As is the case everywhere, health insurance is of primary importance and it is no different in Spain. Whether you are a resident or on a visit healthcare can make enormous inroads in your budget or your savings and so insurance to safeguard you in the event of illness or accident is vital.
There are a number of choices when it comes to healthcare in Spain.
- Social Security contributions to the Public healthcare system
- Private healthcare Insurance
- Euro Health insurance
- 1 How the National Healthcare system works in Spain.
- 2 Who is entitled to National Healthcare in Spain?
- 3 Who is NOT Eligible for National Healthcare in Spain?
- 4 Short term Healthcare in Spain
- 5 International Student Health Insurance
- 6 Healthcare for Residents of Spain
- 7 Social Security and your employer
- 8 Social Security and Self-Employment.
- 9 UK Pensioners:
- 10 Private Health Insurance in Spain
- 11 Private Health Insurance Companies in Spain
- 12 Who to contact in case of Emergency:
- 13 Medication and Treatment – Where to go
- 14 Income and portion % payable
How the National Healthcare system works in Spain.
Many are wary of public healthcare and especially healthcare offered in foreign countries, but Spain has an excellent system that not only compares favourably with the British NHS system but provides better and more up-to-date facilities and equipment than Britain, despite, according to the World Bank, Britain spends a greater % of GDP per capita on healthcare than Spain.
It is also important to note that the National Healthcare Service in Spain does not cover dental care. So if you feel that you need to cover this type of care you will have to look to private insurance cover.
Be aware that although the system covers the whole of Spain, you will have to attend a facility in your area as designated by the system. You will not be able to pick and choose which facility you prefer.
Who is entitled to National Healthcare in Spain?
Residents of Spain: If you are a resident of Spain (regardless of nationality) and you make regular Social Security contributions than you and your immediate family members are entitled to access Spain’s National Health Service. You can be either employed, self-employed or retired and on a pension. However, there is a big ‘but’, If you are still registered on a national healthcare system in a country outside Spain you must de-register before applying to Spain’s National Healthcare Service.
That said, and again, as is the case in any country, Private Healthcare is a better choice if you can afford it, and many take private health insurance in Spain.
To benefit from the excellent Spanish healthcare system you will need to register and be prepared to pay the Social Security contributions according to your income or employment status.
Who is NOT Eligible for National Healthcare in Spain?
Spain like Britain has experienced the problem of EU citizens taking advantage of its Healthcare system and as a result, has put provisos in place as well as the requirement for expats before they can access the system.
Persons not eligible for Healthcare
- Expats who are below retirement age and who are not employed in Spain and who have not registered.
- Anyone who has not followed the required procedures.
- Anyone who has not obtained a SIP card.
- Anyone who has not de-registered from the healthcare system in their home country.
Short term Healthcare in Spain
EU and UK Citizens: If you are registered with the NHS in Britain or your EU country’s national healthcare system, you need to apply for a European Health Insurance Card (EHIC). This will give you access to the National Health Service in Spain. With this card healthcare in Spain will be provided either at a reduced cost or, depending on the service provided, at no cost.
Reviews on the usefulness of this card vary so although you may have some cover it is possible that the card will not cover you for all emergencies or even for full treatment, but merely just enough to get you back home.
If your reason for travelling to Spain is pure to gain medical treatment, you will not be able to use this card.
Even if you do have this card you should ensure that you are fully covered by also taking out Travel insurance so that you do not find yourself with insufficient health cover. It is also a good idea to ensure that your travel insurance provides for repatriation should you be unfortunate and need long term treatment.
Non-EU Citizens: If your country has a bilateral agreement with Spain then you should ensure that you are issued with a Certificate of Right to Medical Care as this will entitle you to free emergency care in Spain.
Countries with bilateral agreements
- Morocco (only if you are working in Spain)
- Tunisia (only if you are working in Spain)
Other Non-EU Citizens: It is advisable to ensure that you purchase travel insurance before leaving for Spain. You will still have to pay direct on the day you receive treatment and apply for reimbursement from the insurance company holding your insurance or the agent/broker from whom you purchased the insurance.
International Student Health Insurance
If it is your plan to study in Spain then you must be aware that you must have health cover in order to succeed with you study visa application. There are different requirements depending on whether you are from an EU country or from outside the EU.
EU-Citizens – You are able to utilise your healthcare membership of your home country. This includes citizens of Switzerland. However, you will need proof that you have this cover. You need to apply for the Health Insurance card (EHIC) – See section on Short-Term Healthcare above.
Non-EU Citizens: If you are from any country outside the EU including the USA and Canada you need to ensure that you purchase private healthcare insurance, and ensure that you are covered for the whole period of study in Spain.
Suggested insurers for students.
The two suggested travel plans can be purchased online. After purchase, the relevant documents are emailed to you immediately. These documents will then be proof of healthcare cover in time for your visa application.
- Atlas Travel Plan
- Europe Travel Plan
Healthcare for Residents of Spain
No matter whether you are an EU citizen or not, if you are planning to move permanently to Spain you can apply to register for the National Healthcare Service before you leave and begin your Social Security contributions as soon as you arrive in Spain.
UK Pensioners: If you are 65 or over and you are planning to retire to Spain. Before you leave you will need an E121 from the Department of Work and Pensions. By acquiring an E121 you have effectively de-registered from the NHS and are now legally permitted to register for healthcare in Spain. You will need this E121 form, with all the other required documents to apply for your Permit of residency.
(See: How to get residence in Spain)
Social Security and your employer
If you are employed your employer is legally required to register you for Social Security and to make the necessary contributions on your behalf as per each salary payment. It is usual that the costs are shared between you and your employer. You can calculate around 6 to 8%.
Social Security and Self-Employment.
As a self-employed individual you come under the regimen especial Trabajadores autónomos scheme and as such you are responsible for ensuring that you are registered for Social Security contributions.
As you are your own employer you must ensure that you can meet these Social Security contributions. Self-employment often means a fluctuating income so it is wise to ensure that your Social Security contributions are covered no matter what. There is no set amount of your income will vary, but you can choose from a range with set minimum and maximum amounts payable.
However, regardless of your contributions as you are self-employed, you are not covered under the National Health Service for:
- Work related illness
- Accidents at work
Should you feel that these are very real risks, then you need to purchase Private Insurance cover.
How to register for the National Health Service in Spain
The first thing is to make sure that you have registered as a resident at your local Town Hall, and have your Certificate of Residence.
Step 1 – Register for National Healthcare
Documents required to register:
- NIE number (tax ID card)
- Valid passport (plus photocopies of the first page and photograph page)
- Your residency Certificate (plus photocopy)
- A completed and signed application form
To download the application form click on ‘Library’ then click ‘Health’ at Citizenadvice
Once you have all the relevant documents you need to take everything to the TGSS (Tesorería General de la Seguridad Social) office near you. Offices are located throughout Spain so finding your local office should not present a problem.
Once you have registered you will be issued with your social security number plus a certificate stating that you are entitled to access the National Healthcare system in Spain.
Step 2 – Your local health centre
Now that you have your permission to access the healthcare system plus your social security number, you need to go directly to your local health centre.
To find your local health centre, go to the map and click on your region. Here
At the healthcare centre , ou present your certificate and register with a doctor. At this point, you request your healthcare TSI card (Tarjeta sanitaria individual). You can choose to have this posted directly to your home address, or you can arrange to collect it.
Step 3 – SIP card
While at the healthcare centre you should request that they arrange for you to receive your SIP (Sistema d’Informació Poblacional) card. This card is proof that you are legally registered and entitled to treatment under the National Healthcare system. Keep this with all your important documents of better still keep it in your wallet so that it is always to hand.
**NOTE: Your SIP card must be presented each time you require medical attention or have a prescription filled at your local healthcare centre/clinic.
Private Health Insurance in Spain
Private Healthcare Insurance in Spain for the local market is not as expensive as the same insurance in Britain, but your choice of health care hospitals will quite naturally be restricted to the private medical domain.
If you are not yet in Spain but planning to move there soon, it is a good idea to arrange for healthcare cover before you move, you can do this through a company regulated by the Financial Services authority as these companies are likely to be more accommodating should any payment dispute arise.
Health Insurance Brokers
Single-company brokers are the norm in Spain. Single-company brokers are no more than agents selling a single company’s products so you will not be given the best overall product on offer. You need to find a broker who is able to find a competitively priced product suited to your needs, in other words, a broker who has the ability to check multiple company products.
If you decide to rely on a broker be sure to ascertain what their commission is and before you buy check online directly with the insurance company to ensure that the commission added is not too high.
Insurance – Seguros
Policy – póliza
You are referred to as the ‘subject’ (el subdito) on a policy.
As the receiver of a payment, you are termed the ‘beneficiary’ (beneficiario).
Private Health Insurance Companies in Spain
Private Health insurers for ex-pats
Adeslas – insures approximately one-third of the privately insured population in Spain. The company covers a number of national hospitals and clinics throughout the country and provides high-quality health insurance products with options of basic medical services and/or specialist services including the dental cover, within Spain.
Aresa – This private health insurance company specialises in meeting the needs of expat residents in Spain. This insurer has its own medical services centres in many of the main centres in Spain.
Asefa – Another leading Spanish Private health care insurer that offers various products specific to the needs of ex-pats resident in Spain. The have one of the best rates for health insurance among the different insurance companies. Unfortunately, the website is in Spanish so basic Spanish is necessary to navigate its pages.
ASSSA – a health insurer based in Spain that boasts of 80 years experience in health insurance and offers products aimed at the expat resident in Spain. Its boasts multilingual staff at both its head office and branches throughout Spain.
AXA – a Multinational very reputable company that offers Global Insurance cover. Also Travel Insurance. In Spain AXA enjoys a large portion of the private healthcare market and has in excess of 1200 employees and therefore a very strong distribution network.
BUPA International – a provider of Health Insurance specific to the needs of Expat residents of Spain. It is also an excellent option for those who spend time in both Spain and their home country. It offers individual and group policies to cover both Spain and the home country of the policyholder.
FiatC – A Spanish insurer based in Spain – they also offer the benefit of a health club which is included in their health insurance. They state that they have a third of the privately insured Spanish population as their clients. And that they guarantee that if you use their nominated facilities you will not be faced with additional costs. However, the website is in Spanish with a rather confused English translation.
Sanitas – This health insurer is the sister company of BUPA. It offers cover in Spain the UK and globally. Policies for residents of Spain can be as low was €30. Cover for Spain
Caser Seguros – Has more than 70 years’ experience in the Spanish Insurance market including Travel, health and dental cover. They offer discounted rates on personal policies and have a very comprehensive website that offers translation into English which is clear and understandable.
DKV (DKVSeguros) – Based in Spain, This International company has an English website and offers a number of health insurance products. It has branches throughout Spain which makes face-to-face discussions easy. The website has a choice of languages including English.
MAPFRE Asistencia- A large and reputable International Insurer, however, its Websites are not encouraging – there is virtually no information available in English. If you have some knowledge of Spanish then you might find what you are looking for. They offer Personal Insurance products.
Cost of Private Health Insurance
We carried out a study to get a price comparison among the different health insurance companies mentioned above. The quotation that we got for monthly insurance without copay (you want to be sure that the insurance you get is without copy, this way you want pay for any charges each time you visit the doctor) is the following:
Top 5 most inexpensive health insurance companies (without copay) for women aged 30
AXA 49 euros/month
Asefa 53 euros/month
Adeslas 56 euros/month
Sanitas 56 euros/month
FiatC 59 euros/month
Top 3 most inexpensive health insurance companies (without copay) for women aged 65
Sanitas 133 euros/month
Adeslas 151 euros/month
FiatC 154 euros/month
Who to contact in case of Emergency:
You may be lucky and get an English speaking operator, but just in case you don’t, it is a good idea to have a few important phrases in Spanish.
“I live at……..” Vivo en
“I need an ambulance.” Necesito una ambulancia
For these calls you do not need an area code – just call direct.
061 or 112
It’s a good idea to keep these numbers in your wallet.
Medication and Treatment – Where to go
You will recognise a pharmacy (farmacia) as it will have a green flashing cross outside the premises.
Spain has an abundance of pharmacies (farmacias) and they are not as strictly regulated as is the case in many other countries. If you have a minor ailment pharmacists are sufficiently qualified to prescribe and dispense treatments without a doctor’s prescription and this includes antibiotic medications. However, don’t disregard the need for a doctor if you are dealing with high temperatures or what could be a serious illness.
Medication in Spain is not as expensive as in the rest of Europe as Spain strictly regulates the cost of drugs.
Prescriptions: even if you are registered and utilise the Spanish Healthcare Service you will be required to pay a portion of the cost of any prescription. Your portion of the cost is calculated according to your income.
Income and portion % payable
The table below is as set out under Spanish law, but these can differ depending on the region so it is meant just as a rough guide.
€18,000 + per year 50% of the cost of the prescription
Less than €18,000 40%
€18,000 + per year 10% with a maximum of €18 per month
Less than €18,000 10% with a maximum of €8 per month
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