Living Abroad – Spanish National Health System

Are you covered by the Spanish National Health System?

If you are in Spain as a tourist, you will probably have brought along your copy of
the E111 form obtained from the national health service in the UK, or you may have
taken out private health cover with your tour operator. In either case, you will be
covered for accidents and urgent illnesses during your stay. The E111 form will only
cover you for emergencies, not for treatment of chronic illnesses or for undertaking
an operation in Spain that you would have to wait a long time for in your home
country. If you run out of or mislay your regular medication whilst in Spain, your
E111 form can be used in any pharmacy to obtain a replacement.

You will have to use the doctors, surgeries or hospitals of the Spanish national
health services, called INSS. If you go to a private doctor or hospital, they will ask
you to pay, so if you are unfortunate enough to need to call an ambulance whilst on
holiday, make sure the driver knows that you need to be taken to an INSS hospital.
There are many private hospitals along the Costa Blanca, and you may find yourself
arriving at one of them as the driver has assumed you had private health cover. If
this happens you should communicate this to the INSS within 24 hours. The
personnel at the private hospital will assist you.

If you have contributed to the national health services of your own country, and that
country has an agreement with Spain on health services, you can also be covered if
you stay for longer periods in Spain, or become a permanent resident here. Then
you need to bring a form E-121 in two copies with you to Spain, and register it with
the Spanish health authorities. The registration is with the local Centro de Salud.
They will keep one of the copies of the form, and fill in and stamp the other one, to
be kept by you.
After a while you will receive in the post a card identifying you as a person with
certain rights to use the Spanish national health services. On it will be given the
name of the doctor you are to visit in case of illness, as well as the address of the
next INSS health centre. If you go on visits to other countries from Spain, you must
remember to get an E-111 from your local health centre, to be covered as a tourist
abroad, even in your home country.

If you are not included in the national health services of your home country, you
may have contracted a private health insurance there. Find out with the insurance
company if they will pay your medical bills in Spain as well. If you are completely or
partly without cover abroad, and a travel insurance does not fill the gap, you should
take private health insurance. Some foreigners feel more comfortable with private
insurance in addition to the public one, because they like to choose their doctor and
hospital, or because they doubt the quality of the state health services. To the last
point we can say: The national health services in Spain are of a very high standard.
You do not have to make appointments in advance to see a doctor, you turn up at
the surgery early in the morning, sign your name on the list, and wait your turn. You
may have to wait a couple of hours before being seen, but the receptionist usually
tells you roughly what time your turn will be based on how many are in front of you
in the queue so that you can go away and have a coffee and come back. As with any
country, there are waiting lists for operations, but not nearly as long as in the UK.

I
have known of cases whereby people have been diagnosed with terminal cancer in
the UK but been refused treatment because of budgetary or time constraints. Those
same people have then moved to Spain to spend their last days in the sun, have
been advised to visit the local doctor and then been admitted to hospital within days
to have life saving treatment.

If you do wish to opt for private health cover, there are a number of private Spanish
or foreign health insurances offered to the foreigners in Spain. The most popular
ones being Adeslas, Asisa, La Estrella, DKV Seguros, Sanitas and Winterthur. Today,
all insurance companies have their “Defensor del Asegurado” (ombudsman for the
insured) who you can present your complaints to if you feel the company is not
dealing correctly with you. If that does not work, you can approach Dirección
General de Seguros (phone 91-339 72 00) in the Ministry of Economy.

If you decide to take up employment in Spain thereby making contributions to the
Social Security system, you will obviously be covered by the Spanish national health
service. Your gestor will assist you in filling out the appropriate forms and register
you in the Spanish Social Security system. Currently, as a self employed person, the
monthly contributions are 220 EUR per month (£146.81), and it is your responsibility
to ensure they are paid. Once you are in the system, the authorities will track your
contributions and if you do not advise them of a change in circumstances, they will
expect you to pay the contributions. Failure to do so will result in fines and
eventually, a withdrawal of health services.