Sickness Benefits

The sickness benefit covers pharmaceutical assistance, compensation for burial expenses in the event of death, health care, including hospitalisation when needed, which comprises the services indicated below, as well as any preventive medicine, as appropriate.

Health Care

  • Duration:

It is provided from the notification of the ailment, as long as required and until recovery or until the last day of the course, if the beneficiary has not registered again by that date.

The ailment is considered as notified by submitting the standard application or any other similar document.

  • Selection of doctor and health centre:
    • If the event that there are not State doctors and health centres, the School Insurance will cover the bills depending on the prices and the student will pay any difference.
    • In emergency cases, either because the student is not in a condition to select the medical centre or due to the distance to the State centre, the student will be paid all expenses fully.
  • Health care, including any hospitalisation required, consists of general surgery services, neuropsychiatry, pulmonary and osseous tuberculosis and obstetrics:

General Surgery:

    • This includes all specialities except those that are purely aesthetic, and cover accommodation and food, operating theatre, medical and pharmaceutical care, as well as replacement prostheses (not orthopaedics).
    • Expenses that arise during the hospital stay from the day of admittance to the day of release, as well as the expenses arising from the diagnosis that lead to the surgical procedure.

Neuropsychiatry:

    • Includes inpatient or outpatient treatment of all neuropsychiatric conditions that, due to their severity, affect the continuation of studies, excluding conditions known under psychological development, behavioural and emotional disorders that normally begin during childhood or adolescence.
    • Psychotherapy sessions provided by psychologists are included as long as they were prescribed by a psychiatrist.

Obstetrics:

    • Includes visits to the obstetrician prior to birth, doctors' fees (obstetrician, anaesthesiologist, nurse and midwife) and hospitalisation expenses for surgery.
    • It does not cover the expenses for new-born care.

Tuberculosis: 

    • In cases of pulmonary tuberculosis, it covers accommodation and food in the appropriate health centres, medical care, major and minor chest surgery and the required pharmaceutical care.
    • In cases of osseous tuberculosis, it covers accommodation and food at the appropriate centres, surgical  treatment and pharmaceutical care.
    • The hospitalisation or treatment period is set at 18 months, which may be extended by 3-month periods up to a maximum of 3 years, but not necessarily continuously.
  • In certain cases, physiotherapy, cobalt therapy, radiation therapy, artificial kidney and radiotherapy, as well as maxillary-facial surgery services may be provided.

Physiotherapy:

    • Recognised when medically justified in treatments following surgery or in trauma cases caused by school injury.
    • The treatment includes a maximum of 30 sessions, although this number of sessions may be exceeded in cases in which the School Insurance medical advisor deems it necessary.
    • Paid in accordance with current rates.

Chemotherapy, radiotherapy and cobalt therapy:

    • Covers treatment sessions, medication, hospital pharmacy, disposable material, laboratory tests, blood transfusions, radiology tests and diagnosis, as well as the hospital stay.
    • Pays 30% of the bill submitted, corresponding to the concepts listed in the previous paragraph, up to a limit of 1,502.53 euros.

Maxillary-Facial Surgery:

    • Covers the medical and pharmaceutical care, hospitalisation and food.
    • It does not include orthodontics nor dentistry treatments.

Pharmaceutical Benefits

  • These are provided for the duration of the health care.
  • In cases of hospitalisation, the pharmaceutical assistance is complete at no charge to the student.
  • In cases of outpatient care, 70% of the corresponding amount is paid, while the beneficiary must pay the remaining 30%.

    In cases in which these benefits have been prescribed by a Social Security doctor, the student will be paid the difference between the 40% paid as a Social Security beneficiary and the 30% corresponding to the protection of the School Insurance.
  • Medication excluded for Social  Security financing is, likewise, excluded from School Insurance financing.
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