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Management / Applications

Where?

The application for the benefit can be submitted:

Deadlines for claiming benefits

  • Todas las prestaciones derivadas de accidente escolar: 1 año.
  • Las prestaciones sanitarias se deben solicitar con carácter previo a la asistencia médica para el reconocimiento del derecho, con la excepción siguiente: en casos de urgencia debidamente acreditada por el facultativo, puede presentarse en el plazo de 5 años.
  • Las prestaciones económicas y gastos de sepelio que no deriven de accidente escolar: 5 años.
  • Las prestaciones por infortunio familiar: 5 años, con una retroactividad máxima de 3 meses.

Documents which must accompany the application

THE FOLLOWING ORIGINAL AND CURRENT DOCUMENTS:
  • DNI or Libro de Familia (booklet containing family details).
  • Foreigners, document showing identity.
  • Proof of legal residence, if necessary, by means of registration in the Central Register of Foreigners or the residence card or authorisation.

PRESENTATION OF THE FOLLOWING DOCUMENTS OR CERTIFIED TRUE COPY OR COPY IN ORDER TO MAKE AN ATTESTED COPY:

  • For non-university students, certificate from the education centre which runs the course and the speciality studied, as well as the School Insurance payments .
  • For university students, receipt of the registration form indicating the course and subjects and the School Insurance payments.
  • The documentation highlighted in the above point, referring to the course prior to the course applied for, in order to show a year's contributions, except in the event of school-related injuries, family hardship benefits and obstetrics (students who, during the previous academic year, were on the last course of studies not included in School Insurance, are exempt from these requirements).

a) Health benefits:

  1. For school-related injury:
    • Injury report, completed in point 4 of the application.
    • Sick leave certificate.
  2. Surgery, obstetrics, neuropsychiatry, pulmonary and osseous tuberculosis:
    • Official medical certificate naming the doctor who will provide the health care, indicating the professional membership number, address of the centre or clinic, speciality, hospital name and date of admittance, if applicable, diagnosis, prescribed treatment and approximate time required for recovery.
    • The above certificate may be substituted by the emergency medical report, if appropriate.
    • For neuropsychiatry, the psychiatrist must indicate the diagnosis in accordance with the international DSM-III-R or CIE/10 classifications, give a brief description of the patient's current condition, the pharmacological treatment and psychological therapy indicated and whether the latter will be provided by a psychologist or by the psychiatrist him/herself.
  3. In cases of physiotherapy, radiotherapy, cobalt therapy, radiation therapy and dialysis: in addition to the requirements indicated in the point above, the medical record producing the application is required, indicating the number of sessions, their type and the total treatment cost.

The request for these benefits included in points 2 and 3 of this section will be prior to the health care for granting the right. The right to reimbursement can only be recognised for treatment provided after the claim has been submitted, not before. It can only be submitted within a period of 5 years in emergency cases that are duly certified by the doctor .

(b) Economic benefits:

  1. Compensation for family hardship: Family Book and certification of large family status, if applicable.
    • Death of the head of household: Death certificate.
    • Bankruptcy: documents that clearly show the causal event of the bankruptcy, as well as the date when it happened.
    • Extension of family hardship benefit: document showing subjects studied during the previous academic year to check that the course was completed.
  2. Compensation for disabilities caused by school injuries:
    • School injury report.
    • Medical certificate specifying what occurred and indicating the permanent after-effects, as well as the reduced capacity of the injured person in relation to the subject studied.
  3. Compensation for burial expenses arising from school or non-school-related injury and disease:
    • Injury report (only if school injury).
    • In the event of death due to disease, a medical report indicating that the beneficiary died as a result of the disease during the two years following the date on which the injury occurred and that the inability to continue with their studies lasted until death.
    • Death certificate in both the case of injury and disease.

Responsible declaration of consent to processing


En la siguiente tabla podrá descargarse los siguientes Documentos.
Documentos Download Fecha
Declaración responsable conformidad del estudiante con el tratamiento Descargar documento Declaración responsable conformidad del estudiante con el tratamiento. The document will open in a new window. Descargar documento Declaración responsable conformidad del estudiante con el tratamiento. The document will open in a new window. (PDF,219 KB) 21/04/2022

Competence

In the case of cash benefits, the application will be decided by the Provincial Directorate of the INSS where the application was submitted.

In the case of health benefits, the application will be decided by the Provincial Directorate of the INSS where the health care was provided, regardless of the province where the student is enrolled or where the family unit resides. In the event that the student moves or transfers to another province with health insurance coverage, they must inform the Provincial Directorate that was responsible for the transfer, so that their file can be transferred to the new province.

Important information

Health cover under the School Insurance scheme is conditional upon submission of the application form. No payment may be made for services rendered prior to their submission, except in the case of emergency care and recognised as such by the Institute.

For the neuropsychiatry extension, this must be requested within the last thirty days of the previous six-month period. The requested extension may not be granted later than 30 days.

When the health care has been received in a non-collaborative centre, and the student has paid the bills, they must justify their prior payment to the centre with the INSS. Either by a proof of payment of the invoice (bank transfer) or the stamp of the payment of the invoice by the centre.

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