Many UK citizens are unsure what healthcare they are entitled to in Spain. Is my TSE (the Spanish version of the European Health Insurance Card) still valid when I visit Spain? If I move to Spain to work, do I need health insurance? If I permanently move to Spain and do not work, what happens to my health coverage? If I am a pensioner collecting UK state benefit, what health coverage do I have?
Spanish Social Security Card
Those questions, and more, are asked by people from Britain when they plan to move to Spain to live, want to spend long stays in Spain and work or travel in Spain. The availability of healthcare is extremely important.
Yes, if you have the correct official work visa and work legally for an employer or as self-employed (autonomo), you have full access to the Spanish social security system because you will be paying into the system. In addition, your dependants can also be covered. You would also be entitled to a Spanish health card that would allow you to receive the necessary care when you are temporarily in another EU Member State.
The European Health Card or TSE, can be used in Spain for stays of up to 90 days if it is still in date. The TSE entitles you to receive medical treatment from the Spanish public health system if you become ill or have an accident whilst in Spain.
If your TSE has expired you must obtain a replacement with the new United Kingdom Global Health Insurance Card (GHIC). This card will cover you for emergencies, chronic or existing illnesses and basic maternity care. It is not a substitute for travel insurance.
Any UK citizen travelling in Spain for less than 90 days regardless of age.
The reciprocal healthcare agreements between the UK and Spain that allows you to use the TSE or GHIC card so long as they are in date. You must take them with you if you go to a public hospital or public health centre. They are not valid in private hospitals or private health centres.
United Kingdom Global Health Insurance Card
Apply through the official NHS website. The UK GHIC and new UK EHIC cards are free. Beware of unofficial websites, they may charge you. Apply through this link
Yes. The reciprocal healthcare agreement between the UK and Spain, indeed all the EU countries, allows state pensioners the same or similar levels of medical care that they would enjoy if they were still in the UK. You must apply for an form called S1. A state pensioner may also apply for an S1 for their dependants, for example a pensioner may have a spouse or partner who is not yet a pensioner. That younger person is eligible for an S1. Their children below the age of 26 years are also entitled to an S1.
A pensioner from the UK who retires to live in Spain is entitled to the same health rights as a Spanish resident. Primary and secondary care is free, but there are other things that are charged. For example, dental care is usually private and there is also a charge for some prescriptions, although the price is low.
You must request an application form by phone from the Overseas Healthcare Services (0044 191 218 1999). This is part of the NHS Business Services Authority (BSA).
You must register your S1 at your local INSS office that you will find here.
You can register online here
Once your registration has been processed, the INSS will send you a Spanish social security number by post. Take this to your local healthcare centre to register. You’ll be given a medical card which you can use when you visit a doctor, hospital or pharmacy.
The NHS is a resident-based system so, if you are not habitually resident in the UK, you are not entitled to NHS healthcare. If you travel back to the UK you should obtain insurance that covers your health needs. Having said that, primary NHS care is free so if you visit a GP you will not be charged but anything more than that will incur charges.
European Health Insurance Card
If you are resident in Spain, not working and not claiming a pension then you will not be entitled to a European health insurance card.
If you are working in Spain then you will be paying social security and will have the right to apply for a European health card that is issued by the Spanish authorities. It is a card that you can use in the UK for temporary stays and that will cover you for anything medically necessary during a short stay in the UK or any other EU country.
If you are resident in Spain, have a Spanish social security number and you are actively paying your contributions into the Spanish Social Security system, you should apply for the Spanish equivalent of the European Health Insurance Card (EHIC) which is the Tarjeta Sanitario Europea (TSE).
If you are travelling back to the UK, or to any other European country, on holiday, on business or to visit family and friends and require medical assistance, presentation of this will entitle you to receive medical assistance, free of charge.
Apply online here.
Under these circumstances you will be applying for a visa to reside in Spain. Part of the visa application (and renewal) process insists that you have adequate health insurance so that you are not a burden on the Spanish health system.
If you renew your visa for five years, you are then entitled to permanent residency. If you have still not reached retirement age there is a system that allows you to make voluntary contributions on a monthly basis. There are eligibility requirements for that, so you can't choose to pay into that system automatically, you have to have been registered with your local council for a minimum of 12 months and have lived in Spain continuously during that time. There are also other requirements, for example, you cannot be entitled to medical cover from another EU country.
The Spanish voluntary healthcare scheme covers the same services as someone who, for example, contributes to social security as a worker, but there are slight exceptions to this scheme: the treatment is the same, but you would have to cover 100% of the costs of any prescriptions. In addition, since you are not contributing to social security, you are not entitled to the European health card, which is based on social security contributions.