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Since the law 16/2012 dated 20 April came into force in Spain (Law of urgent measures to ensure the sustainability of the national health system) many things have changed regarding the requirements for accessing the Spanish public health care system.

The Spanish public health care system has an extensive network of hospitals and health centres, and it’s generally considered to be of excellent quality. Nevertheless you will have to bear in mind that many of the services that before were delivered free of charge will be, in certain cases, charged.

Residents from the EU travelling in Spain

If you are travelling to Spain and you are resident in a EU country you should carry with you the EHC (European Health Card). This card entitles you to free public hospital and public medical care throughout Spain, EU countries, Switzerland, Norway, Iceland and Liechtenstein. Depending on your place of residence you can request the card through your social security or medical authorities. Take into account that dental care in Spain won’t be covered by the EHC except emergency treatments.

If you need regular treatments during your stay (for example haemodialysis), you will have to carry with you specific forms like the E112 and additional authorisations that you will have to ask from your national medical authorities. It’s important to notice that the EHC won’t be valid if you travel to Spain to receive specific medical treatments.

If you forget your EHC you will have to pay your treatments in advance. They will be reimbursed in your home country by providing all the payments receipts.

Residents from outside the EU

Residents from Switzerland, Norway, Iceland and Liechtenstein will have the same rights as EU residents as long as they show the EHC. Spain has also bilateral agreements with Andorra, Brazil, Chile, Ecuador, Peru and Paraguay.

In case of life threatening medical emergencies, pregnancy and childbirth you won’t be denied assistance, but you will have to bear in mind that you might be billed after you received medical care. In all other cases you might be asked to pay in advance, therefore it’s advisable to buy insurance coverage.

Foreign residents in Spain

Access to free healthcare will be restricted to individuals that have to meet at least one of these requirements:

  • Be working (either as employee or self employed), be registered and enrolled (or in an equivalent situation) in the social security. Most of the time this means to be contributing to the Spanish Social security.
  • Be a beneficiary of a pension from the Spanish Social security
  • Be a beneficiary of a public pension or long term sickness benefit from a EU country. In this case you will have to get the necessary document from your home country and register with the Spanish Social Security authorities.
  • Be a beneficiary of any regular benefit from Spanish social security (for example unemployment benefits).
  • Be inscribed at the unemployment office as job seeker, not receiving any more unemployment subsides and not having any other insurance coverage.
  • Be a minor regardless of nationality
  • Be with a disability level of more than 65%

In the case of foreigners, residency (empadronamiento) in Spain alone (and even less foreigners from outside the EU) is not sufficient for having right to free healthcare.

Any national from the EU, the EEA and Switzerland or any other foreigner with a valid residence permit will benefit from free healthcare if they demonstrate that they do not have sufficient income in order to afford private healthcare (this level is set according to the IPREM)

People that are not in the categories above will have to enrol into a private healthcare scheme.

Assistance duration

Spanish healthcare assistance starts from the day after the person is enrolled into the system. The duration of the assistance after a person stops belonging to one of the eligible categories depends on the duration of contributions to Social Security.

In the case of a worker (employee or self employed) who stops contributing to the social security the duration of healthcare coverage will be different according to contributions of more, or less than 90 days within the previous 365 calendar days:

A worker that has contributed more than 90 days will receive:

  • 52 weeks of healthcare assistance after dropping out from social security, if assistance commenced before dropping out
  • 39 weeks after dropping out from social security, if assistance started after dropping out
    Beneficiaries of Spanish social security (for example unemployed) will receive a 39 weeks extension after they stop receiving benefits.

If the worker contributed for less than 90 days, the duration will be of 39 weeks after dropping out (26 weeks for family members of that person).

Workers who have suffered from a professional accident or illness will benefit from healthcare coverage during the full process even if they have dropped out of social security. As a general rule treatments will not be stopped until the person has fully recovered.