Accessing the Spanish Healthcare System

Before making the enormous decision to uproot your current life and making the move towards a better life abroad, there are so many considerations to bear in mind. Will I be able to adapt to a new culture and way of thinking? Where will I live? How will I support myself? Can I afford to move back if it doesn’t work out for me? What if I become seriously ill?

This last question is one that many perhaps do not give as much importance to as they should thinking that if they reside within Europe, they are automatically covered by the National Health System of the country they are in at the time but this may not necessarily be the case so it is important to do your homework beforehand especially if you have a pre-existing medical condition that requires monitoring.

In Spain, the standard line is that if you have not contributed in any way to the national health system, you are not entitled to a GP and you may be liable to pay for any hospital treatment you receive. Even if you are a holder of the European Health Card, it is not intended for residents and is only meant to be used for medical emergencies that occur whilst visiting another EU country on a temporary basis and the card holder’s country of residence is billed for any medical care given but how can one access the healthcare system when residing in Spain? There are a few options here and one in particular that has eluded many people and even professionals as it is not a well known practice and has been kept pretty quiet so after extensive research, this option will be explained in more detail:

1. Social Security Contributions: If you work as an employee or if you register a business activity as self-employed, you automatically pay into the national healthcare system and are entitled to a GP without having to pay any extras besides medication.
2. Pensioners: Pensioners are automatically included and if your pension is from abroad, it can be easily transferred to Spain giving the person the right to a doctor.
3. Private Health Insurance: If you do not work, private insurance is the way to go, however, this may not be so easy for those who have a pre-existing condition as these treatments may not be covered or the insurance company may reject your petition directly.
4. Returning to your country of origin: There are many cases where people have not informed their Social Security system of their status abroad and leave this option available in case of emergency even though this is technically a form of abusing the systems in place, some are too afraid to leave themselves exposed to not being able to receive healthcare in their current place of residence or back home if needed.
5. Special Agreement: Spanish Authorities recognize that this is a widespread concern for many ex-pats and have opened up another avenue to access the national healthcare system if none of the above options apply. Access to the Spanish Healthcare System is regulated by Law 16/2003, 28^th May, however back in 2013 there was an amendment and a new law was approved, Decree (Real Decreto) 576/2013, 26^th July that established a special agreement (convenio especial) so that those who cannot access the system themselves (self-employed/under contract) or as a beneficiary of a family member who has rights to the system, then they may pay into the system directly.

There are of course certain requirements the applicant must meet in order to qualify:

• Proof of residency in Spain during a minimum period of ONE YEAR immediately prior to applying
• To be registered at the local Town Hall (empadronado) upon submitting the application
• That the applicant cannot access the healthcare system by any other means such as those mentioned previously, in their own country or via special agreements between Spain and said country

The applicant must initiate the procedure, it is not up to the Spanish Authorities to inform or submit forms automatically on anybody’s behalf. The competent authority in each Autonomous Region will examine the application and must inform whether it has been accepted or rejected within a maximum of 30 days counting from the day after the application is received. If after 30 days, they do not notify, it is understood the application has been approved. From there, the applicant has a 3 month period in which to formalize the agreement with the authorities but if this period lapses, the procedure is automatically cancelled. The applicant would be advised about any particular conditions in their region and reasons to cancel the agreement.

You are probably wondering now how much this special agreement costs:

• If the applicant is under 65 years of age: 60 euros per month
• If the applicant is over 65 years of age: 157 euros per month

This charge may be increased depending on each Autonomous Region if they offer more than basic services but in the Canaries this is not the case and at the time of print, the above charges are correct, however, they may increase based on the cost of living. Even if the applicant accesses the healthcare system in this way, they are not entitled to the same Social Security card the other beneficiaries to the system have and would be issued with a different document.

The agreement will be terminated for any of the following causes:

1. Upon the death of the applicant
2. If the applicant no longer qualifies
3. If the applicant cancels the agreement
4. For non-payment of the first contribution; two consecutive months or three alternative months
5. For non-fulfillment of any particular conditions specified in their agreement

As mentioned, this agreement is not well known, mainly because its conception was actually intended for professionals such as self-employed lawyers and paralegals who are unable to access the national system because they pay their contributions to private institutions under their industry agreement but this was then opened up to others who may not be eligible to healthcare in their own right.