Healthcare Benefits and Health Cards
Understand how the healthcare system in Spain works...
Qualifying for Healthcare in Spain
Qualifying
for healthcare through the social security system
Any
person who is not affiliated with the Spanish social security system may choose
to take out private health insurance or pay the full amount of any medical
costs.
In
April 2012, Spain introduced a healthcare reform law that affects who is
entitled to free treatment under the social security system. Restrictions apply
to both residents and non-residents.
The
following residents are entitled to free healthcare under the Spanish system:
- State
pensioners resident in Spain, including state pensioners from a country
that has a mutual agreement with Spain. This includes all countries in the
European Economic Area (EEA) They must be in possession of a permanent residence
certificate.
- Employees and
self-employed workers registered with social security and
paying Social Insurance
- Residents in
receipt of certain social security benefits in Spain, or in countries that
have a mutual agreement with Spain
- Those who had
registered for social security payments, but whose entitlement has now
expired
- Those recently
divorced or separated from a partner who is registered with social
security and paying into the Social Insurance fund
Non-registered
foreigners from the EU and countries that have reciprocal agreements with Spain
are eligible for treatment, provided they meet one of the above conditions. The
spouses and children of people in the above categories are also eligible for
free medical treatment, even if the partners are divorced or separated. Their
children will only be eligible if they are under the age of 26.
Residents
who do not belong to the above categories remain eligible for free healthcare
services in Spain as long as their pre-tax income from all sources does not
exceed €100,000 per year. There are exceptions, including early retirees whose
social security contributions to an EU country have met certain levels defined
by regional authorities. For more details, residents unsure of their status
should contact their embassy.
The
following non-residents are also eligible for free healthcare:
- Students under
the age of 26 studying abroad in Spain
- EEA citizens
temporarily visiting Spain with a European Health Insurance Card (EHIC).
This entitles the bearer to free emergency medical treatment for three
months. The hospital or clinic treating the visitor will decide whether
the treatment qualifies as an emergency
Emergency
care remains free regardless of an individual's status, as does pregnancy care.
This includes prenatal and postnatal care, as well as giving birth.
Applications
should be made at a local social security office (INSS) and the following
documents must be presented:
- Valid passport
or national identity card
- Residency
certificate
- Padron
certificate
- A signed
declaration stating that the applicant is not covered by health care by
any other means
- Copies of all
of the above documents
Claiming
healthcare through the social security system
Once
registered with social security, a certificate entitling medical assistance is
issued. This document can be used to apply for a health card (Tarjeta Sanitaria Individual -
TSI) at the local health centre. Once registered at the local
medical centre a SIP card will be allocated. A SIP card (Sistema
de Informacion Poblacional) is issued to each person registered
with the Spanish state health system and should be presented whenever attending
a clinic, hospital or collecting prescribed medication from the chemist.
Social
security pays a percentage of the cost of treatment and hospitalisation; the
patient pays the remaining amount or takes out supplementary health insurance.
Spain uses a co-payment system for prescriptions, meaning residents must pay a
certain percentage towards prescription charges. For workers with an annual
income of less than €18,000, prescribed medicines are covered up to 40 percent
by social security and 10 percent for pensioners with a cap of €8 per month.
Those with an annual income of €18,000-€100,000 are covered for 50 percent of
the cost and pensioners 10 percent with a cap of €18.52 per month. Workers and
pensioners with an income of over €100,000 must contribute 60 percent to the
cost of prescribed medicines, with a cap of €61.75 per month for pensioners.
- A guide to
co-payments for UK pensioners and those of working age can be found
on GOV.UK
- Details are
also available from the Ministry of
Health
Official
prescriptions are green, when part of the cost must be paid by the patient;
pensioners prescriptions are red.
Cards
are individual - children and adults each have their own - and are valid for
four years. The SIP card carries the following information: full name of card
holder, social security number, NIE number (DNI for Spanish citizens), type of
user (such as worker or pensioner) and the expiry date.
To
get a SIP card, apply at the local health centre taking the social security
certificate, passport and NIE/DNI certificate. The health centre issues a
receipt, which has the same function as the card itself and can be used
immediately; the SIP card is sent to the applicant and their beneficiaries by
post. Beneficiaries are family members who are dependent on the worker or
pensioner.
Qualifying
for healthcare outside of the social security system
People
who are not entitled to access free healthcare in Spain must take out
comprehensive private medical insurance or join the Special Agreement (Convenio
Especial). The Convenio Especial is a health insurance scheme run by the
Spanish Government which allows people to access the state-run healthcare
service by paying a monthly fee, not including prescription costs. Applicants
need to be registered residents for one year before they can qualify for the
scheme. The scheme costs 60 Euros for under 65s and 157 Euros for those aged
over 65 and above. It is not yet available in all regions. More information
about the Special Agreement can be obtained from a local social security
office.
- Listing of local social
security offices (in Spanish)
There
are many international companies providing health insurance to foreign
residents. International health insurances offer basic policies, as well as
comprehensive policies, normally with a 24-hour help line in English.