Health insurance in Spain: how it works
Despite the European Union’s best efforts to harmonise social security and health insurance provisions across member states, the Spanish system still has a few specific quirks you should know about. This article gives a brief overview of health insurance in Barcelona and the practical details you’ll need to register.
To be covered by Spanish social security, you need to fulfil two conditions:
- Have your main residence in Spain
- Pay your social security contributions in Spain: if your contributions are made in a different country, you won’t be covered by the Spanish healthcare system.
You’ll still be able to access free care, without being registered, in the following cases:
- Emergency care: if you need urgent care and your condition is serious (loss of consciousness, haemorrhage, etc.), you’ll be admitted to any hospital, whatever your situation.
- European Health Insurance Card (EHIC): if you’re staying in Spain temporarily and you make contributions in an EU member state, request your EHIC at least two weeks before travel through your usual healthcare provider (for UK citizens, this will be the NHS, and entitlement is based on residency rather than NI contributions). This will give you access to the Spanish public healthcare system with nothing to pay up-front.
Conditions of access to healthcare
Registered persons and named beneficiaries
Spanish social security registration goes beyond your period of contributions and extends to certain other beneficiaries.
Your dependents may also benefit from social security coverage, and may include:
- Your spouse or ex-spouse, if they are still dependent on you
- Siblings, with no age limit
- Your children and those of your partner (even without recognised parental links) aged under 26 or in possession of a severe handicap.
Social security cover after leaving the system
- If you have at least 90 days of contributions recorded for the year preceding your departure from the system, your insurance coverage extends for a further 52 weeks (39 weeks for named beneficiaries).
- If your programme of treatment starts after your departure from the system, your health insurance will only be valid for 39 weeks after the end of the contribution period (26 weeks for named beneficiaries).
- If you contributed for less than 90 days, you’ll be covered for 39 weeks after the end of the contribution period (26 weeks for named beneficiaries).
- If your programme of treatment starts after your departure from the system. The 39-week extension is only valid for treatments begun before your departure from the system.
Treatment and medication
You’ll be able to choose your GP, pediatrician or dentist from those within your zone of residence, following the official map. In this case, consultations are free. Each doctor has a maximum patient quota which they must not exceed.
With the exception of pediatricians and dentists, you’ll need a written referral from your GP in order to consult a specialist. Dental care coverage is also fairly minimal.
Certain drugs are reimbursed (between 40 and 90%, depending on your income); these must be prescribed by a GP or specialist doctor. Things such as food supplements, however, will not be reimbursed, even if they’re presecribed by a nutritionist.
Benefits
Sick leave
To be entitled to sick pay, you must have made social security contributions for at least 180 days in the 5-year period preceding your illness (except in cases of accidents at work).
Sick pay is paid from the 4th day of absence from work, and may continue for up to 365 days. If full recovery is expected in the 180 days following this period, the duration may be extended by a further six months. After this point, if you’re still not better, you may be deemed unfit to work (giving you permanent incapacity benefit).
Maternity/paternity
Spanish health insurance covers medical care throughout pregnancy and assistance during and after the birth. Maternity leave is paid at the same rate as your salary during the last month before maternity leave (except in cases of multiple births or simultaneous adoption of more than one minor, in which case you’ll get more).
Maternity pay is granted for 16 consecutive weeks. It may be extended in the case of multiple births, or if your baby is sick or disabled.
The 16 weeks of leave may be freely shared with the child’s father, if he works. However, the mother must take at least 6 weeks of leave following the birth.
Contributions
Social security contributions can go up to just under 30% of your salary, if you’re an employee. The employer pays the largest part.
Freelance workers have to pay through the nose, with obligatory contributions each month, even with zero earnings.
Getting a social security number
Whether you’re an employee or a freelancer, you’ll need to get a social security number before you can sign your first contract or register as self-employed.
To do this, simply visit one of the social security offices in Barcelona. A full list of sites is available here. There’s no need to book agead – just turn up during opening hours.
Once you’re there, you’ll need to fill in a form and take it up to the window with your NIE (original and photocopy) and your passport or national ID card (original and photocopy). You will then be given a document with your official registration number. This is one of the simplest administrative tasks you’ll need to carry out on arriving in Barcelona!
Obtaining the Tarjeta Sanitaria (health insurance card)
Your social security number doesn’t automatically give you access to healthcare. Once you have one, you’ll need to go to the Primary Care Centre nearest to your address to register. To find your nearest centre, enter your address into the search engine here.
You’l need to show your ID card or passport, your social security number and your empadronamiento document. Your card will be sent out to you in the following weeks.
