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Medical

UK residents are entitled to emergency health treatment whilst on short-term visits to Spain, provided they can produce either a valid E-111 form (until the end of December 2005), or a European Health Insurance Card (EHIC) each time they seek treatment from a Spanish National Health hospital or doctor. Dental care, other than emergency tooth extraction, is not covered.

As of 1st September 2005, the EHIC has replaced the E-111 and several other health care forms. The EHIC can be obtained online at www.dh.gov.uk/travellers or by calling (from outside the UK) 0044 191 203 5555. It is issued free of charge.

Private hospitals or doctors will not accept the EHIC. The treatment UK residents receive on temporary visits to Spain is equivalent to that received by Spanish nationals, and may vary from that offered in the UK. Repatriation due to illness is not covered by reciprocal agreements and private insurance is strongly recommended to cover such costs or to provide a choice of clinics or doctors.

Residents in Spain should ensure they are covered by private insurance if Spanish National Insurance does not cover them.

Long-term residents in Spain who are not pensioners, employed persons or officially resident do not normally qualify for Spanish State health care or NHS treatment in England.

UK nationals living in Spain are not entitled to health care in Spain at UK expense. Using an old UK-issued E111 to obtain Spanish health care (which is charged to the NHS) is fraud. They have no right to health care in the UK either, as they are not ordinarily resident in the UK. However, they would receive emergency NHS health care in England, in the same way as those persons who are officially registered as resident in Spain may receive emergency healthcare in England while on a visit there.

UK nationals working in Spain are (or should be) affiliated to the Spanish Social Security system and are covered by Spanish National Health care for which the employer will deduct social security contribution’s from the employee’s pay packet, usually on a monthly basis. Proof of such payments are shown on the pay slip. A social security number card should be obtained from the local Tesorería de Seguridad Social (in Madrid at c/Astros 5 y 7, Tel: 91 503 80 00). This should then be presented at the local medical centre (ambulatorio) along with the correct form, which will entitle the card holder to receive a medical card (tarjeta sanitaria) for ordinary health treatment. A list of medical centres in Madrid is available from the Provinicial Madrid Health Service (Instituto Madrileño de la Salud), c/ Sagasta 6. Medicines are free if prescribed to treat work-related accidents or illness, otherwise patients pay 40% of the cost.

The self-employed should first obtain an NIE (foreigner identification number) from the police (although we advise obtaining a residence card is easier and more useful) and the Alta Fiscal from the Head Tax Office (Hacienda). They should take these two documents to the nearest office of the Tesorería de Seguridad Social and ask for the Alta de Autónomo and the Inscripción en la Seguridad Social. They will receive a social security number card, which will entitle them to the tarjeta sanitaria (health card) from their nearest ambulatorio (medical centre), and full medical cover. The minimum social security contribution for medical cover is 208,18 Euros p/m. (25% less for those under 30, or women over 45).

Anyone who works in Spain for up to a year is entitled to form E128, if the DSS or the Social Security Agency in Northern Ireland, confirm that they and their employer continue to pay UK national insurance contributions. Those employed on a temporary posting, and any dependants who accompany them, are entitled to treatment for ANY condition during the posting, using an E128. However, if they visit a third EU country, they are only entitled to emergency treatment and will need a UK-issued E111.

If the job unexpectedly lasts longer than 12 months, and the appropriate insurance authorities in Spain agree, employees may remain under the UK scheme for a further period of not more than 12 months.

UK nationals who are studying in Spain as an integral part of a recognised UK course are entitled to form E128 for up to two years. They, and any dependants who accompany them, are then entitled to treatment for ANY condition for the period of their course. They should apply to the National Insurance Contributions Office, Newcastle-upon-Tyne. Tel: 0845 915 4811. If the studies are not a compulsory part of a UK course, students are covered by an E128 for up to 12 months. However, if they know in advance that a course will last longer than a year, they are not entitled to an E128.

A student who is undertaking work in Spain that specifically relates to their studies is entitled to form E128 for up to two years.

UK pensioners (anyone receiving an Old Age Pension or a disability pension) who live in Spain will be entitled to receive free medical treatment under the same conditions as Spanish State Pensioners. The UK pays Spain an annual lump sum per pensioner to cover their health costs.

To establish entitlement they must obtain form E121 from the DSS in the UK. To register a UK-issued form E121 they should go to the local INSS office - Oficina del Instituto Nacional de Seguridad Social (the main office in Madrid is c/Padre Damián 4-6, Tel: 91 568 83 00) with their E121, application for a residence card and their passport. The INSS will issue a ‘tarjeta de afiliación’ and assign the pensioner to an outpatients clinic (ambulatorio) and INSALUD doctor. They must apply for a residence card before they can register their E121. Prescribed medicines are free for pensioners and their dependents.

Those who settle in Spain after early retirement, i.e. before the normal UK pensionable age (60 for women, 65 for men), should consult their local DSS office about their medical cover, possibly under form E106, before travelling.

Ill or deteriorating health is costly, and the Spanish Health services do not cover the wide range of assistance pensioners may be used to in the UK. All EU citizens may expect the same social services as any Spanish citizen under the same conditions, subject to local waiting lists and financial contributions. However, they should bear in mind that such things as meals on wheels, day care centres and nursing homes, which are the responsibility of local, regional and municipal authorities, vary from district to district, may be scarce and welfare staff will not usually speak English.

British citizens who have been in Spain for a long time may be admitted to Spanish State homes, but places are very limited even for Spanish pensioners, and there are no British Government or other officially subsidised places. Copies of the Guía Directorio de Centros para Personas Mayores (Directory of Nursing Homes) are available by writing to: IMSERSO, Departamento de Publicaciones, Avda de la Ilustración s/n, c/v Ginzo de Línea, 28029 Madrid. Tel: 91 363 88 88, Fax: 91 363 88 80, www.seg-social.es. More specific information can be obtained by contacting the Consejería de Trabajo y Asuntos Sociales or its equivalent in the area where the pensioner lives.

Private residential homes, which provide various levels of treatment, from purely residential facilities to fulltime nursing care and medical assistance, are expensive - probably no less than £1000 per month, and staff will usually only speak Spanish. However, there are some British run homes, mainly on the Costa Blanca.

It is advisable to take out private insurance, which will cover medical and dental treatment and even repatriation to the UK.

People of independent means are not normally entitled to State Healthcare here in Spain, though there are differences between regions. For further information, those interested should contact their nearest Consulate.

Some UK nationals who have been living abroad for a prolonged period choose to go back to live in the UK.

It is important that those in need of long-term care make, or have made for them, arrangements for care before returning to the UK. Entitlement to long-term care services also depends on being ordinarily resident in the UK (previous payment of income tax or NI contributions does not count). Local health or social services in the UK will need persuading that someone who may be completely unknown to them has any right to scarce local resources.

Source www.ukinspain.com © Crown copyright 2002 - 2003