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You are in: Home » Workers » Benefits / Pensions for Workers  » Health Care » General Scheme » Beneficiaries / Protected Situations

Beneficiaries / Protected Situations




Health care in Spain, which is publicly funded through the National Health System (SNS), provides cover for people who have insured status.

  • Insured status is granted to people in any of the following circumstances:

    1. Being employed by a third party or self-employed, registered with the Social Security system as active or in an equivalent situation.
    2. Being a pensioner in the Social Security system.
    3. Being in receipt of any other periodic Social Security  provision, including unemployment benefits and others of a similar nature.
    4. Having exhausted unemployment benefits and others of a similar nature, being unemployed, not having insured status on any other grounds and residing in Spain. This scenario will not apply to those persons mentioned in article 3 (c) of Law 16/2003 of 28 May (foreigners not registered or authorised as residents in Spain).

  • Individuals not covered by the preceding point or by article 3 of R.D. 1192/2012, of 3 August, who do not have mandatory health insurance by some other means and who are in any of the following situations: 

    • Having Spanish nationality and residing in Spanish territory.
    • Being nationals of a member State of the European Union, the European Economic Area or Switzerland and being registered on the Central Register of Foreign Citizens.
    • Being nationals of a country other than those mentioned above, or stateless, and having authorisation to reside in Spanish terrritory, for as long as that authorisation is valid in accordance with the terms provided for in its specific regulations.

    Cover resulting from special mandatory insurance for health risks arising from specific activities carried out by the insured, whether arranged by that individual or through a third party, shall not be regarded as mandatory health insurance by some other means. Nor shall being a member of a mutual welfare scheme other than the regime of the Social Security system be regarded as such.
  • Minors subject to administrative guardianship shall be regarded as insured individuals.

Temporary Scheme for accessing health care in Spain:

Individuals who, prior to the entry into force of Royal decree-law 16/2012, of 20 April, had access to medical assistance in Spain and do not have insured status in accordance with the provisions of section 2 of article 3 of Law 16/2003, of 28 May, or in accordance with EU regulations or bilateral agreements, along with their beneficiaries, may continue to access medical assistance until 31 August 2012, without the need to prove insured or beneficiary status under the terms of article 3 of Law 16/2003, of 28 May.


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Individuals who, fulfilling the requirements referred to in the following sections, find themselves in any of the following situations shall have the status of beneficiary of an insured individual:

  • Being the spouse of the insured individual or living with them in a relationship analogous to the conjugal relationship, constituting a common-law partnership.
  • Being the ex-spouse, or being legally separated, in both cases being the responsibility of the insured individual on account of being entitled to receive maintenance.
  • Being a descendent, or an equivalent individual, of the insured individual or their spouse, or their ex-spouse, even if they are legally separated, or their unmarried partner, in both cases being the responsibility of the insured individual and less than 26 years of age or, in the event of being over that age, having a recognised disability of 65% or more.

    The following individuals shall be considered to be equivalent to descendents:
    • Minors under the legal guardianship or foster care of an insured individual, their spouse, even if they are are legally separated,  or their unmarried partner, or their dependent ex-spouse, where, in this last case, the guardianship or foster care occurred before the divorce or annulment of the marriage.
    • Brothers and sisters of the insured person.

    Descendents and equivalent individuals shall be deemed to be the responsibility of an insured individual if they live with and depend financially on that individual. For these purposes, the following must be taken into account:

    • Unemancipated minors shall always be considered to be the responsibility of the insured individual.
    • Cases of separation on account of work, studies or like circumstances shall be regarded as living with the insured individual. 
    • Individuals of legal age and emancipated minors shall be deemed not to depend on the insured individual financially if they have an annual income of more than double the amount of the Public Indicator of Multiple Effect Income (IPREM), also calculated annually.

All the individuals mentioned in the preceding paragraphs shall be regarded as beneficiaries, provided that they satisfy the following requirements:

  • Not having the status of insured individuals in accordance with article 2.1.a of |R.D. 1192/2012, of 3 August. 
  • Having authorised and effective residence in Spain, except in the case of those individuals who travel to Spain temporarily and are the responsibility of employees relocated by their company outside Spanish territory, provided that the latter are in a situation equivalent to being insured, paying into the relevant Spanish Social Security regime.

Individuals who satisfy the requirements necessary for having the status of beneficiaries in accordance with this article 3 are not eligible for insured status under article 2.1.b of |R.D. 1192/2012, of 3 August, for as long as they satisfy those requirements.

Where an individual may be the beneficiary of two or more insured individuals, only one of them may recognise that status, with the status of beneficiary of an insured person under the aforesaid article 2.1.a always prevailing.


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Medical assistance for returned Spaniards  and for Spanish workers and pensioners resident  abroad and temporarily in Spain, and for relatives of the above living with or accompanying them.

Returned Spaniards and pensioners, employees and self-employed workers, as well as their relatives, not living in the EU/EEA/Switzerland, who are temporarily in Spain, shall be entitled to medical assistance paid by public funds through the National Health System when, according to the provisions of Spanish Social Security, the provisions of the home state or international Social Security regulations and agreements set for this purpose, do not provide this coverage.

Relatives entitled to medical assistance:

  • The spouse of the persons indicated or whoever lives with them in a similar relationship, as a common law couple.
  • Descendants of the persons indicated, and those of the spouse or common law partner, who are under their responsibility and under 26, or older with a recognised disability equal to or greater than 65 per cent.

The recognition of entitlement to medical assistance lies with the INSS in any case, which shall issue a document accrediting the right. This right shall be maintained until the beneficiary meets the requirements established to obtain such right according to the provisions of Spanish Social Security, the provisions of the home state or international Social Security regulations and agreements.

Returned Spaniards shall justify this status by presenting their withdrawal from the consulate of the country of residence and the census certificate of the town where they have established their residence in Spain.

Law 40/2006, of 14 December, the Statute of Spanish citizenship abroad and RD 8/2008, of 11 January, which regulates the benefit due to need in favour of Spanish residents abroad and returned citizens, amended by Law 26/2015, of 28 July, on the second opportunity mechanism, reducing the financial burden and other social measures.

Medical assistance in application of EU regulations and international agreements:

  1. Individuals entitled to medical assistance under EU regulations on the coordination of Social Security systems or bilateral agreements that cover the provision of medical assistance, shall have access to such assistance, provided that they reside in Spanish territory or when travelling temporarily to Spain, in the manner, to the extent and under the conditions laid down in the aforesaid EU or bilateral regulations.
  2. In no case shall citizens of member States of the European Union, the European Economic Area or Switzerland staying for less than three months be considered non-resident or unauthorised foreign citizens in Spain for the purposes set forth in article 3 ter of Law 16/2003, of 28 May, and as regulated in article 6 of R.D. 240/2007, of 16 February, on entry into, free movement within and residency in Spain for citizens of member States of the European Union and other States that are part of the Agreement on the European Economic Area.

Medical assistance for people with disabilities:

In relation to medical assistance for people with disabilities,  the sole transitional provision of the Consolidated Text of the General Act on the rights of people with disabilities and their social inclusion, approved by Royal Legislative Decree 1/2013, of 29 November (BOE 3/12), shall apply.

The power to recognise the right to medical assistance lies with the |AR/IMSERSO.

Special schemes for civil servants:

  1. Individuals who are members or beneficiaries of the special Social Security schemes managed by the Mutual Society for Spanish Civil Servants, the Armed Forces Social Institute and the Mutual Society for Spanish Court employees keep the scheme of obligatory cover for health care provision, in accordance with the special regulations governing each Mutual Society, which, likewise, determines their respective protected group, including civil servants who have joined any public administration after 1 January 2011 in bodies to which the mutual scheme applies. These civil servants will remain members of the mutual scheme when they become pensioners.
  2. Recognition and control of their status as members or beneficiaries of a mutual scheme is the responsibility of each mutual society, in accordance with its specific regulations and its respective organisational structure.
  3. The mutual societies and the National Social Security Institute or, where appropriate, the Social Marine Institute, shall establish the necessary collaboration and coordination mechanisms to avoid the duplication of inherent and derived rights, where they are incompatible, and to ensure access to the public health care system for those members of the mutual scheme who have opted for that form of medical assistance.

Foreigners not registered or authorised as residents in Spain:

Foreign citizens who are not registered or authorised as residents in Spain shall receive the following types of health care:

  1. Emergency medical assistance in the event of serious illnesses or accident, irrespective of the cause, until medical discharge.
  2. From 01-09-2013, foreign minors under 18 resident in Spain referred to in article 3 ter of Law 16/2003, of 28 May, shall be entitled to public medical assistance from the NHS with the same period as persons with insured status, with the user's contribution rate for those services of the NHS portfolio that require it the same as for those who are actively insured.
  3. From 01-09-2013, pregnant foreign women as referred to in article 3b of Law 16/2003, of 28 May, shall be entitled to NHS care for pregnancy, birth and the postpartum period, to the same extent as individuals with insured status, with the user's contribution rate for those services of the NHS portfolio that require it being the same as for those who are actively insured.

The AR/Public Health Services are responsible for recognising the entitlement to medical assistance.

Provision of medical assistance to applicants for international protection:

  • Individuals applying for international protection whose stay in Spain has been authorised on those grounds shall, while they remain in that situation, receive medical assistance to the extent provided for in the basic common portfolio of NHS health care services regulated by article 8a of Law 16/2003, of 28 May.
  • The necessary assistance, medical or otherwise, shall also be given to applicants for international protection with special needs.
  • The AR/Public Health Services are responsible for recognising the entitlement to medical assistance.

Provision of medical assistance to victims of human trafficking in a period of recovery and reflection:

  • Victims of human trafficking whose temporary stay in Spain has been authorised during the period of recovery and reflection shall, while they remain in that situation, receive medical assistance to the extent provided for in the basic common portfolio of NHS health care services regulated by article 8a of Law 16/2003, of 28 May.
  • The necessary assistance, medical or otherwise, shall also be given to victims of human trafficking with special needs.
  • The AR/Public Health Services are responsible for recognising the entitlement to medical assistance.

Special agreement on the provision of medical assistance to individuals who do not have insured or NHS beneficiary status:

For the purposes of the provisions of article 3.5 of Law 16/2003, of 28 May, those individuals who, not having insured or beneficiary status, do not have access to a system of public health care protection on any other grounds, may receive medical assistance by making the relevant payment or paying the relevant fee arising from the signing of a special agreement.

This means of access to medical assistance, regulated by R.D. 576/2013, of 26 July and developed by Order SSI/1475/2014, establishing the basic requirements of the special agreement on the provision of medical assistance to individuals who do not have insured or NHS beneficiary status, in force since 01-09-2013, allows individuals covered by it, by making a payment, to access the basic common portfolio of NHS health care services, regulated by Article 8 bis of Law 16/2003, of 28 May, with the same guarantees with regard to extent, continuity of care and cover as are enjoyed by individuals with insured or NHS beneficiary status, in the area of public administration with which the agreement was entered into and without prejudice to the content of additional provision one of this royal decree.

The National Health Management Institute is responsible for recognising entitlement to medical assistance through the special Agreement 


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  • Common or occupational disease.
  • Work-related or non-work-related injury.
  • Maternity.
  • Risk during pregnancy.
  • Risk during breastfeeding.

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For the purposes of keeping the entitlement to health benefits where residency in Spanish territory is required, the beneficiary of those benefits shall be understood to be a habitual resident in Spain even where they have spent time abroad, provided that such time does not exceed 90 days in the course of the calendar year (Article 51 of the General Social Security Act).


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