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The Spanish Health Care System

The Spanish Health Care System

The Spanish Healthcare System

You need to make sure you are correctly registered for healthcare as a resident in Spain. You can read the NHS’s guidance on who is able to access healthcare in Spain and how to register.

If you are resident in Spain, you should not be using a European Health Insurance Card (EHIC) from the UK to access healthcare in Spain.

If you live in Spain and receive an exportable UK pension, contribution-based Employment Support Allowance or another exportable benefit, you may currently be entitled to state healthcare paid for by the UK. You will need to apply for a certificate of entitlement known as an S1 certificate.

If you are entitled to an S1, you are also entitled to apply for a UK-issued EHICbut note:

  • you may use an EHIC to access state-provided healthcare during a temporary stay in another European Economic Area (EEA) country or Switzerland
  • the EHIC covers treatment that is medically necessary until your planned return home
  • an EHIC is not a replacement for comprehensive travel insurance
  • for more information you can read our travel advice pages and advice on foreign travel insurance

If you are not an S1 holder, but are registered for public healthcare in Spain in another way and are travelling outside of Spain, you should apply for a Tarjeta Sanitaria Europea (TSE) online (in Spanish), or go to your nearest social security office (Insitituto Nacional de la Seguridad Social).

You should also buy comprehensive travel insurance to cover anything not covered by your TSEEHIC or for travel to countries outside the EU.

The above is the new style SIP card.

Healthcare entitlement

You are entitled to healthcare in Spain if you fall into one of the following categories:

  • you are in receipt of a UK State Pension or some types of long-term sickness benefit
  • you are working or self-employed and paying Spanish social security contributions
  • you are in receipt of a Spanish state pension or benefit
  • you are a permanent resident of Spain
  • you have previously worked in Spain and no longer receive benefit
  • you are a UK posted worker in Spain or family member of someone living and working in the UK
  • you are a family member of someone in the above category
  • you are a student studying in the UK as part of a UK undergraduate course

If you do not fall into any of these categories, you may have entitlement under a local scheme administered by a Regional Health Authority or a Spanish Government pay-in scheme called the Convenio Especial.

Applying as a UK state pensioner or if you are in receipt of a long-term sickness benefit

If you are in receipt of a UK state pension, request an S1 form (previously E121) from the Overseas Healthcare Service on +44 191 218 1999. If you are in receipt of an exportable DWP benefit you can request an S1 from the office which pays your exportable benefit.

You will need to register this at the INSS along with your padrón documentresidency certificate and passport (remember to take photocopies). The INSS will then issue you with a Spanish social security number which you take to your local health centre to register.

Applying as a worker/self-employed person

There are two routes to register depending on where you live in Spain. Your local health centre may accept your original social security document issued by your employer or the TGSS (if you are self-employed). You will also need to present your padrón document and ID. You may also be asked to present a residency certificate.

Some health centres may also require the ‘documento acreditativo del derecho a asistencia sanitaria’ from the INSS.

Applying as an individual in receipt of a Spanish state pension or benefit

Please apply for the ‘documento acreditativo del derecho a asistencia sanitaria’ from the INSS. Present it at the health centre along with your padrón, residency certificate and photographic ID.

Applying as a permanent resident of Spain

If you have held a residence certificate for 5 years or more, you may be eligible for healthcare on the basis of residency, without having previously worked or paid social security contributions in Spain.

You will need to apply at your local INSS office, with your residency certificate, padrón and passport. You will also need to provide a Legislation Letter from the Overseas Healthcare Service (+44 191 218 1999) which states you are not covered by the UK for healthcare. The Spanish application form can be found here.

Applying as someone who has previously worked in Spain but does not receive benefit

Please apply for the ‘documento acreditativo del derecho a asistencia sanitaria’ from the INSS. Present it at the health centre along with your padrón, residency certificate and photographic ID.

Applying as a posted worker or family member of someone living and working in the UK

If you are a worker seconded to Spain, or the family member of someone making UK National Insurance contributions, contact HMRC to see if you have entitlement to an S1 form (previously an E106 or E109).

Once issued, register the S1 form with your local INSS office, before you register with your local GP surgery. Note that if your posting is for less than two years you will need to use a UK EHIC to access healthcare.

Applying as a dependent of someone in the above categories

Dependents and family members are classified differently in Spain than the UK. A list of who can be considered a dependent under Spanish law can be found on the INSS website, in English

If you classify as a dependent of someone covered by Spain i.e. someone working in Spain or receiving Spanish benefit or as a permanent resident, you will need to apply at your local INSS office

You will also need to present a documento de no exportación (Legislation Letter stating you are not covered by the UK for healthcare), which you can request from the Overseas Healthcare Service (+44 191 218 1999). The Spanish application form for dependents can be found here.

If you classify as a dependent of someone covered by the UK e.g. a UK State Pensioner, you should also request a dependent’s S1 form from either the Overseas Healthcare Service (+44 191 218 1999) or the DWP department that issued the original S1.

Students

If you are studying Spain as part of a UK-recognised course you will be covered for healthcare with your UK EHIC.

Pregnancy and children

In Spain access to healthcare by children and pregnant women is protected by law. Please see the social worker at your local health centre for more details.

Purchasing public health insurance – Convenio Especial

If you are not covered for state-run healthcare through any other means, the Spanish regional health authorities offer a special pay-in scheme (convenio especial). This is a public health insurance scheme available nationwide where you pay a monthly fee to access state-run healthcare. The scheme is managed by each autonomous region and you have to be registered with the padrón (Town Hall register) for at least 1 year before applying.

Policy holders pay on an individual basis for access to public healthcare, regardless of pre-existing conditions, anywhere in Spain. Children will also need to join the scheme, as long as their parents have sufficient income to be able to pay their subscription. If you have any doubt about your means to pay for your children to join the scheme, you must make an appointment with the social worker at your local health centre.

The basic monthly fee is 60€ for the under 65s and 157€ for those aged 65 and above. However, prescriptions are not subsidised at this rate so you would pay 100% of prescription costs. This form of cover doesn’t give holders the right to an EHIC at this time, so if you wish to travel, you will need to take out private travel insurance. To apply, you will need to enquire at your local health centre or an office of your Regional Health Authority.

Change of circumstances

It is your responsibility to keep the Overseas Healthcare Team or office which pays your exportable DWP state pension/benefit up to date with any changes in circumstances which may affect your entitlement to an S1 (E121). This is especially important if you move back to the UK to live. If you move address within Spain, please ensure you inform the Spanish social security office of your change of circumstances.

Healthcare after the UK leaves the EU

If the UK leaves the EU with a deal and you are resident in Spain, your current rights on access to healthcare in Spain will remain the same as long as you remain a resident in Spain.

If the UK leaves the EU without a deal, your access to healthcare may change. You should ensure you are correctly registered for healthcare and, if in any doubt, consult with your regional healthcare authority. You can read the Spanish government’s guidance on access to Spanish healthcare and Brexit.

If the UK leaves the EU without a deal, the Spanish Royal Decree states that if you are currently registered for healthcare in Spain as a resident, you will be able to continue to access healthcare until at least the end of 2020. This is provided the UK makes the same agreement for Spanish nationals in the UK. We will update this guidance when there is a formal agreement between the UK and Spain about this.

Should UK nationals face changes in their circumstance and wish to return to the UK, they will have an entitlement to NHS services as soon as they take up ordinary residence in the UK.

If the UK leaves the EU without a deal your Spanish TSE may not be valid for use in the UK. If you are an S1 holder your UK-issued EHIC may not be valid for travel to other European member states. In either case, you should ensure you have comprehensive travel insurance.

You should read the NHS guidance on healthcare for UK nationals in Spain and how it may change after the UK leaves the EU.

Going to the doctor in Spain

In Spain, you get primary heath care through a health centre (centro de salud or centro de asistencia primaria or CAP), or a general doctor (médico de cabecera). Before you can see a doctor, you’ll need to register (see above).

Click on this map to find your local health centre. The health centre will probably have around six doctors and you may not see the same one each time you visit, although in some centres you can book to see the same doctor, particuarly if you are in ongoing treatment. Find a doctor with his or her own practice through the phone book or by personal recommendation.

Doctors may offer both private and state healthcare; make sure you are clear which type of healthcare you want. There may be separate surgery times for private and state patients. You should be given a leaflet called Carta de Derechos y Deberes (Charter of Rights and Obligations) that sets out your rights as a patient. You usually make an appointment to see a doctor at a health centre although doctors with individual practice may offer a first-come-first-served basis. You have the right to be accompanied by a friend or relative during consultations. You can change doctors easily, just by re-registering.

Going to see a specialist

If you want to be seen by a medical specialist in Spain you’ll need to be referred by a family doctor. If you have private health insurance, you’ll be able to see a specialist much faster than going through the public system.

Hospitals

In an emergency you can go straight to a hospital A&E or ER (Urgencias).

If you want to get any other type of hospital treatment, you’ll need a referral from a doctor. There are public and private hospitals. Only the public hospitals provide free treatment. Some hospitals offer both private (privado) and state healthcare services (asistencia sanitaria pública), so make sure the staff knows which service you want.

When you go to hospital you’ll need to show your social security card or proof of private insurance.

If you are discharged from a hospital and need medication, you have to take the hospital medical report to a pharmacy for the prescription to be fulfilled, as hospital doctors don’t issue prescriptions.

Pharmacies in Spain

You can take a prescription to any pharmacy (farmacia). Look for a shop with a large green cross sign outside.

Pharmacy opening hours
Pharmacies are usually open Monday to Friday from 9.30am to 2pm and 5pm to 9.30pm, and Saturdays 9.30am to 2pm. There’s usually a notice on the pharmacy window or door with details of the nearest 24-hour pharmacy (farmacia de guardia) – or you can find a list of pharmacies online.

Prescription charges in Spain

You have to pay a percentage of the cost of prescription medicines, and the cost is non-refundable. How much you pay depends on your income and whether you are of working age or a state pensioner. For example, if you are of working age and your annual income is less than EUR 18,000 you have to pay 40 percent of the cost of the medication. If your income is between EUR 18,000 and 100,000 you pay 50 percent, and if it’s over EUR 100,000 then you pay 60 percent. State pensioners pay 10 percent unless their income is over EUR 100,000, in which case they also pay 60 percent. You can find out more about this co-payment system, in Spanish, here.

Registered pharmacists can also provide health consultations and guidance on health matters.

Visiting the dentist in Spain

Dental treatment is not covered by the state healthcare system unless in an emergency. You must either pay for dental treatment unless you have private health insurance. Find a dentist by looking in the phone book or by personal recommendation. Just call up and make an appointment.

Pregnancy and birth in Spain

The standard of care for pregnant women in Spain is highly regarded in both the private and public sectors. The degree of medical contact is reasonably high, with an initial appointment with a doctor or midwife (comadrona/llevadora) to confirm the pregnancy, antenatal appointments and hospital scans. Most births take place in a hospital although home births are becoming increasingly popular. A word of warning: if you wish to give birth at a private clinic, it’s advisable to take out medical insurance well ahead of getting pregnant otherwise it might be hard to find an insurer.

In an emergency

In a serious, life-threatening emergency, call the pan-European number 112 free of charge from any mobile/cell phone or landline. The Spanish word for A&E or ER is urgencias.

Other emergency numbers include:

  • 060 for an ambulance (ambulancia)
  • 961 496 199 – emergency dentists
  • 963 600 313 – on duty pharmacy

Useful Spanish phrases in an emergency

  • Accident: Accidente
  • Emergency: Emergencia/Urgencia
  • I need an ambulance: Necesito una ambulancia
  • I need a doctor: Necesito un medico
  • Heart attack: Ataque cardiaco/Infarto
  • Stroke: El accidente vascular cerebral
  • I need a dentist: Necesito un dentista

 

 

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Cru Property Management And Holiday Rentals
VIP Member
Cru Property Management And Holiday Rentals

I am resident here with SIP card had a flying visit to Villajoyosa yesterday as had allergic reaction. Not an emergency but was in and out in 30mins. However for 2 injections and seeing 2 nurses in A&E the cost of treatment came to 788€. If I hadn’t been covered that would have cost me. Must have insurance!

Carol Andrew
VIP Member
Carol Andrew

I have lived in Spain for 14 years. My husband was very ill for several years. I can assure you that the health care here is second to none and free if you are working or receiving a UK state pension. If you live here then legally you have to prove that you are covered by state health care or have private medical insurance.

RUTH HARRISON
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RUTH HARRISON

IS THERE A TELEPHONE NUMBER FOR A TRANSLATER LAST YEAR MY HUSBAND NEEDED TO BE SEEN BY A DOCTOR SHE COULDNT SPEAK OR UNDERSTAND ENGLISH

RUTH HARRISON
Guest
RUTH HARRISON

last year my husband needed attention being a diabetic his big toe was going navy blue it was ok in the morning we attended the local health clinic it was hard explaining what was wrong as not many medical staff didnt understand english is there a translater service we could contact we are planning a visit this year.