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 € 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.

Everybody should keep, next to the phone, the name and phone number of a doctor speaking your language, or of the local health centre, as well as a company providing ambulance services, and the closest hospital where you would want to go to in an emergency (depending if you are covered by the National Health Service or rely on private services).

Karen Milacic is a graphic and web designer living as a British expat on the Costa Blanca for the past five years. Visit her other web sites at: http://www.villa-angels.com; http://www.thedesignbusiness.co.uk; http://www.costablanca-webhosting.com