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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.

Duration:

The financial coverage, in whole or in part, of medical care provided in a private health centre or professional, will be provided from the date of submission of the application to the INSS for sickness care, for as long as it is needed and until you are cured or the date of completion of the course (if you have not re-enrolled by that date).

For assistance provided prior to the submission of the application, there is no cover, unless the assistance was provided in an emergency. The urgency must be indicated in the report of the centre or private practitioner and assessed as such by this Institute. In urgent cases, the application may be submitted within five years.

The medical care covered by the School Insurance includes:

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.
  • The neuropsychiatry benefit has a maximum initial duration of six months. Any extension must be requested within the last thirty days of the recognised period.
    • Example: if a neuropsychiatric benefit is recognised from January to June, the extension must be requested within 30 days before the last day of June.

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 newborn 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, dialysis and radiotherapy 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.
  • 30% of the bill presented will be paid, corresponding to the items listed in the previous paragraph, up to a limit of 1,502.53 euros.
  • These are provided for the duration of the health care.
  • Medicines will be paid for as long as they are not excluded from Social Security funding.
  • 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%.

The same amounts shall be paid as in the case of death due to a non-school accident, provided that the victim of an illness dies as a result of the illness within two years of the date on which the illness was diagnosed and provided that the impossibility of continuing studies lasted until death.

Sickness burial expenses will be paid from the date of application and must be applied for within five years (art. 53.1 of the revised text of the General Social Security Act), counting from the day after the day on which the death occurs.

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