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Spain: Health Insurance

Overview

If you’re visiting, living or working in Spain, it’s extremely risky not to have health insurance for your family, because if you’re uninsured or under-insured you could be faced with some very high bills. When deciding on the type and extent of health insurance, make sure that it covers all your family’s present and future health requirements before you receive a large bill. A policy should cover you for all essential health care whatever the reason, including accidents (e.g. sports accidents) and injuries, whether they occur in your home, at your place of work or while travelling. Don’t take anything for granted, but check in advance.

Spanish health insurance doesn’t cover car accidents, which are automatically covered by Spanish car insurance. Therefore, if you have Spanish health insurance and your car is insured by a foreign insurance policy, you may not be covered for car accidents.

If you’re planning to take up residence in Spain and will be contributing to social security there, you and your family will be entitled to subsidised or free medical and dental treatment. However, most Spaniards and foreign residents who can afford it take out private health insurance, which offers a wider choice of medical practitioners and hospitals, and more importantly, frees them from public health waiting lists. If you aren’t covered by Spanish social security, it’s important that you have private health insurance (unless you have a very large bank balance). The policies offered by Spanish and foreign companies generally differ considerably in the extent of cover, limitations and restrictions, premiums, and the choice of doctors, specialists and hospitals.

Proof of health insurance must usually be provided when applying for a visa or residence permit. Note that some foreign insurance companies don’t provide sufficient cover to satisfy Spanish regulations and therefore you should check the minimum cover necessary with a Spanish consulate in your country of residence. Long-stay visitors should have travel or long-stay health insurance or an international health policy. If your stay in Spain is limited, you may be covered by a reciprocal agreement between your home country and Spain. When travelling, you should always have proof of your health insurance with you.

Visitors

Visitors spending short periods in Spain (e.g. up to a month) should have travel insurance, particularly if they aren’t covered by an international policy. If you plan to spend up to six months in Spain you should take out a travel, long-stay or international health policy, which should cover you in your home country and when travelling in other countries. Premiums vary greatly, so shop around. Most international health policies include repatriation or evacuation (although it may be optional), which may also include shipment by air of the body of a person who dies abroad to his home country for burial. Note that an international policy also allows you to have non-urgent medical treatment in the country of your choice.

Most international insurance companies offer health policies for different areas, e.g. Europe, worldwide excluding North America, and worldwide including North America. Most companies also offer different levels of cover, for example basic, standard, comprehensive and prestige. There’s always a limit on the total annual medical costs, which should be at least €300,000 (although many provide cover of up to €1.2 million), and some companies also limit the charges for specific treatment or care such as specialists’ fees, operations and hospital accommodation. A medical examination isn’t usually required for international health policies, although pre-existing health problems are excluded for a period, e.g. one or two years.

Claims are usually settled in major currencies and large claims are usually settled directly by insurance companies (although your choice of hospitals may be limited). Always check whether an insurance company settles large medical bills directly – if you’re required to pay bills and claim reimbursement it can take several months before you receive your money. It isn’t usually necessary to translate bills into English or another language, although you should check a company’s policy. Most international health insurance companies provide emergency telephone assistance.

The cost of international health insurance varies greatly depending on your age and the extent of cover. With most international insurance policies, you must take one out before you reach a certain age, e.g. between 60 and 80 depending on the company, to be guaranteed continuous cover in your old age. Premiums can sometimes be paid monthly, quarterly or annually, although some companies insist on payment annually in advance. When comparing policies, carefully check the extent of cover and exactly what’s included and excluded (often indicated only in the very small print), in addition to premiums and excess charges.

In some countries, premium increases are limited by law, although this may apply only to residents of the country where a company is registered and not to overseas policyholders. Although there may be significant differences in premiums, generally you get what you pay for and can tailor premiums to your requirements. The most important questions to ask yourself are: does the policy provide the cover required and is it good value for money? If you’re in good health and are able to pay for your own out-patient treatment, such as visits to a family doctor and prescriptions, then the best value is usually a policy covering specialist and hospital treatment only.

Residents

If you contribute to Spanish social security, you and your family are entitled to free or subsidised medical and dental treatment. Benefits include general and specialist care, hospitalisation, laboratory services, discounted drugs and medicines, basic dental care, maternity care, appliances and transportation. Over 95 per cent of the population are covered by the public health scheme, including retired European Economic Area (EEA) residents (with a residence permit) receiving a state pension. All autonomous regions have their own health schemes, such as Andalusia with its Servicio Andaluz de Salud/SAS and Catalonia, where the Institut Catalá de la Salut/l’ICS operates. If you aren’t entitled to public health benefits through payment of Spanish social security or being in receipt of a state pension from another EEA country, you must usually have private health insurance and must present proof of your insurance when applying for your residence permit. If you’re an EEA national of retirement age, who isn’t in receipt of a pension, you may be entitled to public health benefits, if you can show that you cannot afford private health insurance.

Anyone who has paid regular social security contributions in another EU country for two full years before coming to Spain is entitled to public health cover for a limited period from the date of their last contribution. Social security form E106 must be obtained from the social security authorities in your home country and be presented to the local provincial office of the Instituto Nacional de la Seguridad Social (INSS) in Spain. Similarly, pensioners and those in receipt of invalidity benefits must obtain form E121 from their home country’s social security administration. Retirees living in Spain and receiving a state pension from another EU country are entitled to free state health benefits.

You will be registered as a member of the health service and given a social security card (tarjeta sanitaria), a list of local medical practitioners and hospitals, and general information about services and charges. If you’re receiving an invalidity pension or other social security benefits on the grounds of ill-health, you should establish exactly how living in Spain affects those benefits. In some countries, there are reciprocal agreements regarding invalidity rights, but you must confirm that they apply to you. Citizens of EEA countries can make payments in their home country entitling them to use public health services in Spain and other EEA countries.

The public health service places the emphasis on cure rather than prevention and treats sickness rather than promotes good health. There’s little preventive medicine, such as regular health checks and a comprehensive immunisation programme for children (preventable diseases such as TB, tetanus, diphtheria and typhoid haven’t yet been totally eradicated). The public health service has limited resources for out-patient treatment, nursing and post-operative care, geriatric assistance, terminal illnesses and psychiatric treatment. Perfunctory treatment due to staff shortages, long waiting lists as a result of a shortage of hospital facilities, and a general dehumanisation of patients are frequent complaints made against Spain’s social security health system. Many problems are related to crippling bureaucracy, bad management and general disorganisation. However, attempts at reform have had some success and there are several public hospitals run as successful profit-making enterprises. Eventually, the health service intends to make all hospitals and general practices, self-administrating.

When you receive your social security card, you’re usually assigned a general doctor (médico de cabecera) at a health centre (centro de salud) in the area where you live. You can switch to another doctor in the same area, depending on availability and a doctor’s number of patients. No payment is made when visiting a public health service doctor, where you’re simply required to produce your social security card.

Private Health Insurance

If you aren’t covered by Spanish social security you should take out private health insurance. It’s advantageous to be insured with a company that pays large medical bills directly. Most private health insurance policies don’t pay family doctors’ fees or pay for medication that isn’t provided in a hospital or there’s an ‘excess’, e.g. you must pay the first €60 of a claim, which often exceeds the cost of treatment. Most, however, pay for 100 per cent of specialist fees and hospital treatment in the best Spanish hospitals.

Comprehensive private insurance with a Spanish company for a family of four (with two children under 16) should cost around €2,000 per year. Annual insurance for a man under 60 should be around €450 (policies for women under 60 are up to twice as expensive). There may be an annual surcharge for those aged over 60, which increases with age, and supplements for certain services such as basic dental treatment or for pregnant women. Generally, the higher the premium, the more choice you have regarding doctors, specialists and hospitals. Note that Spanish insurance companies can cancel a policy at the end of the insurance period if you have a serious illness with continuous high expenses, and some companies automatically cancel a policy when you reach the age of 65. You should avoid such companies, because to take out a new policy at the age of 65 at a reasonable premium is difficult or impossible. If you already have private health insurance in another country, you may be able to extend it to cover you in Spain.

More pages

Page 1: Overview
Page 2: Changing Employers or Insurance Companies

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