Guidance

Spain: healthcare

Healthcare advice for British nationals living or planning to live in Spain.

Overview

The rules for getting state healthcare in Spain are different from those in the UK. This guide is for British nationals living, or planning to live, in Spain and the different ways to access healthcare.

There will be no change to the rights and status of EU nationals living in the UK, nor UK nationals living in the EU, while the UK remains in the EU.

If you are a UK State Pensioner and you register for healthcare in Spain as a resident, you will maintain full access to the UK NHS.

This short video highlights the importance of thinking about healthcare before moving to Spain and further information is available on the Healthcare in Spain website.

The Spanish social security office (INSS) also has comprehensive information on accessing healthcare in English. You can access this webpage here.

Healthcare entitlement

You are entitled to healthcare in Spain if you fall into one of the following categories:

  • you are in receipt of a UK State Pension or some types of long-term sickness benefit
  • you are working or self-employed and paying Spanish social security contributions
  • you are in receipt of a Spanish state pension or benefit
  • you are a permanent resident of Spain
  • you have previously worked in Spain and no longer receive benefit
  • you are a UK posted worker in Spain or family member of someone living and working in the UK
  • you are a family member of someone in the above category
  • you are a student studying in the UK as part of a UK undergraduate course

If you do not fall into any of these categories, you may have entitlement under a local scheme administered by a Regional Health Authority or a Spanish Government pay-in scheme called the Convenio Especial.

Applying as a UK state pensioner or if you are in receipt of a long-term sickness benefit

If you are in receipt of a UK state pension, request an S1 form (previously E121) from the Overseas Healthcare Service on +44 191 218 1999. If you are in receipt of an exportable DWP benefit you can request an S1 from the office which pays your exportable benefit.

You will need to register this at the INSS along with your padrón document, residency certificate and passport (remember to take photocopies). The INSS will then issue you with a Spanish social security number which you take to your local health centre to register.

Applying as a worker/self-employed person

There are two routes to register depending on where you live in Spain. Your local health centre may accept your original social security document issued by your employer or the TGSS (if you are self-employed). You will also need to present your padrón document and ID. You may also be asked to present a residency certificate.

Some health centres may also require the ‘documento acreditativo del derecho a asistencia sanitaria’ from the INSS.

Applying as an individual in receipt of a Spanish state pension or benefit

Please apply for the ‘documento acreditativo del derecho a asistencia sanitaria’ from the INSS. Present it at the health centre along with your padrón, residency certificate and photographic ID.

Applying as a permanent resident of Spain

If you have held a residence certificate for 5 years or more, you may be eligible for healthcare on the basis of residency, without having previously worked or paid social security contributions in Spain.

You will need to apply at your local INSS office, with your residency certificate, padrón and passport. You will also need to provide a Legislation Letter from the Overseas Healthcare Service (+44 191 218 1999) which states you are not covered by the UK for healthcare. The Spanish application form can be found here.

Applying as someone who has previously worked in Spain but does not receive benefit

Please apply for the ‘documento acreditativo del derecho a asistencia sanitaria’ from the INSS. Present it at the health centre along with your padrón, residency certificate and photographic ID.

Applying as a posted worker or family member of someone living and working in the UK

If you are a worker seconded to Spain, or the family member of someone making UK National Insurance contributions, contact HMRC to see if you have entitlement to an S1 form (previously an E106 or E109).

Once issued, register the S1 form with your local INSS office, before you register with your local GP surgery. Note that if your posting is for less than two years you will need to use a UK EHIC to access healthcare.

Applying as a dependent of someone in the above categories

Dependents and family members are classified differently in Spain than the UK. A list of who can be considered a dependent under Spanish law can be found on the INSS website, in English

If you classify as a dependent of someone covered by Spain i.e. someone working in Spain or receiving Spanish benefit or as a permanent resident, you will need to apply at your local INSS office

You will also need to present a documento de no exportación (Legislation Letter stating you are not covered by the UK for healthcare), which you can request from the Overseas Healthcare Service (+44 191 218 1999). The Spanish application form for dependents can be found here.

If you classify as a dependent of someone covered by the UK e.g. a UK State Pensioner, you should also request a dependent’s S1 form from either the Overseas Healthcare Service (+44 191 218 1999) or the DWP department that issued the original S1.

Students

If you are studying Spain as part of a UK-recognised course you will be covered for healthcare with your UK EHIC.

Pregnancy and children

In Spain access to healthcare by children and pregnant women is protected by law. Please see the social worker at your local health centre for more details.

Purchasing public health insurance – Convenio Especial

If you are not covered for state-run healthcare through any other means, the Spanish regional health authorities offer a special pay-in scheme (convenio especial). This is a public health insurance scheme available nationwide where you pay a monthly fee to access state-run healthcare. The scheme is managed by each autonomous region and you have to be registered with the padrón (Town Hall register) for at least 1 year before applying.

Policy holders pay on an individual basis for access to public healthcare, regardless of pre-existing conditions, anywhere in Spain. Children will also need to join the scheme, as long as their parents have sufficient income to be able to pay their subscription. If you have any doubt about your means to pay for your children to join the scheme, you must make an appointment with the social worker at your local health centre.

The basic monthly fee is 60€ for the under 65s and 157€ for those aged 65 and above. However, prescriptions are not subsidised at this rate so you would pay 100% of prescription costs. This form of cover doesn’t give holders the right to an EHIC at this time, so if you wish to travel, you will need to take out private travel insurance. To apply, you will need to enquire at your local health centre or an office of your Regional Health Authority.

Change of circumstances

It is your responsibility to keep the Overseas Healthcare Team or office which pays your exportable DWP state pension/benefit up to date with any changes in circumstances which may affect your entitlement to an S1 (E121). This is especially important if you move back to the UK to live. If you move address within Spain, please ensure you inform the Spanish social security office of your change of circumstances.

Visitors to Spain

A UK issued European Health Insurance Card (EHIC) is valid for holidaymakers and temporary visitors who need to use the state health system while in another EU country. If you are not normally a resident of the UK, and therefore do not have entitlement to a UK-issued EHIC, the Spanish authorities may decide to treat you as a private patient.

If you are a resident in the UK, you should apply for your EHIC before travelling to other European Union Member States. A UK EHIC is usually valid for three to five years – but if you stop being a UK resident, you need to return your EHIC to the Department of Health immediately.

This short video explains how to use the EHIC card in Spain and further information is available on the Healthcare in Spain website.

The EHIC gives you access to medically necessary, state-provided healthcare during a temporary stay in Spain. When you show your EHIC, you will receive treatment under the same conditions and at the same cost as people insured in Spain. Be aware that each country’s healthcare system is different. Services that cost you nothing at home might not be free in Spain (for example, prescriptions).

The EHIC is not an alternative to travel insurance. It does not cover any private healthcare or costs such as a return flight to your home country or lost/stolen property.

If you are refused treatment on your EHIC in Spain, please contact the healthcare team at healthcare.spain@fco.gov.uk.

European Health Insurance Card for UK state pensioners resident in Spain

If you are a UK state pensioner living in Spain and registered for healthcare with an S1, the UK is responsible for issuing your EHIC to use on a temporary stay in the UK and a third EU country. For more information, telephone the Overseas Healthcare Team on +44 191 218 1999.

The EHIC gives you access to medically necessary, state-provided healthcare during a temporary stay in Spain.

Planned treatment

The EHIC does not cover your costs if you are travelling for the express purpose of obtaining medical treatment. If this is the case you must apply for form S2 from your local NHS Trust.

Oxygen

If you need to receive oxygen therapy during a temporary visit to Spain, you must request it in advance, in writing, from the Spanish authorities. You should send this request at least one month before you are due to travel.

Oxygen therapy needs to be arranged by customers directly with the Spanish authorities. The Healthcare Teams at the British consulates provide a list of contacts and a template letter in Spanish on the Healthcare in Spain website to help you make these arrangements.

Once you have sent the oxygen request directly to the Spanish authorities, it is your responsibility to follow up with the relevant oxygen provider to confirm your request has been processed.

Prescriptions

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 a pensioner and have paid more than you should have for prescription medication, speak with your pharmacists or local health centre to confirm the process in your region to claim a refund.

Contact us

If you have a specific question regarding access to healthcare in Spain, please email the Healthcare Team on Healthcare.Spain@fco.gov.uk

Published 2 April 2013
Last updated 23 October 2018 + show all updates
  1. Updated September 2018
  2. Amended August 2017
  3. EHIC video removed.
  4. Information on changes to EHIC rules from 1 July 2014 added to the guide.
  5. New links provided for a template letter for applying for oxygen therapy in Spain.
  6. Information added about the 'Convenio especial'.
  7. Additional information added on accessing health services for those not entitled to state run healthcare.
  8. Contact details added for the Healthcare Team.
  9. First published.