Different routes for accessing healthcare in Spain

• If you are not entitled to healthcare cover from Spain or the UK, you might be able to join the Spanish government’s special pay in health insurance scheme known as the Convenio Especial. More info down below.

For now and until the Brexit is a done deal about two years down the line, UK Spain Life offers their readers a quick guide to registering for healthcare in Spain as a permanent resident.

Use the flowchart below to find out which situation best matches your individual circumstances, so you can register correctly for healthcare.

The contact details for the organisations in the flowchart can be found on the Spanish government’s useful Contact page.

And further down we have provided with links to a directory of health centres and hospitals throughout Spain.

Your entitlement to register for healthcare will be decided by local authorities.

Also be aware that registration may take some time, so don’t wait until the last moment.

ACCESSING PUBLIC HEALTHCARE IN SPAIN

Click on the flowchart (and then the icon in the top righthand corner) to enlarge.

Which country is competent for your healthcare cover in Spain?

This depends on your personal circumstances, including situations such as whether you are working or have worked in Spain, receive a U.K. state pension or if you are a family member of someone who has Spanish cover.

When will SPAIN cover you?

• If you work and pay social security contributions in Spain, you will be covered by this country’s healthcare system and all you need to do is head down to a local health centre and register with your social security number.
• If you receive a Spanish state pension or benefit, the INSS (social security office) will issue you a letter of confirmation. You must present the document at your local health centre.
• If you are not entitled to healthcare through any ot the options listed above in Spain or any from the U.K. listed below but you have a residence certificate (green A4 paper or card obtained at the National Police) in Spain issued before 24th April 2012, you may be eligible for healthcare on the basis of residency (read the Spanish law Real Decreto-ley 16/2012, de 20 de abril for reference on this following link Ref. BOE-A-2012-5403). If so, apply at INSS for the document that confirms this known in Spanish as the “documento acreditativo del derecho a asistencia sanitaria.” More information on the FAQs page. If you are required to present a letter of no export or in Spanish “documento de no exportación”, apply for it by phoning the Overseas Healthcare Team on +44 191 218 1999. In the U.K., this document is called Legislation Letter.

When will the UK cover you?

The government of the United Kingdom will cover your healthcare costs in Spain if you are a U.K. pensioner, a U.K. posted or self-employed worker or if you receive a long-term sickness benefit.

You could also be covered if you are a dependent family member of someone in the above situation. Please make sure you change your healthcare entitlement as soon as you are in receipt of healthcare cover in your own right as listed in the paragraph below.

U.K. state pensioners or those in receipt of a long-term sickness benefit can register for healthcare in Spain by applying for an S1 (E121) form from the International Pension Centre (IPC) (+44) 191 218 7777.

This form can take up to 28 days to arrive at your address in Spain so it is highly recommended that you apply for it before moving to Spain. If any of your family members need healthcare as your dependent because they may not be entitled to any cover in Spain, then they will also need to apply for a separate S1 form as your dependent.

Once you have received the S1 form, you will need to register it at the nearest Spanish INSS or social security office.

The S1 gives you the same medical cover in Spain as a Spanish national under the country’s state-run health system.

However, the coverage may not be the same as you would receive at the NHS in the U.K., which means you may have to pay for some treatments or services and some social services may not be available.

U.K. posted workers are those who remain insured in the U.K. National Insurance scheme.

Before moving to Spain your U.K. employer will need to fill out the application form CA3821 and the worker will need to complete the CA3822.

You can find the forms by clicking here. They will need to be returned to the International Caseworker’s Insurability Team (ICW) at the address given on the application forms.

If you have any enquiries about the forms, please contact Her Majesty’s Revenue & Customs on +44 191 203 7010.

You will receive an A1 along with an S1 form if your posting will last more than two years. For periods less than two years, you should continue to use a U.K. European Health Insurance Card in conjunction with the A1.

If you are issued an S1 you will need to take it to the nearest INSS office to register for healthcare. You will also need to take your Certificado de empadronamiento or ‘padrón‘, which you get from your local Town Hall. As soon as you’ve registered at the INSS, you will receive a Documento acreditativo that you will need to take together with your ‘padrón‘ every time you go to the local GP or public hospital. But don’t expect to be assigned a GP like you would in the U.K. because your S1 form for healthcare is only temporary.

A dependent of a family member working and living in the U.K. can also request an S1 form from HMRC by calling +44 191 203 7010. As above, you will need to register at the INSS.

Registering with Spanish Authorities

In order to register your S1 form with the Spanish social security office (INSS), you will also need to obtain the following documents:

1. Certificate of Residence in Spain (Certificado de Residencia with your Numero de Identificacion Extranjero) – available from your nearest National Police station. You can be assigned an NIE without having taken out residency, therefore please make sure your NIE is printed on a green form – not a white one. You can find out more information on residency requirements here.
2. Certificate as a Local Resident (Certificado de Empadronamiento or ‘padrón’) from the Town Hall.

You will also need to show your valid passport when registering your forms. Your local INSS office will let you know if you require any other documents.

If you a are a dependent, please make sure you legalise your marriage/birth certificate with a Hague Apostille from the Legalisation Office in the United Kingdom as you will be asked for proof of this by the local authorities. You can now do this online.

No entitlement to healthcare cover?

If you are not entitled to healthcare cover from Spain or the United Kingdom, you still may be eligible to join the Spanish government’s special pay-in health insurance scheme known as the Convenio Especial.

This scheme provides access to the state healthcare system for a monthly payment of €60 per person under the age of 65 and €157 for those age 65+. It covers all pre-existing medical conditions but not prescriptions. You will not be issued a European Health Insurance Card (EHIC) for healthcare cover in another EU country other than Spain.

In order to apply, you must have been registered at the local Town Hall on the ‘padrón’ (or Certificado de Empadronamiento) in Spain for at least 1one year and you must not be receiving any healthcare benefits from the U.K.  This scheme is only available in the following locations, however:

• Andalusia: there is no link available yet. Please enquire this directly at your nearest local health centre.
• Balearic Islands: there is no link available yet. Please enquire directly at the Points of Contact.
• Canary Islands: you can make an enquiry and subscribe at your nearest local health centre.
• Castilla y León
• Galicia
• Madrid
• Murcia
• Valencia

Updates for the other regions will be provided when they’re operational. schemes are launched.

If you are not yet eligible to sign up for the Convenio Especial or if it’s not yet available in your region, you might have to take out private health insurance or pay every time you go to the doctor or receive treatment.

RESIDENCY-BASED HEALTHCARE

If you have permanent residency in Spain you could be entitled to healthcare on the same basis as a Spanish national. The two other conditions are that your annual income is under 100,000€, and that you have no other healthcare entitlements.

For more information please read here.

You can download the application form here. However, you will need to take the form to your local INSS office alond with the accompanying documents, such as residency, padrón and passports and photocopies of all.

If you do not submit an annual tax return in Spain, you may be asked to prove your taxable income from the U.K. To request this information please contact the HMRC at +44 135 535 9022 . You should ask for documents stating:

• Your taxable income in the U.K. for a particular tax year, or
• confirmation that HMRC have no record of taxable income in the U.K. for a particular tax year (you make be asked to fill in a form on your statement of income – please see here).

You must state that:

• You are living or working abroad; and
• You need proof of income, or lack of it, for an overseas tax authority.

Alternatively, you can make the request in writing to HMRC at Customer Operations, PAYE and Self Assessment, Lynx House, 1 Northern Road, Cosham, Portsmouth, PO6 3XA.

• Andalucía
• Aragón
• Principado de Asturias
• Baleares
• Canarias
• Cantabria
• Castilla-La Mancha
• Castilla y León
• Cataluña
• Extremadura
• Galicia
• La Rioja
• Comunidad de Madrid
• Región de Murcia
• Comunidad Foral de Navarra
• País Vasco
• Comunidad Valenciana
• Ceuta
• Melilla

Spain uses a co-payment system where residents are required to pay a percentage of the cost of their prescription medication.

1.  If you are of working age, you will need to pay between 40-60 percent on all your prescriptions, depending on your annual income. For more information click here.
2.  If you are a pensioner, you will only have to pay 10 percent. These are also capped depending on your annual income. For more information click here.
3. If you suffer from a chronic or serious illness or have AIDS, you will only pay 10 percent, capped at 4,26€ per medication. For more information visit the Ministry of Health, Social Services and Equity’s website here.

Within the EU?

You will need a European Health Insurance Card (EHIC).

If you are covered by the UK for healthcare and you are going on holiday or temporary stay to another EEA country, you will be covered by your UK EHIC. To apply for an EHIC, you can do so by calling on (+44) 191 279 0575 or by emailing this S1 renewal application form to nhsbsa.ehicenquiries@nhsbsa.nhs.uk.

If you are covered by Spain for healthcare, you should apply for a Tarjeta Sanitaria Europea (EHIC equivalent) from your nearest social security office (Instituto Nacional de la Seguridad Social) in person or online here.

Outside of the EU?

Make sure you have adequate travel health insurance and accessible funds to cover the cost of any medical treatment abroad and repatriation. Visit Gov.uk for country specific information.

Treatment in the UK for Spanish Residents

One way would be to apply for planned treatment through the S2 route and the other would be through the Cross Border Directive paying up front for the costs of the treatment abroad and claiming reimbursement from the Spanish National Health system.

1.  S2 (formerly E112) route: you will need to request an authorisation from your doctor (GP) or specialist in Spain and from the relevant health authority in your region. This authorisation will then need to be taken to the nearest INSS office along with your health card and ID (NIE-Passport) for them to issue you with the S2 form.

You will need to pre-arrange the treatment by doing the following:

• Contact the state-run hospital where you would like the treatment carried out in the UK;
• Book appointments needed to see the specialist there after authorisation has been given by your doctor in Spain and hospital in the UK and ask for the UK hospital’s contact details so they can be added to the form;
• A photocopy of your passport
• A copy of your medical history
• A copy of any prescriptions from Spain (and a copy in English)
• An address and contact telephone number where you will be staying in the U.K.

Please make sure the treatment is arranged and pre-approved by the national health authorities in Spain and the U.K. More information on this can be found on the EU Commission’s website.

2. Cross Border Directive allows patients to seek treatment abroad, pay the costs up front, and then seek reimbursement from their country of residence upon their return. You would be entitled to apply for treatment under the Cross Border Directive as long as the treatment is considered medically necessary and would be made available to you under the state public health system in Spain. It covers both treatments given in state-run hospitals and by private service providers. Please note that you will only be reimbursed up to the amount the operation would have cost in Spain.

For more information, please get in touch with the National Contact Point for the Spanish authorities regarding Cross-Border issues: Ministry of Health, Social Services and Equity or via email: oiac@msssi.es