The good news: most applicants are accepted
For the majority of people applying for Spanish health insurance for the NLV — healthy adults under 65 with no significant recent medical history — acceptance is straightforward. All six major insurers will process your application through a standard health declaration and issue a policy without exclusions or conditions.
The declaration process for most applicants takes 15 to 30 minutes online. Common minor conditions such as:
- Seasonal allergies and hay fever
- Mild controlled asthma
- Well-managed Type 2 diabetes (stable, no complications)
- Controlled hypertension on standard medication
- Past sports injuries that have resolved
...are typically accepted by most major insurers with full coverage from day one, or with a short waiting period for that specific condition only.
The picture changes with more significant health history, older age, or combination of both. The sections below address these situations specifically.
Who may face issues: applicants at higher risk of exclusions or refusal
The following profiles are most likely to encounter either exclusions (a specific condition not covered) or outright refusal:
- Active or recent cancer — applicants currently in treatment, or within 5 years of completing cancer treatment, face exclusions or refusal at most standard insurers. Sanitas is the most likely to accept on a case-by-case basis.
- Severe or unstable cardiac conditions — recent heart attack, ongoing cardiac treatment, heart failure. Well-managed stable cardiac conditions are usually acceptable.
- Recent major surgery — within the last 6–12 months. Insurers typically require a period of stability before they will accept the condition.
- Applicants over 70 — the market narrows sharply. Caser stops accepting at 69. Several others have 70–75 upper limits. ASSSA is the primary option for 75+ applicants.
- Multiple significant conditions — where any one condition might be acceptable individually, a combination of conditions can trigger more intensive underwriting or refusal.
Declaration-based vs full underwriting: what happens at each insurer
Most Spanish insurers use a two-stage approach: first a health declaration (a questionnaire you fill in), then individual underwriting if significant conditions are declared.
The declaration typically asks about:
- Current medications and ongoing treatments
- Hospital admissions in the last 5 years
- Diagnoses of specified conditions (cancer, heart disease, diabetes, etc.)
- Any planned surgical procedures
If your declaration is "clean" — no significant conditions — the policy is usually issued immediately or within 24 hours. If you declare conditions, the insurer underwrites individually. Outcomes are either: (a) full coverage, (b) coverage with named exclusions, or (c) refusal.
Sanitas: the most accommodating insurer for medical history
Sanitas has the most flexible and transparent underwriting approach of any major Spanish insurer. For applicants with a medical history, Sanitas should be the first port of call.
Key reasons why Sanitas is best for applicants with health conditions:
- Pre-existing conditions are accepted with declaration — on the Residents plan, Sanitas applies individual underwriting rather than blanket exclusions. Many conditions others refuse are accepted, sometimes with a waiting period for that specific condition.
- 58,000+ specialists on the network — including access to leading specialists for managing complex conditions. The BLUA app's English doctor filter means you can access specialists in English.
- Accepts new applicants up to age 70 — the widest standard age acceptance window of any major insurer at the premium tier.
- BUPA-backed underwriting expertise — Sanitas benefits from BUPA's international underwriting experience, which means more nuanced case-by-case assessment for complex applicants.
Different insurers underwrite differently. Sanitas is often the most accommodating for applicants with a medical history. A refusal from Adeslas or DKV does not predict an outcome with Sanitas or ASSSA — try both before concluding that cover is unavailable to you.
ASSSA: best for older applicants and 75+
ASSSA accepts new applicants at ages where most other insurers stop. While Caser stops at age 69 and most mainstream insurers become restrictive in the low 70s, ASSSA accepts applicants well above 75 — and in some cases into their early 80s — making them the primary option for older applicants who cannot access other products.
ASSSA's expat-specialist focus means their team understands the visa application process in detail. They can advise on certificate wording and the documentation required for consulate submissions. For US consulate applications specifically, ASSSA has an excellent track record.
Note: ASSSA may still apply exclusions for serious pre-existing conditions. Their wide age acceptance does not mean unconditional acceptance regardless of health. But they will consider applications that most other insurers decline simply on age grounds.
Maximum entry age by insurer
The table below shows the maximum age for new applicants at each insurer. These are the ages at which a new policy can be started — existing policyholders can typically renew beyond these limits.
| Insurer | Max new applicant age | Notes |
|---|---|---|
| Caser | 69 | Strict cutoff |
| DKV | 65 | Strict cutoff |
| ASISA | 70 | May vary by region |
| Sanitas | ~70 | Case by case above 65 |
| Adeslas | ~75 | Individual assessment |
| ASSSA | 75+ (often 80+) | Most flexible in market |
Age limits reflect standard underwriting policies as of 2026. Always confirm directly with the insurer or broker for your specific age and health profile.
What to do if you are refused
If you receive a refusal or an unacceptable exclusion from one insurer, take the following steps:
- Try Sanitas first — if you have not already. Sanitas underwrites more individually and accepts more cases than any other mainstream insurer.
- Try ASSSA — particularly if the refusal was age-related. If age is the primary issue, ASSSA is the specialist option.
- Get a specialist broker — a broker who works specifically with Spanish visa applicants will know which insurers are currently accepting specific types of cases. This matters because underwriting criteria change and individual underwriters within the same insurer can produce different outcomes.
- Accept exclusions if necessary — a policy that excludes a specific pre-existing condition can still qualify for the visa (see section below). Full coverage of all conditions is preferable but not required for visa purposes.
Can you still get a visa with a policy that excludes a condition?
Yes. This is one of the most important points for applicants with medical history to understand.
The Spanish consulate does not check which specific conditions are covered or excluded by your policy. What the consulate verifies is that you hold a qualifying policy — meaning:
- No copayments or deductibles
- Coverage across full Spanish territory
- Minimum 12-month duration
- With a private insurer
- Including repatriation
- Certificate issued in Spanish
A policy that excludes, for example, diabetes treatment — because diabetes was declared and underwritten with a specific exclusion — meets all of the above requirements and will be accepted for your visa. You would pay for diabetes-related care out of pocket (or use public health once registered in Spain), but everything else would be fully covered.
Frequently asked questions
Yes, but it is uncommon for healthy applicants under 65. Refusal is most likely for applicants with significant recent medical history (active cancer, recent major surgery, severe chronic conditions) or applicants who exceed an insurer's maximum entry age. If refused by one insurer, try others — each underwrites differently. Sanitas has the most accommodating underwriting approach for applicants with a medical history.
Most pre-existing conditions do not result in an outright refusal. You will typically complete a health declaration, and the insurer will either accept you with full coverage, accept you with that specific condition excluded for a period, or in rare cases decline your application. Minor conditions like controlled hypertension, mild asthma, or hay fever are usually accepted without any exclusion.
Age limits vary by insurer: Caser accepts up to 69, Sanitas up to approximately 70 for new policies, ASISA up to age 70, Adeslas up to approximately 75, and ASSSA accepts new applicants beyond age 75 — potentially into their early 80s. ASSSA has the most flexible upper age limit of any mainstream insurer in the Spanish market.
Sanitas often accepts applicants with cardiovascular conditions that other insurers decline. Well-managed conditions such as controlled hypertension, previous stable cardiac procedures, or a past heart attack (depending on time elapsed and current health) may be accepted, sometimes with a waiting period for that specific condition. Sanitas is the recommended first port of call for applicants with any cardiac history.
No. Each insurer underwrites independently. A refusal from Adeslas or DKV does not predict an outcome with Sanitas or ASSSA. Sanitas is generally the most accommodating for applicants with a medical history. If refused by two or more insurers, a specialist broker can identify further options.
Yes. The Spanish consulate does not check which conditions are covered or excluded. What is verified is that you hold a qualifying policy — no copayments, full Spanish territory, 12 months minimum, private insurer, repatriation included. A policy that excludes a specific condition can still meet all of these requirements and be accepted for your visa.
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