Health Insurance in Spain: What You Need to Know

You will be able to access public health care in Spain under different rules, depending on whether you are a resident or non-resident of the country.

For non-residents of Spain, there is the option of using the European Health Insurance Card (EHIC). It allows access to health care within the European Union or EFTA. However, the EHIC only entitles you to essential and unscheduled benefits, so your coverage will be limited.

The use of the free European Health Insurance Card is possible for those who are entitled to receive health care services in Poland and have a card with a current expiration date. When going to a hospital or health center, it is necessary to carry an identity document and an EHIC card.



Pensioners are entitled to receive public medical care in Spain.
The condition is to have a document confirming entitlement to health care services, namely the S1 form. This document can be obtained from the country in which the person is covered by the health insurance system, and it must be register within Spain with the Tesoreria General de la Seguridad Social. The S1 document confirms the right to receive health care in an EU or EEA country other than the country in which the person is insured. This is especially important for people who migrate between countries or intend to stay temporarily or long-term outside their country of insurance.

If you are a resident of Spain, you are entitled to state health care. However, in order to benefit from it, it is necessary to meet several conditions and obtain the appropriate documents.

The primary document that must be obtained is the social security number (Número de la Seguridad Social), which is used to contribute to medical care from your salary. It is necessary to begin the process of gaining access to health benefits. Obtaining social security opens up a number of possibilities, such as access to free health care, security in case of illness or accident, eligibility for maternity care, receipt of survivor's benefits, pension, annuity and disability benefits. The procedure for obtaining social security varies depending on the type of employment: employees are registered with the social security office by their employer, while the self-employed must register themselves with the Tesoreria General de la Seguridad Social. you also need an individual health card, or Tarjeta Sanitaria Individual (TSI), to receive free health care.

This card entitles you to receive benefits. You must present it every time you need medical attention or want to purchase prescription drugs. To obtain a health card, go to the nearest Health Center (Centro Salud) with your insurance number, proof of registration and proof of identity (ID card, passport, NIE number or driver's license).



The Individual Health Care Card (TSI) is the official document used to identify each citizen when accessing and using the services of the National Health System (SNS), in accordance with Law No. 16/2003 of May 28 on the consistency and quality of the National Health System. It is issued by the health administrations of each autonomous region and the National Institute for Health Management (INGESA) for residents of their territory who have a confirmed right to public health care.

The TSI issued by any competent health administration is valid throughout the National Health System, allowing access to facilities and SNS health services throughout the country, facilitates access to health services, and identifies at the pharmacy so that drugs prescribed by electronic or physical prescriptions can be dispensed.

Regardless of the title under which the right to health care is obtained and the health administration issuing the card, all health cards must contain a series of common basic data and be linked to a unique personal identification code for each citizen in the National Health System (CIP-SNS), according to Royal Decree No. 183/2004 of January 30, regulating the individual health card. However, the very appearance of the of the card will be different for each Autonomous Community.

Each insured holder of the right to public health care through special insurance systems will be issued a health card, with adjustments due to the features of these insurance systems.

The Ministry of Health is responsible for coordinating the exchange of information between Autonomous Communities and interoperability between all SNS health cards, which is done through the Personal Identification Code of the National Health System (CIP-SNS), which acts as a key for linking the various Autonomous Personal Identification Codes (CIP-A).

When each citizen's data is entered into the BDPP-SNS, he or she is assigned a Personal Identification Code of the National Health System (CIP-SNS), which acts as a key for linking the various autonomous personal identification codes (CIP-A) that each person may be assigned throughout his or her life.

The CIP-SNS will be unique and unrepeatable throughout each person's life, regardless of the relevant health administration responsible for his or her health care at any given time.

The CIP-SNS will facilitate the retrieval of a patient's health information, which may be stored in different areas of the National Health System, so that they can be located and consulted by health professionals, only if this will help improve health care.

The Spanish Health Service will also have solutions for unusual situations, for example, you can apply for health care while being a legal foreigner without means. In that case, you should go to the nearest Health Center, where you will be referred to a health care social worker who will examine and assess your personal situation. After the analysis, a temporary assistance document may be issued.

If you wish to use this option, you must have actual residence in Spain for a minimum of 3 months. To start the procedure, the following documents are required: application (available at the Health Center), identification document (passport, NIE, etc.), certificate of registration.

A foreigner with private insurance can also use the state health service on the basis of it. In this case, the required documentation is: identification document (NIE, passport, etc.), certificate of registration (optional), private health insurance card. Such a person will be entitled to an inclusion document, which will show the health card number.

If your private health insurance does not cover certain treatments (serious, emergency and/or contagious diseases), it is possible to apply for ASU (illness benefit) for these treatments. In this case, go to the Health Center and ask to see a health care social worker.



Individuals without health insurance, and who prove actual residence in Spain for at least one year, can enter into a Special Agreement, which is a form of paid insurance. This contract may be taken out by individuals who meet the following conditions:
• a) To document actual residence in Spain for a continuous period of at least one year immediately preceding the date of application for the special contract.
• b) To be registered, at the time of application for the special contract.
• c) Not having access to the public health care system for any other reason, whether under national laws, EU social security regulations, or bilateral agreements concluded by Spain with other countries in this area.

You can register with administrative authorities at three different levels: national, regional (Autonomous Communities) and local. In person at administrative offices or by sending documents by mail. The Special Agreement covers health care, except for pharmaceutical costs. Here is a list of the documents you need to submit when you want to enter into such an agreement:
• 1. Application for a Special Health Care Agreement.
• 2. If you have a DNI or NIE number and agree to verify your information electronically, it will be checked by the registration verification system.
• 3. Permission to make automatic SEPA bank account debits.

The cost of the Special Agreement in 2024 is:
• - For a person under 65: 60 euros per month.
• - For a person over 65 year of age: 157 euros per month.

Premiums are collected by direct bank debit to the account of the institution selected by the applicant. Payment should be made within the first 10 days of the month.

It is possible in this case to choose a different Health Center/Hospital than the one assigned according to the address of residence, or to choose a specific specialist, you can request this change by submitting an application to the selected Health Center. The answer comes within a maximum of 15 days. With a digital certificate or Cl@ve password, you can make this request online.

Funding for medicines and medical products in Spain is provided by public funds, and the patient's share of the cost depends on his or her income. Active workers and beneficiaries of social security benefits pay a deductible of 60%, 50% or 40%, depending on income. Retirees pay a deductible contribution of 10%, 60% or are exempt, also depending on income. The exemption from fees also applies to persons with disabilities, recipients of social integration income, recipients of non-contributory pensions, unemployed persons after exhausting their benefits, persons being treated after accidents at work, retirees with low income, recipients of child allowances and children with disabilities over 33%.

It is also worth considering the option of purchasing private health insurance. Spain offers a wide selection of private medical plans, which can provide additional benefits such as faster access to specialists, better treatment conditions and a wider range of medical services. Private hospitals and clinics are often equipped with state-of-the-art equipment and offer high quality medical care. This is especially useful for dental care, which is not provided in public health care.