The special agreement for healthcare assistance allows affiliation with the National Health System (SNS), the public health insurance regime, and is aimed at economically inactive foreign citizens who need to contract health insurance to reside in Spain, in accordance with the following regulations: 

– Royal Decree 240/2007, of February 16, on entry, free movement, and residence in Spain of citizens from the Member States of the European Union and other States party to the Agreement on the European Economic Area. 

– Directive 2004/38/EC of the European Parliament and of the Council, of April 29, 2004, concerning the right of Union citizens and their family members to move and reside freely within the territory of the Member States. 

– Royal Decree 557/2011, of April 20, approving the Regulation of Organic Law 4/2000, on rights and freedoms of foreigners in Spain and their social integration, after its reform by Organic Law 2/2009. 

Foreign citizens receiving public pensions do not need to subscribe to the special agreement if they demonstrate, through the corresponding certification, that they are entitled to healthcare financed by the State of the country from which they receive their pension. For example, with the S1 form for pensioners from the European Union (EU)/European Economic Area (EEA)/United Kingdom/Switzerland. 

It must be borne in mind that the European Health Insurance Card (EHIC) only provides access to healthcare in the SNS during temporary stays; it is not a valid document to establish residence in Spain. 

Citizens from an EU Member State or a State party to the EEA Agreement, and family members who are not nationals of those States, who have legally resided in Spain for a continuous period of five years, are holders of the right to reside permanently, and therefore have the right to healthcare in the SNS funded by public funds (1), and do not need to subscribe to the special agreement. 

The special agreement for healthcare assistance in the SNS is different from the special agreement in the Social Security System, which allows complete contribution periods to receive a contributory retirement pension. 

The requirements are:

– To demonstrate effective residence in Spain for a minimum continuous period of one year immediately prior to the application date for the special agreement. The residence requirement will be considered fulfilled when residence periods are proven in the territory of other EU Member States, EEA, Switzerland, or the United Kingdom. 

– To be registered in any Spanish municipality at the time of submitting the application for the special agreement. 

– Not to have access to a public healthcare protection system under any other title, whether through national regulation, European Social Security regulations, or bilateral agreements Spain has signed with other countries in this area. 

1. What coverage does it include?

It enables affiliation with the SNS, through the payment of a fee, without co-payments or waiting periods, covering all services in the basic common healthcare portfolio of the SNS, which includes preventive, diagnostic, treatment, and rehabilitation activities carried out in healthcare or social healthcare centers, as well as urgent medical transportation. Both primary care and specialized care are included, whether outpatient or hospital inpatient. 

Ambulatory pharmaceutical services, outpatient Ortho prothesis services, dietary products, and non-urgent medical transportation have a 100% copayment to be paid by the patient. 

The special agreement allows access via an individual health card, either physical or virtual, to healthcare within the Autonomous Community, as well as during temporary moves to other Autonomous Communities and cities of Ceuta and Melilla within the SNS, and during a temporary stay in the EU/EEA/UK/Switzerland using the Provisional Substitution Certificate (CPS) in physical and/or virtual format issued by the National Institute of Social Security (INSS). 

2. What is the cost?

a) If the subscriber is under 65 years old: €60 monthly fee. 

b) If the subscriber is 65 or older: €157 monthly fee. 

3. What documentation must be presented?

a. Identification document of the applicant (ID card, Foreigner Identity Number (NIE), Passport, or Residency Card). 

b. Proof of effective residence in Spain or in the territory of other EU Member States, EEA, Switzerland, or the UK for at least one continuous year immediately prior to the application for the special agreement.

This can be demonstrated with a residence certificate issued by the General Directorate of the Police or a registration certificate issued by a Spanish municipality. Also, by a document issued by a consulate, a public domicile/residence document from an authority of a Member State according to Regulation (EU) 2016/1191, or any other legally valid means for foreign citizens from other EU/EEA/Switzerland/UK states. 

c. Registration certificate in a Spanish municipality (“padrón”).

According to Article 16.2.f of Law 7/1985, of April 2, regulating the Bases of Local Regime, the municipality will request the Foreigner Identity Card (TIE) or, prior to registration in the Central Register of Foreigners (RCE), the EU Citizen Registration Certificate for those originating from the EU/EEA. If these documents are not provided, registration in the “padrón” will be done using the identification document number or an in-force passport issued by authorities of the country of origin. Municipalities cannot deny registration in the “padrón” to foreign citizens who habitually reside in the municipality, regardless of whether they have legal residence in Spanish territory.

According to Article 18.2:“The registration of foreigners in the municipal register shall not constitute proof of their legal residence in Spain nor shall it grant them any rights not conferred by current legislation, especially concerning the rights and freedoms of foreigners in Spain.” Therefore, it is an independent registry from the Central Register of Foreigners (RCE), which is carried out through registration at police stations or Foreigners’ Offices and does not require submitting a registration certificate. 

d. Responsible declaration or certificate of non-exportation of the right to healthcare coverage in Spain from their country of origin, issued by the competent authority of their country, certifying that they do not have access to a public healthcare protection system under any other title, whether through national regulation, European Social Security regulations, or bilateral agreements signed by Spain in this area. 

This requirement applies only to foreign nationals from countries to which European Regulations No. 883/04 and No. 987/09 regarding the coordination of social security systems are applicable (Germany, Austria, Belgium, Bulgaria, Czech Republic, Cyprus, Croatia, Denmark, Slovakia, Slovenia, Estonia, Finland, France, Greece, Hungary, Ireland, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Norway, Netherlands, Poland, Portugal, Romania, Sweden, and Switzerland), the cooperation and trade agreement between the European Union and the United Kingdom, or countries with bilateral Social Security agreements (Andorra and Chile). 

4. Where is it subscribed?

The special agreement for healthcare assistance is signed with the Autonomous Community’s Health Service in the municipality where the foreign citizen is registered, or with the National Institute of Health Management (INGESA) in the cities of Ceuta and Melilla. 

You can access the websites of the Autonomous Community Health Services through the following link for information on how to subscribe to the special agreement: https://www.sanidad.gob.es/organizacion/ccaa/directorio/home.htm

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