Healthcare in Spain

If you a considering moving to Spain it is understandable to have questions and concerns about your entitlements to healthcare in Spain.

Below we have a provided some answers to some frequently asked questions. The answers have been provided in conjunction with the Department of Health and the British Consulate in Spain. It applies to UK nationals in Spain.

If I fall ill when I am living in Spain, who will be responsible for paying for my my healthcare in Spain?

This will depend on your specific circumstances, for example:

  • Whether you are currently working or have ever worked in Spain,
  • Whether you are in receipt of a UK state pension or
  • Whether you are a family member of someone who has healthcare cover in Spain.

In what circumstances would Spain cover my healthcare?

Spain will provide you with healthcare cover if:

  • You work and pay social security contributions in Spain. In this case, you should register at your local health centre with your social security number.
  • If you are in receipt of a Spanish state pension or benefit, the social security office in Spain (INSS) will issue you with a document to confirm this. You will need to present this document at your local health centre in Spain.
  • If you registered as a resident in Spain before 24th April 2012, you may be eligible for healthcare as a resident. If this is the case you would need to apply for the ‘documento acreditativo del derecho a asistencia sanitaria’ from your local INSS office.

In these circumstances you will be entitled to Spanish state run healthcare on the same basis as a Spanish national.

In what circumstances would my healthcare in Spain be covered by the UK and how do I register?

You will be covered by the UK for healthcare if:

  • You are a UK state pensioner.
  • You are in receipt of a long-term sickness benefit.
  • You are a UK seconded/posted/self-employed worker (i.e. those who remain insured in the UK National Insurance scheme) or
  • You are a dependent family member of someone in the above situations.

UK State Pensioners and those in receipt of UK Long Term Sickness Benefit can register for healthcare in Spain by applying for an S1 form (previously called E121, E106 or E109). This can be obtained from the International Pension Centre (IPC) (+44) 191 218 7777.

If you are moving to Spain it is recommended that you apply for an S1 form before moving as it can take up to 4 weeks to arrive at your Spanish address.

If any of your family members need to receive healthcare as your dependent 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 Social Security Office (Instituto Nacional de la Seguridad Social – INSS).

The S1 gives you the same medical cover in Spain as a Spanish national under the Spanish state-run health scheme. Please note that this cover may not be the same as you would expect to receive on the NHS in the UK. You may have to pay for some treatments or services and some social services may not be available.

UK posted workers should arrange for their UK employer to complete the application form CA3821. The worker will need to complete the CA3822. You can find the forms by clicking here.

Both forms should then be sent to the International Caseworker’s Insurability Team (ICW) at the address provided on the application forms. Any enquiries should be directed to HMRC.

If the posting is to last for more than two years, you will receive receive an A1 together with an S1 form. You will then need to take the S1 to your nearest INSS (Spanish social security office) to register for healthcare in Spain. 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 and you will need to take this with you, together with your padrón every time you go to the local GP or public hospital. Because your healthcare cover is provided on a temporary basis, you will not be assigned to a GP like you would in the UK.

If the posting is for less than two years, you should continue to use a your UK European Health Insurance Card (EHIC) in conjunction with the A1.

Do you need to pay for medical prescriptions in Spain?

Spanish residents are required to pay a percentage of the cost of their prescription medication. The percentage depends on your age and income:

  1.  If you are of working age, you will need to pay between 40-60% on prescriptions, depending on your annual income.
  2.  If you are a pensioner with an annual income of less than €100,000, you will have to pay 10% of prescriptions. The costs are capped at with €8 or €18 a month depending on your income;
  3. If you are a pensioner with an annual income of more than €100,000, you will have to pay 60% of prescription costs. These  costs are capped at €60 per month.
  4. If you suffer from a chronic or serious illness or have AIDS, you will pay 10% on prescriptions, capped at 4,26€ per medication.

Can I still access treatment in the UK if I am a resident of Spain?

There are two ways in which you could still access treatment in the UK even if you become a resident in Spain.

  1. S2 (formerly E112):

You can arrange to be treated by a UK NHS hospital whilst being a resident of Spain by obtaining an S2 document.

In order to obtain treatment this was you will need to:

  • Request authorisation from your doctor or specialist in Spain and from the relevant health authority in your region.
  • Take this authorisation to you nearest social security office (INSS) in Spain together with your health card and ID (NIE and Passport) so that they may issue you with a S2 form.
  • Pre-arrange your treatment by contacting the UK NHS hospital where you would like the treatment carried out.
  • Make an appointment to see the specialist there and ask for the UK hospital’s contact details so they can be added to the S2 form;

You will need to take with you:

  • 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 UK.

The treatment must be pre-approved by the national health authorities in both Spain and the UK.

  1. Cross Border Directive:

The Cross Border directive allows EU patients to obtain treatment abroad, pay the costs up front, and then be reimbursed by their country of residence upon their return.

You can apply for treatment in the UK as a Spanish resident under the Cross Border Directive as long as:

  1. the treatment is considered medically necessary and
  2. it would be made available to you under the state public health system in Spain.

The directive covers both treatment provided by both state-run hospitals (NHS) and by private hospital.  You will however only be reimbursed up to the amount the treatment would have cost if you had received the treatment in Spain so will have the bear any difference between the costs.

Your treatment will need to be pre-arranged and authorised by both the UK and Spanish health authorities.

I don’t have an entitlement to Healthcare in Spain. What should I do?

If you are not entitled to healthcare cover from Spain or the UK, you may be able to join the Spanish government’s pay-in health insurance scheme called the Convenio Especial. This scheme is only available within certain areas of Spain which include, Andalusia, the Balearic Islands, Castilla y Leon, Galicia, Madrid, Murcia and Valencia. New schemes are being launched in other areas so check the up to date position for the required area.

This Spanish healthcare scheme provides access to the Spanish state healthcare system for a monthly fee of:

  • €60 per person under the age of 65; or
  • €157 for those age 65 or over.

It covers all pre-existing medical conditions but not prescriptions. You will not be issued with a European Health Insurance Card (EHIC) for healthcare cover outside of Spain (within the EU) with this scheme.

In order to apply for the Spanish pay-in health insurance scheme, you must:

  • Have been registered at the local Town Hall on the ‘padrón’ (or Certificado de Empadronamiento) in Spain for at least 1 year; and
  • you must not be in receipt of any healthcare cover from the UK.

You may also be required to provide written proof that you are not covered by the UK. You can request this in the form of a “Legislation Letter” from the Overseas Healthcare Team by calling on (+44) 191 218 1999.

If you are not 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, otherwise you will have to pay every time you go to the doctor or receive medical treatment in Spain.