Perhaps it is something that gets unnoticed until the necessity kicks in. But we are talking about a crucial aspect of your life in Spain. Getting health insurance in the Spanish territory as an expat can create doubts for many. But in this guide we will solve them all by giving you all the details that you need.
About the Spanish healthcare system: a quick overview
In this section, we will explore the basics of the Spanish Health Care System.
And, for sure, there’s no other way to start than by stating how good it is.
Rated as the 6th European country in regards to the number of doctors per inhabitants, Spain has one of the best healthcare systems in our planet; ranking first in Europe and 3rd in the world when it comes to efficiency.
No doubt about it: the Government spends 10% of its GDP on it.
But what makes it that good?
As you may already know, health care in Spain is divided into private and public.
In that sense, the public healthcare services in Spain offer universal solutions, meaning that all long-term residents and Spanish citizens have basic and preventative medical care guaranteed, plus emergency care.
And that for free or for a really reduced price.
Even though the private part of the health care system is also of excellent quality, what makes Spain rank so high on the world’s rankings it the amazing offerings of the public health system. It offers a nearly complete array of services for virtually no price.
How does the system receive financing?
Each worker in the country pays a monthly fee that is directed to this specific purpose:
- If you are a self-employed worker you will pay your monthly contribution to the social security (being 60€ on the first year and 280€ afterwards)
- If you work for a company, it will be deducted from your monthly salary.
Should you get a private or a public insurance contract?
As we have just mentioned, the public health system in Spain works wonderfully well.
Nevertheless, the SNS (“sistema nacional de salud”), does not cover every single expense. If you need to go to the dentist, for example, buy some medications at the pharmacy or go through a really specific treatment, you will have to pay from your own pocket. Those types of expenses are not included.
That would be one of the first situations in which you want to get a private insurance contract: to expand even further the public offerings.
Besides, depending on the specific surgery or treatment the waiting list can be quite long. Therefore, if you would like to cut waiting times, going for the private path is also advisable.
Finally, and perhaps the most important part for expats living in Spain, private insurance contracts for immigration reasons. In many immigration procedures, like obtaining certain types of residence permits, you need to submit a private contract. And that is a crucial requirement.
Therefore this may be the decisive factor that drives you to pay the monthly extra fee.
Let’s explore that in more depth.
Do you need private health insurance in Spain in order to get residency?
After 2013, the year in which the law that regulates the Spanish Health Care System was modified, things changed. That was the period after which the public and free health care services became inaccessible for many individuals.
This situation explains why many visas and permits in Spain require you to contract private health insurance. As an expat in Spain, if you are not working, you must demonstrate that you won’t cost a lot of money to the Spanish government if an accident happens. That is why you must get an insurance.
Which are the specific immigration situations in which you are required to get a private health insurance contract?
- It is required to get the residency card as a family member of a European Union citizen
- Also necessary for those European Union citizens who want to register in Spain (there are some exemptions we will see in a moment)
- If you are regrouping a family member, like your parents, they also must possess the same health coverage that social security would offer to any other citizen
- If you are a non-EU citizen who is studying in Spain under her student visa (in this case, you need semi-complete health insurance)
- To get other permits like the non-lucrative residency or the golden visa
- Tourists. They need to get travel insurance with basic conditions. This specific type of insurance can be obtained for 30, 60 or 90 days; depending on the duration of the stay in Spain.
Foreigners who can access the public health care system (SNS)
On the other hand, there are several situations in which expats living in Spain don’t need to get a private health insurance contract and can benefit from the public system.
Which are those situations?
- Retired individuals in Spain and state pensioners*
- Those who work as self-employed/freelancers (the pay a monthly contribution to social security)
- Foreigners with a work contract living in Spain with a work permit (they get the social security contribution deducted from their salary)
- Those visiting a student who is under 26 years old from the EU
- Expats who come from a country that offers universal health care services, it is probable that they have health assistance in Spain also covered. That is the case with the UK, for example.
- Pregnant women who live in Spain and his or her child
- Residents in Spain who receive state benefits
- Europeans who are temporarily in Spain and have an EHIC card (we will talk about that later on)
- Individuals who had just got divorced from a partner who was registered on the social security
*The situation for citizens from any European Union/EEA country or from Switzerland is a bit different. Why? Because they have free healthcare in Spain. The only thing they need to do is obtain an S1 form and start the application procedure.
European travelers who temporarily reside in Spain
What happens if you are a European Union citizen who is visiting Spain just for a while?
Things look good for you.
There’s a card, called EHIC (European Health Insurance Card), that will grant you to the same coverage as if you were registered on the SNS at a much lower cost than if you paid for private insurance, or even enjoying it for free (same cost as any other Spanish national).
That is because during the first 3 months in Spain you will have free healthcare with the EHIC.
Therefore, this card works completely fine if you will stay for a short period of time in the country. But if you are planning to stay for the long-run, bear in mind that you must register on the SNS.
*As a side note, EU students who study in Spain are covered by the EHIC.
Which are the requirements that make your health insurance contract valid for your residency application?
As we have just seen, many times it will be a crucial requirement to have a private health insurance contract in order to obtain your residence permit or your stay status.
Nevertheless, you must take into consideration that not all contracts will work here.
The main idea here is that your insurance must be able to match the conditions of those from the public healthcare system in Spain.
Hence, the main requirements that your insurance contract must meet are:
- It can’t have copayments, meaning that you pay whenever you go to the doctor.
- The insurance contract can’t have lacking periods
- It must be complete and offer the maximum amount of possible coverages: hospitalization, hospital displacement, all kinds of surgical interventions, etc.
- Coverage on the whole Spanish territory
These are all the factors that you should consider when choosing one company or the other.
Bear in mind that not the best offer or the one at the most competitive price will work. So don’t look for the cheapest, make sure that all the requirements are met first of all (otherwise your application will be denied).
Which are the main companies that offer private health insurance contracts?
In this section we have gathered the 3 main options you will have as an expat when choosing a health insurance contract.
Depending on the company, the age of the person who is contracting, gender and health requirements, the price will vary. Nevertheless, and just to give you a broad idea, expect something from 50 to 200€ per month.
These three companies are:
Again, don’t base your decision solely on price. Make sure to check that the contract meets the right requirements that will make your application possible.
In that sense, there are two websites that will really help you compare among the different options. You can give it a try here:
Find the best deal with our partners
As a group of lawyers who have dealt with many immigration cases during years, for sure we work with our partners that can offer you the best possible deals. Deals at conditions that are specific for our clients (much better than those you could get by your own).
That is why, if you would like to have access to a private health care contract that meets all the requirements that a contract must have, at a fairly competitive price, do not hesitate to ask us!
How to register on the Spanish health care system as an expat
And, finally, the step by step process that will help you get your health insurance card as a foreigner.
The exact process you should follow as an expat in order to register on the health care system is as follows:
For sure, the first step for many legal procedures in Spain: registering yourself in your address. This process is called “empadronamiento”, and you can get more specific information here.
It simply means going to your local town hall and filling out a form in which you state which is your address and who is living there.
Then you will receive a certificate of registration (“certificado de empadronamiento” in Spanish).
You must be identified in the eyes of the Spanish Social Security.
Hence, you need a specific identification number for that purpose.
If you are working for a given company, your employer will be the one who issues that number for you.
If you work as a self-employed or don’t yet have it, you can go to the social security office (“Tesorería General de la Seguridad Social) and request it.
You will be required to fill an application form, show your residence certificate and your passport/valid ID.
Again, if you are working for someone, you don’t need to incur in any extra step. That is something implicit whenever you sign your work contract. That payment will get deducted from your monthly salary automatically.
If you register yourself as a freelance/autonomo in Spain, you will need to specifically register on a specific regime called RETA in order to start paying your social security contribution monthly.
For that specific part of the process, you’ll need your NIE number and valid passport.
As a self-employed, the specific amount will be charged to your bank account monthly.
4. Obtaining your individual health card (TSI)
Then you will receive a document that grants you access to medical assistance in Spain.
It will be with that document that you can now request your individual health card (TSI) in your closest health center. You’ll need to present your passport and NIE along with that certificate.
You can pick it up there once it is available, or you can request that they send it to your address.
Do you need help throughout the process?
If you feel that there’s too much information and would like to have a team of people who work on that every single day managing the whole process for you… stop worrying.
Let us do the paperwork for you.
Hey, it is completely normal. Life was not meant to spend time on the boring legal stuff.
No matter if it is to register to the Spanish healthcare as an expat or to manage any other immigration procedure.
Let us be in charge and avoid a big headache: