Guide to health insurance in Spain
All residents in Spain have access to the free public Spanish healthcare system, although private insurance may be necessary in certain situations.
The Spanish healthcare system ranks amongst the best in the world and is funded by social security payments, meaning the majority of residents do not require private insurance to access Spanish healthcare. Depending on your circumstances, however, some additional health insurance cover may be required, while private health insurance offers quicker medical treatment in private facilities. Expat health insurance provider Bupa Global discusses the Spanish healthcare system and any changes that might apply to expats.
If you are living and working in Spain, you will generally pay income tax (social security) that goes towards providing you with free state healthcare in Spain. Additionally, as of 2015, illegal immigrants and foreigners not registered with the Spanish tax office are entitled to free state healthcare, since Spain overturned its previous ban implemented in 2012.
Who is covered by Spanish healthcare?
All employees and self-employed workers in Spain are required to make social security contributions, which in turn entitles them to Spanish health cover. The spouse and children of workers are also entitled to healthcare in Spain, provided they also reside in Spain. Some additional conditions are listed below.
EU, EEA and Swiss nationals whom have reached retirement age in their home country are entitled to free health care in Spain. In order to qualify they must obtain a Form S1 (previously known as E121) from their country of residence. Acquiring this form prior to departure is advisable and will help simplify the registration process in Spain.
European Health Insurance Card
EU residents staying in Spain on a temporary basis can use their European Health Insurance Card (EHIC) which entitles them to receive medical treatment at the same cost as a Spanish national.
Third country nationals
Non-EU/EEA nationals may have to provide proof of private health cover before being granted a visa. Some non-EU nations, however, do have an agreement in place with Spain so it's important to enquire about your entitlements with the consulate or embassy in your home country prior to arrival.
EU nationals studying in Spain will also be covered by their EHIC throughout their period of study. Non-EU students, however, may be required to take out a private health insurance plan prior to arrival, although their university can provide more detail.
How to register for Spanish healthcare
Spain's healthcare system is funded by contributions to the country's General Social Security Fund, known as Tesorería General de la Seguridad Social (TGSS). Anyone working in Spain receives a social security number and will make monthly contributions via payments which are automatically deducted from their wages, with employers also contributing a percentage to the scheme for each worker. This in turn entitles empolyees to free Spanish healthcare.
Your contributions are based on minimum and maximum contribution rates set by the government each year. In 2015, general employees contributed 4.7 percent of their annual salary to the social security system, while employers were required to contribute the equivalent of 23.6 percent of the employee's earnings.
If you are self-employed you are responsible for paying your own social security contributions, and you can apply for a social security number at your nearest Social Security Office (Oficina del Instuto Nacional de Seguridad Social). This involves completing a TA1 application form, as well as presenting your passport and a national identification card, such as the NIE (tax identification number) card. The NIE card is issued upon completion of a residency application. If you have an electronic DNI or other certificate, you can opt to apply online, otherwise your accountant can complete the registration process for you.
Once you have been formally registered with the social security system, you will receive a document entitling you to medical assistance. This form can then be used to apply for a health card, known as a Tarjata Sanitaria Individual or TSI. You can receive your health card by applying at your closest state health centre, where you must present your social security and national insurance certificates, as well as your passport.
Healthcare cover in Spain
You Tarjata Sanitaria Individual (TSI) health card is valid for four years and should be presented whenever you use a public health service or purchase a prescription from a pharmacy. The TSI covers care from doctors and at hospitals, as well as 40 percent of the cost of prescription drugs (free for pensioners). Although individuals are liable for the remaining 60 percent of the cost, prescription drugs in Spain are relatively cheap. Treatment at home is also included, which can be particularly useful to the elderly and disabled.
Presenting a TSI card means you pay no fees when receiving treatment at hospitals or from a doctor. The 60 percent prescription fee at pharmacies, however, must be paid by you at the time of purchase.
Dental work does not fall under the public care system and must be paid for in full by the individual, unless they hold a private insurance policy. Dentist fees in Spain are relatively inexpensive and the general quality of care is of a high standard, although private health insurance can halve the costs with dental insurance costing as low as EUR 10–20 per month.
Choosing a doctor
With regards to doctors and paediatricians, you can select one from within your local healthcare district. To see any other specialist practitioners, however, you must be referred by your GP.
Private health insurance in Spain
If you require additional health services, private health insurance providers offer a range of packages which cater specifically to your age, health condition and other circumstances. As ever, it's important to thoroughly research your options and seek as much advice as possible before committing to a specific health plan. Foreigners may like to check if their package provides the same protection in Spain as it does in their country of origin.
While the quality of Spain's public healthcare is of a high standard, some residents do opt for private healthcare in order to avoid the sometimes lengthy waiting times associated with the public service. This is an important factor to consider when weighing up the private care avenue, particularly if you have a medical history which suggests you will require regular treatment. If this is the case, then cutting down on waiting times may be a priority for you.
A private care plan can also enable you to select a doctor with a strong grasp of English, which may be of particular importance to those who expect to be in regular contact with their GP. Lists of English speaking doctors are often available from tourist offices and embassies.
Families may also want to explore various family insurance packages in order to get the best possible value for money, and some insurance firms also provide additional cover, such as 100 percent dental cover.
EU nationals who travel frequently outside of the EU may also consider private health insurance, as the EHIC card only covers travel within the EU.
Special agreement for Spanish healthcare: Convenio Especial
Spanish authorities offer a special agreement pay-in scheme, known as Convenio Especial, available to those who may have issues accessing free Spanish healthcare. It is essentially a public health insurance scheme which provides cover in exchange for a monthly fee that is calculated on a number of factors. The previously announced package consisted of a monthly fee of EUR 60 for those aged 65 or under, while those over 65 must pay EUR 157, although variations may exist between regions. However, prescription costs and health transport services do not form part of the cover nor health transport. The scheme is currently being rolled out in a number of regions with a view to being available throughout the country.
Expatica / Updated by Bupa Global
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Bupa Global offers a variety of health insurance packages to expats in more than 190 countries around the world.
Updated 2014; July 2015.
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