If you have a medical history, the question we hear most often is the same: "Will a Spanish insurer cover me?" The honest answer in 2026 is — sometimes yes, sometimes no, and increasingly it depends on which condition and which insurer. The market has moved this year, and not always in the same direction. Here's what's actually possible right now with the two providers we work with: Sanitas and Caser.
The starting point: disclosure is non-negotiable
Both Sanitas and Caser require you to declare existing conditions on the application. This is not a tick-box exercise — the medical questionnaire (cuestionario de salud) is the contract. Anything you fail to disclose can be used to refuse a claim or void the policy later, even years down the line. We say this plainly because we've seen it happen.
The good news is that disclosure does not automatically mean rejection. It triggers one of four outcomes: full acceptance, acceptance with a carencia (waiting period), acceptance with a permanent exclusion for that specific condition, or decline. Most applicants land in the middle two categories.
How Sanitas is handling pre-existing conditions in 2026
Sanitas continues to use individual medical underwriting on most expat-facing policies, including the NLV-compliant Mas Salud and Sanitas Mas Salud Mundi tiers. In 2026 they've quietly tightened on a few areas and loosened on others.
What tends to be accepted with a condition exclusion:
- Controlled hypertension and high cholesterol — usually accepted, sometimes with a short carencia on cardiovascular claims
- Asthma (mild to moderate, no recent hospitalisation) — commonly accepted with exclusion for asthma-related treatment
- Historical injuries, repaired fractures, healed surgeries with no ongoing treatment — usually fine
- Anxiety or depression where you are stable and not currently medicated — case-by-case in 2026, often accepted with mental health exclusion
What is generally declined or heavily restricted:
- Active cancer or treatment within the last five years
- Type 1 diabetes (Type 2 is reviewed case-by-case — this is one area Sanitas has softened slightly in 2026)
- Recent cardiac events, strokes, or coronary procedures within five years
- Active autoimmune disease under treatment
- Severe or recently hospitalised mental health conditions
How Caser compares in 2026
Caser's underwriting on the Caser Salud Integral and Activa Premium products is broadly similar but differs in two notable ways this year. First, Caser has become a touch more willing to accept Type 2 diabetes applicants over 50 where the condition is well-controlled and there's evidence of regular monitoring — we've seen approvals in 2026 that would not have come through in 2025.
Second, Caser's approach to musculoskeletal history (back pain, joint replacements, slipped discs) has tightened. Where in 2025 you might have got a clean acceptance, in 2026 we're seeing more exclusions written specifically around the affected joint or vertebra. Not a refusal — just a narrower policy.
Caser is also slightly more flexible on historical mental health where the applicant has been off medication and stable for two or more years.
Carencias: the waiting periods that matter
Even without a pre-existing condition, both insurers apply standard carencias on new policies: typically six months for surgery, ten months for childbirth, and shorter periods (three to six months) on hospitalisation and specialist consultations. Where a pre-existing condition is disclosed and accepted, the insurer may extend the carencia for treatments linked to that condition — or, more often, exclude it permanently rather than make you wait.
The practical implication: if you need cover starting day one for a known condition, neither private insurer will give you that. Public cover via convenio especial after one year of empadronamiento is the route for genuinely high-need cases.
NLV applicants — what counts as compliant
For Non-Lucrative Visa renewals and first applications, the consulate requires full cover with no co-payments, no waiting periods on essential care, and no exclusions that would leave you uninsured for foreseeable treatment. A policy with one or two specific exclusions for a stable, non-active condition generally still satisfies the consulate — we have NLV approvals on file every month with declared conditions. A policy with multiple major exclusions, or one that excludes hospitalisation entirely, will not.
This is the key 2026 point: the consulates are reading certificates more carefully than they did two years ago. If you're declaring a condition, the policy needs to be written cleanly so the limitation does not undermine the overall cover. We can structure this with both Sanitas and Caser — it just requires the application to be presented properly.
What's improved, what's worse vs 2025
Better in 2026: Type 2 diabetes acceptance rates (both insurers), historical mental health more leniently treated, faster underwriting decisions (typically 3–5 working days now rather than 7–10).
Worse in 2026: Tighter musculoskeletal exclusions, premium loadings now applied more often where in 2025 you'd have got a flat rate, and stricter documentation requirements for any condition mentioned in the last five years of medical history.
Have a condition you're worried about? Let us run it past both insurers before you apply.
Get a Personalised Eligibility ReviewWe've placed cover for hundreds of applicants with disclosable conditions. The single biggest factor in getting accepted is how the application is presented — not the condition itself. Send us your details and we'll tell you honestly what's likely with each insurer before you commit to anything.
This article reflects underwriting practice observed with Sanitas and Caser as at June 2026. Individual outcomes depend on full medical disclosure and insurer assessment. 247 Expat Insurance is a registered insurance intermediary in Spain.