健康保险合同

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Name*

Full legal first and middle names Full legal last name(s)

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Identification Document*

Document number*

Please attach your passport or NIE*

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 4 MB.

Please attach a scan or good quality photo of the document

Address*

address city province zip country

Region where you will live in Spain*

Email*

Phone*

Date of Birth*

DD dash MM dash YYYY

Age 0

Height in Centimetres*

Weight in kilograms*

Marital status*

Sex*

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Nationality*

Profession*

decesos line

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Decesos 0

Number of Beneficiaries in Total*

Please enter a number from 1 to 7.

Date of effect of the policy*

DD dash MM dash YYYY

Please choose the starting date for the coverage. All policies will start from the day 1 of any month.

Additional Beneficiary 1 Form

Date of Birth*

DD dash MM dash YYYY

Age 1

Name*

Full legal first and middle names Full legal last name(s)

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ID*

ID Number*

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Height in Centimetres*

Weight in kilograms*

Marital Status*

Sex*

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Profession*

Decesos 1

Additional Beneficiary 2 Form

Date of Birth*

DD dash MM dash YYYY

Age 2

Name*

Full legal first and middle names Full legal last name(s)

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ID*

ID Number*

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Height in Centimetres*

Weight in kilograms*

Marital Status*

Sex*

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Female

Profession*

Decesos 2

Additional Beneficiary 3 Form

Date of Birth*

DD dash MM dash YYYY

Age 3

Name*

Full legal first and middle names Full legal last name(s)

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ID*

ID Number*

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Height in Centimetres*

Weight in kilograms*

Marital Status*

Sex*

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Profession*

Decesos 3

Additional Beneficiary 4 Form

Date of Birth*

DD dash MM dash YYYY

Age 4

Name*

Full legal first and middle names Full legal last name(s)

Spell the name exactly as it's shown on the passport or ID card.

ID*

ID Number*

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Height in Centimetres*

Weight in kilograms*

Marital Status*

Sex*

Male

Female

Profession*

Decesos 4

Additional Beneficiary 5 Form

Date of Birth*

DD dash MM dash YYYY

Age 5

Name*

Full legal first and middle names Full legal last name(s)

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ID*

ID Number*

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Max. file size: 64 MB.

Height in Centimetres*

Weight in kilograms*

Marital Status*

Sex*

Male

Female

Profession*

Decesos 5

Additional Beneficiary 6 Form

Date of Birth*

DD dash MM dash YYYY

Age 6

Name*

Full legal first and middle names Full legal last name(s)

Spell the name exactly as it's shown on the passport or ID card.

ID*

ID Number*

Please attach ID

Max. file size: 64 MB.

Height in Centimetres*

Weight in kilograms*

Marital Status*

Sex*

Male

Female

Profession*

Decesos 6

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Medical conditions selected?

Yes

Declared pre-existing conditions

Your quotation was prepared based on the pre-existing conditions above, declared when filling out the quote request.

Health Questionare Scan*

拖拽文件到此处，或者

Accepted file types: pdf, jpg, jpeg, Max. file size: 10 MB, Max. files: 7.

Specific Health Questionnaire is required for Salus Global application.

You can download the pdf in this link: SALUS GLOBAL

Instructions: Please fill in one application form including all individuals to be insured and one separate health questionnaire for each individual to be insured.

NO need to include payment details in the document.

Please note this policy includes repatriation coverage so home address needs to be on the document.

Please print a copy for every insuree, answer the questions, sign and upload here.

All fields are mandatory: location, date etc.

Tip: If you don´t have a scanner by hand, you can use any of the scanner apps available for your Apple or Android phone or tablet.

Specific Health Questionnaire is required for DKV Seleccion application.

You can download the pdf in this link: DKV SELECCION

Please print a copy for every insuree, answer the questions, sign and upload here.

All fields are mandatory: location, date etc.

Tip: If you don´t have a scanner by hand, you can use any of the scanner apps available for your Apple or Android phone or tablet.

Specific Health Questionnaire is required for DKV application.

You can download the pdf in this link: DKV Salud

Please print a copy for every insuree, answer the questions, sign and upload here.

All fields are mandatory: location, date etc.

Tip: If you don´t have a scanner by hand, you can use any of the scanner apps available for your Apple or Android phone or tablet.

Specific Health Questionnaire is required for Adeslas Seniors application.

You can download the pdf in this link: ADESLAS SENIORS

Please print a copy for every insuree, answer the questions, sign and upload here.

All fields are mandatory: location, date etc.

Tip: If you don´t have a scanner by hand, you can use any of the scanner apps available for your Apple or Android phone or tablet.

Health declaration

Please let us know if any of the applicants suffer or have suffered from any of the following injuries or conditions, by ticking the boxes where appropriate.

Medical Conditions*

Have or have had cancer or a tumour

Diabetes

Hepatitis B, C, D

Cardiac, vascular, pulmonary, autoimmune or respiratory diseases

Metabolic (of the endocrine system) or digestive disorders

Rheumatological, bone or musculoskeletal conditions

Any diseases of the nervous system, the eyes or the ears

Haematological or blood clotting problem

Kidney, the urological and genitourinary tract, or gynaecological diseases

Infectious diseases

Transplants

Lesions, ongoing sequelae or complications from any diseases, congenital, chromosomal or hereditary disorders, malformations or accidents?

Ailments not fitting any mentioned above

I confirm that none of the applicants have any pre-existing health conditions to declare

Description*

Please supply further information. (making clear which of the insured persons it refers to if you are applying for several people)

SALUS health insurance policy is only available with Annual Payment.

Please select "Wire Transfer" or "Credit or Debit Card".

How you will pay*

Wire Transfer (or Wise)

Direct Debit (monthly)

Credit or Debit Card

If your Credit or Debit Card is not issued in Europe, please make sure it supports two-factor authentication. It is required when making online card payments in Europe since January 15, 2021.

Monthly Direct Debit is available only for owners of Spanish bank account. Please choose Wire Transfer (or Wise) if you need to pay entire year (VISA application). You can change to monthly draft later if you prefer so.

SALUS health insurance policy requires Annual Payment

Please select Annual Payment for ADESLAS Student insurance discount

Please select Annual Payment for DKV Student insurance discount

Periodicity*

Please fill out other fields.

5% discount apply on Annual Payments

If you require proof of insurance for visa or residency application, please take into account that the certificate will show the dates of your coverage. Spanish agencies require 1 full year of coverage.

Monthly Total*

Quarter Total*

Annual Total*

(a month with discount)*

You will be charged monthly rate in the first 5 days of every month. If a proof of insurance will be required before the date insurance policy comes into force, first quarter will still be payable by Wire Transfer (Wise) or Credit Card.

Month*

Annual Payment*

Period of Coverage in Months*

Payment Amount*

价格:

Health Insurance Monthly

价格: 0.00 €

Health Insurance Quarter

价格: 0.00 €

Health Insurance Annual

价格: 0.00 €

ADESLAS Student Annual

价格: 0.00 €

DKV Student Annual

价格: 0.00 €

DKV Student R Annual

价格: 0.00 €

Annual Discount 5%

0.00 €

Extra Protection

You can compliment your health policy by selecting any of the following options. Click the checkbox to see the price.

Repatriation

Add Repatriation

Click here for Repatriation details

90Eur per person for 12 months.

Repatriation to Spain is included in your Health Policy. However, if you are not from Spain originally, you might want to have Repatriation coverage to your home country.

Sometimes this type of coverage can be required by official Spanish institutions for immigration purposes.

Hidden

Repatriation + Life

100Eur per person for 12 months.

Additionally to Repatriation to your home country, Life insurance is included.

Funeral Insurance

Death Insurance

Click here for Death Insurance details

12 months coverage. (Includes Repatriation.)

Much more than just death insurance

An innovative policy with maximum protection for your loved ones and extensive coverage in cases of death, accidents, illness, travel and legal assistance.

Assistance in case of death

• Funeral service
• Free choice of burial sites in Spain
• Escorting of mortal remains, travel and accommodation expenses
• Transport or repatriation of accompanying insured person(s)
• Accompanying person for the return of minors
• Early return due to death of a family member

Health and personal care

• 24-hour medical hotline
• Second international medical opinion
• Access to an extensive dental care network at special prices
• One free dental cleaning a year per policyholder
• Preferential agreements in preventive medicine
• Access to specialists. It provides, at preferential prices, the specialists and diagnostic means with doctors in more than 30 specialities such as Paediatrics, Physiotherapy, Eye Surgery, Dentistry...
• Home Teleassistance

Worldwide Travel Assistance

• Healthcare information service
• Medical transfer or repatriation of wounded and sick persons
• Transportation of a family companion with the policyholder hospitalised for more than five days
• Immobilisation in hotel due to illness or accident
• Repatriation or transportation of accompanying policyholders
• Companion for minors and disabled people
• Administrative services for hospitalisation
• Hospitalisation deposit
• Medicine shipment
• Emergency dental expenses
• Healthcare in case of accidents or illness
• Interpreter in case of illness or accident abroad
• Cash advance abroad
• Urgent message services
• Dispatch or forwarding of objects forgotten while in transit
• Luggage tracing and shipping assistance
• Urgent travel due to casualty in permanent residence
• Information service for trips abroad

Juridical and legal Assistance

• Free telephone assistance regarding any personal matters related to the policyholder, family matters, home, work, criminal matters, claims, etc.
• First consultation free of charge
• Management procedure in case of death
• Online will

Repatriation

价格: 0.00 €

Repatriation + Life

价格: 0.00 €

Death Insurance

价格: 0.00 €

Fx correction

Total

Annual receipt

Please send me annual bill

Mark this box if you want to receive the annual bill in your email, detailing all the operations done by the Association and its expenses.

GIDEA GESTIÓN INTEGRAL PRODUCT GRAN CONSUMO, S.L.U. does not act as a mediator or intermediary between the Client and the insurance agencies, nor does it manage their products. For this, each Client is assigned an agent of the company. Consequently, GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. is not a part of said contract, and the services provided by it will accrue fees that will be invoiced independently.
GIDEA GESTIÓN INTEGRAL PRODUCT GRAN CONSUMO, S.L.U. is a service company that is dedicated to facilitating access to families that come to reside in Spain and promotes the contracting of the necessary services to provide users with well-being. It has a continuous service of attention, in different languages, during the duration of the contracted service. Among others, the services offered are: administration services, processing of residence permits and additional documentation, search for housing, schools, contracting supplies, insurance and other services demanded by the group.
The signing of this document obliges the Client to pay the receipts issued by GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U., in accordance with the conditions expressed above. Said payment will be made on the agreed day, which will be considered for the purposes of this document as a “collection day”. It is expressly stated that, in case of not paying the receipt drawn on the same day of collection, the Client will have a period of five (5) days to pay, in addition to the receipt, the corresponding surcharge that arises from the Return costs, an issue for which express notification from GIDEA GESTIÓN INTEGRAL PRODUCT GRAN CONSUMO, SLU will not be necessary. This surcharge oscillates around five euros (€ 5.00), although depending on the entity this cost may be higher or lower, being, in any case, at the customer's expense to pay such amount, regardless of its value.
Once the five-day recovery period has elapsed without the Client having satisfied the amount owed and, where appropriate, the corresponding surcharge, GIDEA GESTIÓN INTEGRAL PRODUCT GRAN CONSUMO, S.L.U. to cause the withdrawal of the Client based on the breach of the obligations by the former. Therefore, it is expressly stated that the return of a single receipt, automatically and immediately entails the withdrawal from the group and any possible claims. In any case, non-payment by the Client will allow GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U to claim the debt that could have arisen through the channel it deems appropriate.
Once the Client has been unsubscribed from the group, they may request GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. reinstatement, upon payment of the amounts and amounts owed and a penalty surcharge of thirty euros (€ 30.00) for compensation expenses.
Once the Client cancels the group contract with GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. he will no longer receive the corresponding coverage. Said cancellation will take place, as stated above, in the event of non-payment or breach of obligations by the Client; due to the lack of veracity of the answers formulated in the contractual documents (Quote Request, health questionnaire and others), regardless of whether it is a consequence of fraud or negligence; and, in any case, at the discretion of the latter, expressed specifically and unequivocally by written communication within a period of one month before the corresponding receipt is issued. In any of the cases, when unsubscribed from the group GIDEA GESTIÓN INTEGRAL PRODUCT GRAN CONSUMO, S.L.U. the group will be released from any obligations that the insurance at their expense could establish.
GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, SLU, as policyholder, assumes the commitment to comply with each and every one of the obligations assigned to it and, especially, to make the monthly payment, the corresponding premium and, in general, of be up to date on everything related to the payments regarding Company. Regardless of the payment protocol that the Company may have, the Client undertakes to deposit to GIDEA GESTIÓN INTEGRAL PRODUCT GRAN CONSUMO, S.L.U. the amount corresponding to the agreed form of payment (annual, semi-annual, quarterly or monthly), so that it can be defrayed, month by month, the amounts that were generated as consideration for the contracted service.
The revision of prices of the health group will be annual and will take effect on January 1. GIDEA GESTIÓN INTEGRAL PRODUCT GRAN CONSUMO, S.L.U. The new conditions will apply on January 1 of each annuity, leaving the client to accept or not such modifications. In the event that the Client does not specifically express his rejection of the modifications within thirty days of said application, it will be understood as tacitly renewed.
GIDEA GESTIÓN INTEGRAL PRODUCT GRAN CONSUMO, S.L.U. will make available to the client the invoices that accrue for the services provided at the client's request by email that will be addressed to the following address: office@gideagestion.com
In this form you do have a checkbox available if you prefer to receive in your email the corresponding invoices and receipts accrued for the provision of services of this Company. In any case, it may be requested at any time as indicated in the previous paragraph.
The whole text of the present Contract have been written in Spanish and English, both versions being deemed authentic, but for legal purposes in a case of discrepancy shall prevail the text in Spanish.

CONDICIONES DE SERVICIOS
GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. no actúa como mediador ni intermediario entre el Cliente y las agencias aseguradoras, ni gestiona sus productos, para ello cada Cliente tiene asignado un agente de la compañía. En consecuencia, GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. no forma parte de dicho contrato, y los servicios prestados por la misma devengarán honorarios que se facturarán de forma ajena e independiente.
GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. es una empresa de servicios que se dedica a facilitar el acceso a familias que vienen a residir a España y promueve la contratación de los servicios necesarios para dotar de bienestar a los usuarios. Posee un servicio continuo de atención, en diferentes idiomas, durante la duración del servicio contratado. Entre otros, los servicios que ofrece son: servicios de administración, tramitación de permiso de residencia y documentación adicional, búsqueda de vivienda, colegios, contratación de suministros, seguros y otros servicios demandados por el colectivo.
La firma del presente documento obliga al Cliente al abono de los recibos girados por GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U., conforme a las condiciones expresadas con carácter precedente. Dicho pago se realizará el día pactado, que será considerado a efectos del presente documento como “día de cobro”. Se hace constar de forma expresa que, en caso de no abonar el recibo girado el mismo día de cobro, el Cliente tendrá un plazo de cinco (5) días para abonar, además del recibo, el correspondiente recargo que se origine con motivo de los gastos de devolución, cuestión para lo cual no será necesaria notificación expresa por parte de GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. Dicho recargo oscila en torno a los cinco euros (5,00 €), si bien dependiendo de la entidad dicho coste puede ser superior o inferior, siendo, en todo caso, a costa del cliente sufragar tal importe, con independencia de su valor.
Transcurrido el periodo de recobro de cinco días sin que el Cliente haya satisfecho la cuota adeudada y, en su caso, el correspondiente recargo, se procederá por GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. a causar la baja del Cliente en base al incumplimiento de las obligaciones por parte de aquél. Por tanto, se hace constar expresamente que la devolución de un único recibo conlleva, de forma automática e inmediata, la baja del colectivo y la reclamación. En todo caso, el impago por parte del Cliente permitirá a GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U reclamar la deuda que se hubiera podido originar por el cauce que estime conveniente.
Una vez el Cliente haya sido dado de baja del colectivo podrá solicitar a GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. la reincorporación al mismo, previo pago de los importes y cantidades adeudados y de un recargo de penalización de treinta euros (30,00 €) por el concepto de gastos de compensación.
Una vez el Cliente cause baja respecto del colectivo GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. dejará de recibir la correspondiente cobertura. Dicha baja tendrá lugar, tal y como se ha hecho constar anteriormente, en caso de impago o incumplimiento de las obligaciones por parte del Cliente; ante la falta de veracidad de las respuestas formuladas en los documentos contractuales (Solicitud, cuestionario de salud y otros), con independencia de que la misma sea consecuencia de dolo o negligencia; y, en todo caso, por voluntad de éste, manifestada de forma expresa e inequívoca mediante comunicación por escrito en un plazo de un mes antes de que sea girado el recibo correspondiente. En cualquiera de los casos, producida la baja del colectivo GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. quedarán liberadas de cuantas obligaciones pudiera establecer el seguro a su cargo.
GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U., como tomador del seguro, asume el compromiso de cumplir con todas y cada una de las obligaciones que tiene asignadas y, especialmente, de efectuar el pago mensual, la prima que corresponda y, en general, de estar al día en todo lo relativo a pagos respecto de la Compañía. Con independencia del protocolo de pago que pudiera tener la Compañía, el Cliente se compromete a depositar a GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. el importe correspondiente a la forma de pago pactada (anual, semestral, trimestral o mensual), de forma que pueda ir sufragando, mes a mes, las cantidades que se fueran generando como contraprestación por el servicio contratado.
La revisión de precios del colectivo de salud será anual y tendrá efecto el día uno de enero. GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. aplicará las nuevas condiciones el uno de enero de cada anualidad, quedando en manos del cliente el aceptar o no tales modificaciones. En caso de que el Cliente no manifieste expresamente su rechazo a las modificaciones en un plazo de treinta días desde dicha aplicación, se entenderá renovado de forma tácita.
GIDEA GESTIÓN INTEGRAL PRODUCTO GRAN CONSUMO, S.L.U. pondrá a disposición del cliente las facturas que se devenguen por los servicios prestados a petición del cliente mediante correo electrónico que habrá de dirigir a la siguiente dirección: oficina@gideagestion.com
Marque la casilla correspondiente en el formulario si desea recibir en su correo electrónico las correspondientes facturas y recibos devengadas por la prestación de servicios de esta empresa. En todo caso, podrá solicitarse en cualquier momento conforme a lo indicado en el párrafo anterior.

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Special Conditions to sign?

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Special Terms Signed

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Insurance provider specific conditions, exclusions etc.

Client receives this text with a prompt to follow further with their application and receive the payment information.