REGISTERING FOR HEALTHCARE
Which country is competent for your healthcare cover in Spain?
This depends on your personal circumstances, including situations such as whether you are working or have worked in Spain, are in receipt of a UK state pension or whether you are a family member of someone who has cover.
In which situations will SPAIN cover you?
If you work and pay social security contributions in Spain, you will be covered by 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 INSS (social security office) will issue you with a document confirming this. You must present the document at your local health centre.
If you are not entitled to healthcare through any options listed above in Spain or any from the UK listed below, and you have a permanent residence certificate (green card obtained from the National Police), you may be eligible for healthcare on the basis of residency (read the Spanish law Real Decreto-ley 16/2012, de 20 de abril for reference on this following link Ref. BOE-A-2012-5403). Please apply for the ‘documento acreditativo del derecho a asistencia sanitaria’ from the INSS. If you are required to present a documento de no exportación (Legislation Letter), you will need to apply for one from the Overseas Healthcare Team (+44 191 218 1999).
In which situations will the UK cover you?
You will be covered by the UK for healthcare if you are a UK state pensioner,a UK posted worker (also self-employed) or in receipt of a long-term sickness benefit then you should be covered by the UK. You could also be covered if you are a dependent family member of someone in the above situation. Please make sure that you change your healthcare entitlement as soon as you are in receipt of healthcare cover in your own right, as listed in paragraph below.
UK state pensioners or can register for healthcare in Spain by applying for an S1 (E121) form from the Overseas Healthcare Team (+44) 191 218 1999. Those in receipt of a long-term sickness benefit can apply through the International Pension Centre (IPC) (+44) 191 218 7777. The form can take up to 28 days to arrive at your Spanish address so it is highly recommendable to apply for it before moving to Spain. If any of your family members need to receive healthcare as your dependent because they may not be entitled to any healthcare cover in Spain in their own right, 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. This cover may not be the same as you would expect to receive on the NHS in the UK so you may have to pay for some treatments or services and some social services may not be available.
UK posted workers are those who remain insured in the UK National Insurance scheme. Before moving to Spain your UK employer will need to fill out the application form CA3821 and the worker will need to complete the CA3822. You can find the forms by clicking here. They will need to be returned to the International Caseworker’s Insurability Team (ICW) at the address given on the application forms. If you have any enquiries about the forms, please contact Her Majesty’s Revenue & Customs (HMRC) on (+44) 191 203 7010.
You will then receive an A1 along with an S1 form if your posting will last more than two years. For any period less than two years you should continue to use a UK European Health Insurance Card in conjunction with the A1. If you are issued with an S1 you will need to take it to the nearest social security office in Spain (Instituto Nacional de la Seguridad Social) to register for healthcare. 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 that you will need to take together with your ‘padrón‘ every time you go to the local GP or public hospital. You will not be assigned a GP like you would in the UK because your S1 form for healthcare cover is temporary.
A dependent on a family member working and living in the UK can also request an S1 form from Her Majesty’s Revenue & Customs (HMRC) by calling (+44) 191 203 7010. As above it will need to be registered at the Spanish social security office (INSS).
Registering with the Spanish authorities
In order to register your S1 form with the Spanish social security office (INSS), you will also need to obtain the following documents:
- Certificate of Residence in Spain (Certificado de Residencia with your Numero de Identificacion Extranjero) – available from your nearest National Police station. You can be assigned a NIE without having taken out residency therefore please make sure your NIE is printed on a green form – not a white one. You can find out more information on residency requirements here.
- Certificate as a Local Resident (Certificado de Empadronamiento or ‘padrón’) from the Town Hall;
You will also need to show your valid passport when registering your forms. Your local INSS office will be able to tell you if there are any other documents they require.
If you a are a dependent, please make sure you legalize your marriage/birth certificate with a Hague Apostille from the Legalisation Office in the UK as you will be asked for proof of this by the Spanish authorities and at the Spanish social security office. You can now do this online.
No entitlement to healthcare cover? If you are not entitled to healthcare cover from Spain or the UK, you might be able to join the Spanish government’s special pay-in health insurance scheme known as the Convenio Especial. This scheme provides access to the state healthcare system for a monthly payment of €60 per person under the age of 65 and €157 for those age 65+. It covers all pre-existing medical conditions but it does not cover prescriptions. You will not be issued with a European Health Insurance Card (EHIC) for healthcare cover outside of Spain (within the EU).
In order to apply, 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. Please see list below:
- Andalusia: there is no link available yet. Please enquire at your local local healthcare centre.
- Balearic Islands: you can enquire directly at the Points of Contact
- Catalunya: you can apply at your local healthcare centre
- Canary Islands: you can make an enquiry and apply at your local healthcare centre.
- Castilla y León
If you have permanent residency in Spain you could be entitled to healthcare on the same basis as a Spanish national. You must not have entitlement to healthcare through any other means (e.g. linked to a UK state pension or benefit). The INSS are likely to request that you are not covered by the UK for healthcare. The document you need is called Legislation Letter and can be requested from the Overseas Healthcare Team on +44 191 218 1999, or by email at firstname.lastname@example.org.
However, you will need to apply in person at your local INSS office (take the above documentation along with your residency, padrón and passports and photocopies of each one). Please consult the INSS directly for the full list of requirements to support your application.
SERVICES NEAR YOU
You can find out where the nearest local health centre or public hospital is to your home in Spain. You can click on the Autonomous Community you are living in on the map or from the list below. The will take you to the selected region’s official healthcare website where you can do a quick search and find out where to go to see a doctor. In most webpages they will require your postal code or full address.
- Principado de Asturias
- Castilla-La Mancha
- Castilla y León
- La Rioja
- Comunidad de Madrid
- Región de Murcia
- Comunidad Foral de Navarra
- País Vasco
- Comunidad Valenciana
Spain uses a co-payment system (information in Spanish) where residents are required to pay a percentage of the cost of their prescription medication.
- If you are of working age, you will need to pay between 40-60% on prescriptions, depending on your annual income.
- If you are a pensioner, you will only have to pay 10% of prescriptions. These are also capped depending on your annual income.
- If you suffer from a chronic or serious illness, you will only pay 10% on prescriptions, capped at 4,26€ per medication. For more information visit the Ministry of Health, Social Services and Equity’s website here.
If you have any queries on specific medications, you can contact the Spanish Medicines Agency (Agencia Española de Medicamentos y productos Sanitarios – AEMPS) for more information. You can do this by sending an email to Departamento de Medicamentos de Uso Humano – email@example.com
You can also contact the pharmacy department of the Ministry of Health:
Dirección General de Cartera Básica de Servicios del Sistema Nacional de Salud y Farmacia
Paseo del Prado, 18-20
Tel.: 915964015 Fax: 915964007 E-mail: firstname.lastname@example.org
Have a look at the list of subsidised prescriptions by the Spanish National Health system here.
HEALTHCARE COVER ABROAD
Within the EU?
You will need a European Health Insurance Card (EHIC).
If you are covered by the UK for healthcare and you are going on holiday or temporary stay to another EEA country, you will be covered by your UK EHIC. To apply for an EHIC, you can do so by calling on (+44) 191 279 0575 or by emailing this S1 renewal application form to email@example.com.
If you are covered by Spain for healthcare, you should apply for a Tarjeta Sanitaria Europea (EHIC equivalent) from your nearest social security office (Instituto Nacional de la Seguridad Social) in person or online here.
Outside of the EU?
Make sure you have adequate travel health insurance and accessible funds to cover the cost of any medical treatment abroad and repatriation. Visit Gov.uk for country specific information.
PLANNED TREATMENT IN THE UK
Planned treatment in the UK for a resident in Spain
Here is some information on how you could access treatment abroad through the NHS in the UK as a resident in Spain.One way would be to apply for planned treatment through the S2 route and the other would be through the Cross Border Directive up fronting the costs of the treatment abroad and claiming reimbursement from the Spanish National Health system.
1. S2 (formerly E112) route: you will need to request an authorisation from your doctor (GP) or specialist in Spain and from the relevant health authority in your region. Then, this authorisation will need to be taken to the nearest social security office (INSS – Instituto Nacional de la Seguridad Social) together with your health card and ID (NIE-Passport) for them to issue you with the S2 form.
You will need to pre-arrange the treatment by doing the following:
- contact the state-run hospital where you would like the treatment carried out in the UK;
- book appointments needed to see the specialist there after authorisation has been given by your doctor in Spain and hospital in the UK and ask for the UK hospital’s contact details so they can be added to the form;
- you will also require 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.
Please make sure the treatment is arranged and pre-approved by the national health authorities in Spain and the UK.
More information on this can be found on the EU Commission’s website.
2. Cross Border Directive: this directive allows patients to seek treatment abroad, pay the costs up front, and then seek reimbursement from their country of residence upon their return. You would be entitled to apply for treatment under the Cross Border Directive as long as the treatment is considered medically necessary and would be made available to you under the state public health system in Spain. It covers both treatment given in state-run hospitals and by private service providers. Please note that you will only be reimbursed up to the amount the operation would have cost if you were to have been treated in Spain.
Treatment will need to be pre-arranged and authorised by both the UK and Spanish health authorities in advance.
For more information, please get in touch with the National Contact Point for the Spanish authorities regarding Cross-Border issues
RETURNING TO THE UK
If you are returning to the UK to live, please make sure you de-register with the Spanish authorities and if you are covered by the UK for healthcare in Spain, please inform the relevant UK department as well. If you don’t, the UK might still be paying for you in Spain if you are a UK state pensioner for example!
As a reminder, please be aware that within the UK, free NHS treatment is provided on the basis of someone being ‘ordinarily resident’. It is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK.
For more information please visit Gov.uk.