Medical Assistance

Procedure

Medical Assistance Procedure

General Information


Purpose:

The purpose of Social Security healthcare is to provide the medical and pharmaceutical services required to preserve or restore the health of its beneficiaries, as well as their capacity to work.

Insured parties:

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

  • A worker employed by another person or a self-employed worker, affiliated and registered or in a situation similar to registered.
    A pensioner in the Social Security system. 
  • A recipient of any other periodic Social Security benefit, including unemployment benefit or allowance. 
  • An unemployed person who has exhausted unemployment benefits and others of a similar nature, does not have insured status on any other grounds, and resides in Spain. 
  • Individuals who do not have mandatory health insurance by some other means and who are in certain situations.
  • Children in state care.

More information on insured parties

Beneficiaries / Requirements:

Status as a beneficiary of an insured party is granted to people in any of the following circumstances, among others:

  • The spouse of the insured person or the cohabiting partner of the insured person with a similar relationship, forming a domestic partnership.
  • The former spouse or legally separated partner, dependent on the insured person due to being entitled to receive alimony.
  • A descendant, or an equivalent individual, of the insured individual or their spouse, even if they are legally separated, or of their dependent ex-spouse or of their domestic partner, in both cases being dependent on the insured individual and under 26 years of age, or in the event of being over that age, having a recognised disability of 65% or more.
  • Brothers and sisters of the insured person.

They shall have beneficiary status if they fulfil the requirements of:

  • Not having insured person status under article 2.1.a of RD 1192/2012.
  • Having authorised and effective residence in Spain, except in the case of those individuals who travel to Spain temporarily and are dependent on employees relocated by their company outside Spanish territory, provided that the latter are in a situation equivalent to being registered, contributing to the relevant Spanish Social Security regime.

More information on beneficiaries

Contents:

The list of National Health System benefits includes benefits for public health, primary care, specialist care, emergency care, pharmaceutical products, orthotics and prosthetics, dietary products and healthcare transport.

The benefits are provided through a range of techniques, technologies and procedures that include the portfolio of common services, which is separated into the following types:

  • Basic care services: Including prevention, diagnosis, rehabilitation and emergency health care provided at health and social health centres. These are fully funded by public funds.
  • Supplementary: Including outpatient care, such as pharmaceuticals, orthotics and prosthetics, health products and non-emergency health transport. These are subject to a contribution by the user.
  • Ancillary services: These are not classed as benefits and are considered as extra support for improving pathologies. These are subject to a contribution and/or reimbursement by the user.

More information

Duration:

Insured persons and their beneficiaries, for as long as the pathology continues.

In the case of workers who are no longer affiliated with Social Security and their family members, the duration varies according to the period for which contributions have been made. 

More information on duration 

Deadlines:

Entitlement to health care for both the insured person and their dependants begins the day of affiliation in the Social Security System and becomes effective on the day after applying for active contributor status in the appropriate Scheme.

Refusal / Expiry:
  • When the conditions required for being insured or a beneficiary of the entitlement are no longer met.
  • Due to death.
Forms:

The application form for recognition of entitlement to health care, both for the future insured person and the beneficiaries.

Documentation:
  • DNI or official document which identifies the insured and their beneficiaries.
  • Family record book or Civil Registry certificates proving the family relationship with the insured person, when the entitlement is requested for beneficiaries...

More information

Where to process it:

At any Social Security support and information centre, the provincial offices of the Social Marine Institute (ISM) or through the e-Office, if they have a digital certificate.

Competent body:

The granting and control of insured or beneficiary status will be the responsibility of the National Social Security Institute (INSS) or, where appropriate, the Social Marine Institute (ISM).

The entitlement to health care shall be provided by the competent health authorities; the health centres in the autonomous communities will provide access to health care benefits by issuing individual health insurance cards.

Other important information:

Other circumstances and special situations.

Medical Assistance: consult eligibility and issue of the document that accredits eligibility

European health card.

Provisional replacement certificate (CPS).

Special Social Security schemes.

Frequently asked questions

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