You should never go to another country without health coverage. Will you be given free treatment by the Spanish national health system? Some important points to start with:From the beginning of 2006 the form E 111 shall not be used anymore for European citizens who want to visit Spain as tourist. Instead you must bring with you the European Health Insurance Card (EHIC) from the health office in your home country.With the European Health Insurance Card you are covered for emergency treatment in Spain, but nothing more. The Spanish health authorities are controlling what they call the “health tourism”.
At the end of this information, we publish an article describring the situation a per January 2007.
If you have come to Spain as a tourist, you may be covered for any health risks by the insurance of the tour operator, or if going on your own you may have taken out travel insurance. Or you may have brought with you the European Health Insurance Card that gives you coverage in accidents or urgent illnesses in certain countries abroad.
But if you buy a property in Spain and stay here permanently, or for several longer periods over the year as a non-resident, you ought to consider if you have sufficient health coverage.
Travel insurance
For a person who is not covered by the national health services of his country, and who stays in his property in Spain for one or more shorter periods of the year, a travel insurance may suffice. Some feel that they are sufficiently covered by the insurance included with the travel they buy, or from an insurance given by a credit card company or some other private entity. We recommend everyone to sit down with the small print of the conditions for such "inclusive" coverage, to make sure it is sufficient. It may become a very expensive oversight if you have a serious accident or become so seriously ill that you cannot be moved.
If you are confident the very economical travel insurance will give you and your family the protection you need, this is a good solution. But make sure that this insurance does not lapse (for instance you overstaying the period of coverage, or by your credit card expiring). Be prepared to pay for the treatment and the medicines you get in Spain, presenting the bills upon returning to your home country.
The E111 is out
If you are covered by the national health services of your country, and that country has an international agreement on reciprocal health services, the best solution for someone who wants to stay in Spain for one or more shorter periods without becoming resident, is the European Health Insurance Card.
It is issued by the national health services in your own country, and you should have it together with your passport, ready for any emergencies. You will have to use the medics, health stations or hospitals of the Spanish national health services, called INSS, or the regional health services. If you go to a private doctor or hospital, they will ask you to pay. In almost all tourist municipalities you will find a "Centro de Salud". That is the place to approach. If you need to go straight into hospital, you must ask to be taken to one of the hospitals of the INSS, or if you have been taken to a private hospital you should communicate this to the INSS within 24 hours. The personnel at the hospital will assist you.
We must stress that the European Health Insurance Card is to be used only in emergencies, not for treatment of chronically illnesses or for taking an operation in Spain that you would have to wait a long time for in your home country. But if you run out of your normal medicine while staying in Spain, the card can be used..
The E-121 for permanent residents
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, even if you have an EHIC. 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 medic you are to visit in case of illness, as well as the address of the next health centre.
If your EH is valid and you are using it for emergency treatment, you will not have to pay for the intervention of the medic, the stay in the hospital or for most medicines.
Private health insurances
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 medic 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 has improved immensely, and is of a very high standard. What you cannot avoid, not in Spain and also not in your home country, are queues and waiting times.
There are a number of private Spanish or foreign health insurances offered to the foreigners in Spain. You only have to read one of the publications in foreign languages to find their addresses or agents. You may also ask other foreigners who have been staying in Spain for a long time for their experiences.
One of the leading Spanish health insurance companies offer a very comprehensive coverage for a price of less than 2.000 Euros per year for a married couple of 61 years of age.
The most important health insurance companies in Spain are 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 want to present a formal complaint to this office, proceed as follows:
* Write the complaint in Spanish, add a copy of the contract and the bills that the company eventually refuses to pay and all other documentation of relevance.
* The Dirección General will then transmit the complaint to your insurance company and demand an answer within 10 days.
* After the insurance company has answered, the Dirección General will give you the content of this answer, and you have 10 days to comment on their arguments.
* If you just maintain your original complaint, the Dirección General will give their opinion on the case, which is not binding for either party. If their opinion is favourable to the client, the insurance company has 1 month to decide whether they accept the ruling or not. If it is favourable to the company or if the company ignores it when it is favourable to you, you have to bring the matter to court.
Preparing for emergencies
We recommend every person to have next to the phone the name and phone number of a medic 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).
If there is a local information office for the foreigners in your area, they will provide you with a list of medics speaking foreign languages, public health centres, as well as public and private hospitals and clinics.
3. Health services for foreigners in Spain
In addition to the more detailed information on this subject on our web page, there are certain changes that all should take into account. The most important is that tourists/non-residents from the EU/EES-countries can not any more use an E111 from their home country to have emergency health treatment during their stay in Spain. Instead, they must present the European Health Insurance Card. If anyone has not yet got such a card from their national health organisation, it must be applied for. The non-residents do not need to register in the local health centre in the place where they are staying in Spain, they just approach the centre (or other parts of the public health system) when having an emergency.
We stress emergency, meaning injuries from an accident or a new illness contracted during the stay in Spain, that need immediate attention. You can also use the public health organisation if you have an unexpected worsening of a chronic illness, or if you have run out of medicines you normally take. But please do not, as a tourist, try to use the Spanish health facilities for operations or treatments that could have been done in your home country. We shall come back to this under the chapter on “health tourism”.
The E121 still valid
Anyone wanting to stay permanently or for longer periods in Spain as a retired person, must bring the form E121 from the health authorities in the home country, certifying that you form part of the public health system. Do not think that the European Health Insurance Card (EHIC) replaces the E121. It does not. Only with the E121 you will, as a retired person, be given the same treatment as the Spanish themselves.
Upon arrival in your Spanish municipality, you must at once present yourself in the local health centre (Centro de Salud) for registration, with the E121, your passport, eventually residence permit/certificate from the town hall that you are in the “padron municipal”, and the NIF-card. They will issue a provisional card, giving the name and phone number of your personal medic, until you receive the permanent SIP-card from the regional health authorities.
The authority in health services has been transferred from the national government to the regions. That is why the services have different names in the various regions. On our web-page you will find the addresses and phone numbers of the health centres all over tourist Spain, as well as for public hospitals, in the case you have an emergency.
Be aware that in principle you also have the right to phone your doctor and ask that he visits you in your home, if you are bedridden and cannot move. However, the doctors in most health centres are overworked and will only go out in real emergencies.
Early retirement
We need to stress, once more, that the E121 is only for retired persons, meaning people who have reached the legal retirement age of their country. There are several other E-forms, for people in other situations, like students studying abroad, people going abroad to work or doing business, or people who have taken early retirement.
Normally, the early retired do not get an E121 from their national health organisation, and for that reason they are not entitled to the full health coverage in Spain.
It is only with an E121 you can be sure to be registered in the Spanish National Health and get a SIP card confirming your complete coverage. You will get emergency treatment, as any tourist.
There are some examples of early retired who have been registered and got a SIP card, but this may due to largess from the Spanish side, not because they had a legal right. Any early retired who wants to stay in Spain for prolonged periods should inform themselves carefully in their National Health Office before leaving. Probably the only solution offered is a private health insurance up to the legal retirement age of your country. Then an E121 will be issued.
“Health tourism”
During the last year there have been several reports on statements from regional political leaders on the so called “health tourism” to Spain and the need to stop it. Representatives of the government of Francisco Camps in the Valencia region have been specially aggressive, but giving very few concrete examples of foreigners misusing the Spanish health system. Ironically, the present “conseller” for health in the region is Rafael Blasco, previously responsible for urbanistic matters and great defender of the LRAU and LUV laws permitting abuses against many small landowners, both foreigners and Spanish.
Rafael Blasco has been intoxicating the public opinion with diffuse statements, saying that “the Valencia hospitals are attending to more than 56.000 foreign tourists” and that the “total health cost of this group are more than 84 million Euro..” He has been announcing a new regional law “to avoid the fraud of certain collectives when it comes to using the health services….” He has warned that the new “pioneer” legislation will introduce a system of accreditation involving the SIP card and some legitimation before obtaining the services (!)
We must confess that we are a bit bewildered. We thought the situation was the following:
- That Spain and the Valencia region were eager to get more tourists visiting, and that tourism is the main economical sector in the country, giving a number of economical benefits. - That with some millions of foreign tourists visiting the region every year, there will always be some falling sick or involved in accidents, and also having to visit a doctor or go to hospital. - That any person visiting the local health centre (Centro de Salud) is already required to present either their SIP-card, or if being foreign tourists from a country part of the “European health agreements”, their EHIC (European Health Insurance Card). - That any person not being able to document themselves in the way mentioned above, would be recommended to go to a private doctor or hospital.
Spain is being paid
The fact is that in accordance with existing European agreements, Spain is being paid by the other countries of the Union (and in EES) for the citizens of their countries using the health services in Spain. There is no country not paying in accordance with the agreements. And as far as we know, Spain has not proposed any changes in them.
The problem may be that the transfers from our countries go to Spain, not to the various regions. And the regions may be in disagreement with the national government on the distribution of the money. The regions have a tendency to spend more money than what they receive from the government. And when they for this reason are unable to give their citizens the services expected, it is convenient to put the blame on the foreigners.
But it is an incorrect and sordid practice to cast suspicion on what counsellor Blasco refers to as “certain collectives”. His campaign has started to colour the attitude of certain doctors in the public health centres. During a 4-minute consultancy with a new doctor in my local health centre, the young lady told me that I could also ask for a diagnosis and eventual treatment in the health centres of my country! I had to tell her that I had for more than 20 years contributed to the Spanish national health system.
In the end of January the Valencia government demanded in the Supreme Court a change in the distribution of the reimbursement for health costs from the national government to the regional ones. It maintain that the region got only 80% of the costs, produced by national and foreign tourist coming to Costa Blanca, together with the foreign residents. The government has answered that the key of distribution for the health costs where determined by the Aznar government in 1999.
We shall be reading carefully any new law promoted by Mr. Blasco!
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