information and product information sheet), Allianz Salud (product information sheets, Reembolso as of February 2020) and Cigna Global (Policy Rules, version February 2026, and website). Where the documents are in Spanish, the statements are our own summary of the Spanish wording. Plans and terms may change. What your policy covers follows solely from your condiciones generales and condiciones particulares. The requirements for residence and visas are set by the relevant authorities and consulates. Get in touch if you would like us to compare plans for you.
