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Beneficiaries / Protected Situations

Entitlements to medical assistance

They have the right to health protection and medical assistance in accordance with the provisions of article 3.1 of Law 16/2003, of 28 May, on the cohesion and quality of the National Health System: 

  • All persons with Spanish nationality and foreigners who have established their residence in Spanish territory.
  • Persons entitled to medical assistance in Spain in application of Community regulations on the co-ordination of Social Security systems or bilateral agreements covering the provision of medical assistance, provided that they reside in Spanish territory or during their temporary movements to Spain, in the form, to the extent and under the conditions established in the Community or bilateral provisions indicated.

Requirements

In accordance with article 3.2 of Law 16/2003, of 28 May, on the cohesion and quality of the National Health System, in order to have access to publicly funded medical assistance, people must in one of these situations:

  • Have Spanish nationality and habitual residence in Spanish territory.
  • Have a recognised right to medical assistance in Spain by any other legal means, even if they do not have their habitual residence in Spanish territory, provided that there is no third party obliged to pay for such care. In particular, those who are in one of the following situations of the Social Security schemes:
    1. Be a worker employed by another person or self-employed worker, affiliated and in a situation of registration or assimilated to that of registration. 
    2. Be a contributory pensioner under these schemes. 
    3. Be in receipt of any other periodic benefit from these schemes.

Likewise, workers employed by another person and self-employed workers and pensioners, Spaniards of origin residing abroad and their family members accompanying them on their temporary trips to Spain, as referred to in Royal Decree 8/2008, of 11 January, which regulates the benefit for reasons of need in favour of Spaniards residing abroad and returnees.

  • Be a foreigner and legally and habitually resident in Spanish territory and not be obliged to accredit compulsory health care coverage by any other means.

The verification of these requirements is currently the responsibility of the National Social Security Institute and the Social Marine Institute in their respective areas of management.

The legal residence of foreign nationals is evidenced by the corresponding residence permit.
Habitual residence is certified by census registration.

Those who do not find themselves in any of the above situations may obtain this benefit by payment of the corresponding consideration or fee derived from the subscription of a special agreement.

The management of special agreements is the responsibility of the Autonomous Regions (Public Health Services).

The holders or beneficiaries of the special schemes managed by the General Mutual Society for State Civil Servants, the General Judicial Mutual Society and the Social Institute of the Armed Forces shall maintain their specific legal regime. This group is managed by the Mutual Societies.


Other cases with specific regulations

Medical assistance for returned Spaniards of origin and for Spanish workers and pensioners of origin residing abroad who are temporarily displaced to the national territory and for their family members who settle with them or accompany them. (Royal Decree 8/2008, of 11 January, which regulates the benefit for reasons of need in favour of Spaniards living abroad and returnees).

Spanish nationals residing abroad who return to Spain, as well as workers employed by another person and self-employed workers and Spanish pensioners residing abroad (who do not reside in the EU/EEA/Switzerland) on their temporary trips to our country will be entitled to medical assistance when, in accordance with the provisions of Spanish Social Security legislation, those of the State of origin or the rules or International Social Security Agreements established for this purpose, this coverage is not provided for.

The family members of returning Spaniards of origin who settle with them in Spain, and those of pensioners and workers employed by another person and self-employed Spaniards of origin, resident abroad, who accompany them on their temporary trips to Spain, shall also be entitled to medical assistance in Spain, through the National Health System, when, in accordance with Spanish Social Security provisions, those of the State of origin or the international Social Security regulations or Conventions established for this purpose, these family members do not have this coverage provided for.

For the above purposes, they shall be deemed to be family members entitled to medical assistance:

  • The spouse of the persons indicated in paragraph 1 or whoever cohabits with them in an affective relationship analogous to a marital relationship, constituting a domestic partnership.
  • The descendants of the persons referred to in paragraph 1 or those of their spouse or unmarried partner, who are dependent on them and who are under 26 years of age or over 26 years of age with a recognised disability of 65% or more.

The recognition of the right to medical assistance in all these cases corresponds to the National Social Security Institute, which will issue the document accrediting the right. This right shall be retained until the beneficiary meets the requirements established for obtaining it in accordance with the Spanish Social Security provisions, those of the State of origin or the rules or International Social Security Conventions.

Returning Spaniards of origin will justify their status by presenting the consular certificate in the country of residence and the registration certificate in the municipality where they have established their residence in our country.

Medical assistance in application of community Regulations and international Conventions:

Persons entitled to medical assistance in application of community regulations on the coordination of Social Security systems or bilateral agreements that include the provision of medical assistance shall have access to it, provided that they reside in Spanish territory or during their temporary movements to Spain, in the manner, to the extent and under the conditions established in the Community or bilateral provisions indicated.

Under no circumstances shall nationals of Member States of the European Union, the European Economic Area or Switzerland who are in the situation of a stay of less than three months regulated in article 6 of R.D. 240/2007, of 16 February, on the entry, free movement and residence in Spain of citizens of Member States of the European Union and other States party to the Agreement on the European Economic Area, be considered as foreigners not registered or authorised as residents in Spain for the purposes set out in article 3 ter of Law 16/2003, of 28 May.

Medical assistance for persons with disabilities (Royal Legislative Decree 1/2013, of 29 November, approving the Consolidated Text of the General Law on the Rights of Persons with Disabilities and their Social Inclusion)

The special system of social and economic benefits for people with disabilities who were not included in the field of application of the Social Security System, established by the former Law 13/1982 of 7 April 1982 on the social integration people with disabilities (LISMI), is maintained.

Competence for the recognition of entitlement to medical assistance under this special system was initially vested in the Institute of Social Services and the Elderly and subsequently in the Autonomous Regions.

Medical Assistance by the Special Schemes for Civil Servants

Persons who are members or beneficiaries of the special Social Security schemes managed by the General Mutual Society for State Civil Servants, the Social Institute of the Armed Forces and the General Judicial Mutual Society, maintain the system of compulsory health benefit coverage in accordance with the special regulations governing each Mutua society, which also determines their respective protected group, including civil servants who have joined any public administration after 1 January 2011 in bodies that are part of the field of application of mutualism. These officials shall retain their status as mutual society members when they become pensioners.

The recognition and control of the status of member or beneficiary is the responsibility of each mutual society, in accordance with its specific regulations, as well as its respective organisational structure.

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 their own or derived rights when these are incompatible, as well as to ensure access to the public health system for the group of members who have opted for this type of medical assistance.

Foreigners not registered or authorised as residents in Spain (art. 3 ter Law 16/2003, de 28 May, of cohesion and quality of the National Health System).

Foreigners who are not registered or authorised as residents in Spain have the right to health protection and medical assistance under the same conditions as Spanish nationals.

Such assistance shall be at the expense of the public funds of the competent administrations provided that such persons meet all of the following requirements:

  • Not being obliged to prove compulsory health care coverage by any other means, by virtue of the provisions of European Union law, bilateral agreements and other applicable regulations.
  • Not being able to export the entitlement to health cover from their home country or country of origin.
  • There is no third party obliged to pay.

This care does not generate an entitlement to medical assistance coverage outside Spanish territory financed by the public funds of the competent administrations, without prejudice to the provisions of the applicable international social security standards.

The competence for the recognition of the right to medical assistance corresponds to the Autonomous Regions/Public Health Services.

The Autonomous Regions, within the scope of their competences, shall establish the procedure for applying for and issuing the certifying document accrediting foreigners to receive this welfare benefit.

Applicant for international protection (Fourth additional provision of Royal Decree 1192/2012, of 3 August, which regulates the status of insured and beneficiary for the purposes of medical assistance in Spain, at public expense, through the National Health System).

Applicants for international protection whose stay in Spain has been authorised for this reason shall receive, while they remain in this situation, medical assistance to the extent provided for in the basic common portfolio of NHS care services regulated in article 8 bis of Law 16/2003, of 28 May.

Necessary assistance, medical or otherwise, shall also be provided to applicants for international protection with special needs.

The competence for the recognition of the right to medical assistance corresponds to the Autonomous Regions/Public Health Services.

Victims of human trafficking in a period of establishment and reflection (Additional Provision Five of Royal Decree 1192/2012, of 3 August, which regulates the status of insured and beneficiary for the purposes of medical assistance in Spain, charged to public funds, through the National Health System).

Victims of trafficking in human beings whose temporary stay in Spain has been authorised during the period of recovery and reflection shall receive, while they remain in this situation, medical assistance to the extent provided for in the basic common portfolio of NHS care services regulated in article 8 bis of Law 16/2003, of 28 May.

Necessary assistance, medical or otherwise, shall also be provided to victims of trafficking in human beings with special needs.

The competence for the recognition of the right to medical assistance corresponds to the Autonomous Regions/Public Health Services.

Special agreement on the provision of medical assistance (Royal Decree. 576/2013 of 26 July)

For the purposes of the provisions of Article 3.3 of Law 16/2003 of 28 May, those persons who, not being insured or beneficiaries, do not have access to a public health protection system by any other means, may obtain the provision of medical assistance through the payment of the corresponding consideration or fee derived from the subscription of a special agreement.

This means of access to the provision of medical assistance, regulated in the R.D. 576/2013, of 26 July and developed by Order SSI/1475/2014, which establishes the basic requirements of the special agreement for the provision of medical assistance to persons who are neither insured nor beneficiaries of the NHS, in force since 01-09-2013, allows  the persons who sign it to access, against payment of a financial consideration, the benefits of the basic common portfolio of NHS healthcare services regulated in article 8 bis of Law 16/2003, of 28 May, with the same guarantees of extension, continuity of care and coverage enjoyed by persons who are insured or beneficiaries of the NHS, in the area corresponding to the public administration with which the agreement is formalised and without prejudice to the provisions of the additional provision of article 8 bis of Law 16/2003, of 28 May, with the same guarantees of extension, continuity of care and coverage that the persons who have the status of insured or beneficiaries of the NHS enjoy, in the area corresponding to the public administration with which the agreement is formalised and without prejudice to the provisions of the additional provision of this royal decree.

The competence for the recognition of the right to medical assistance through the special agreement corresponds to the National Health Management Institute.

Maintenance of the requirement of effective residence (art. 51 TRLGSS)

For the purposes of maintaining the entitlement to health benefits for which effective residence in Spanish territory is required, the beneficiary of these benefits shall be understood to have their habitual residence in Spain even when they have stayed abroad, provided that these do not exceed 90 days during each calendar year.

Insured and beneficiary for the purposes of international regulations and the contribution to the pharmaceutical benefit

For the purposes of the provisions of the international regulations on the coordination of Social Security systems, and the revised text of the Law on guarantees and rational use of medicines and health products, approved by Royal Legislative Decree 1/2015, of 24 July, the persons listed in the section on holders of the right to medical assistance are considered insured persons.

For the same purposes, the spouse or person with a similar relationship of affectivity, who must accredit the corresponding official registration, as well as the descendants and assimilated dependants of the same who are under 26 years of age or who have a disability to a degree equal to or greater than 65% shall have the status of beneficiaries of the previous insured persons, provided that they fulfil all of the following requirements:

  • That they have their legal and habitual residence in Spain, unless this is not required by virtue of the corresponding international regulation, or they are persons who temporarily move to Spain and are in charge of workers transferred by their company outside Spanish territory in a situation assimilated to that of being registered in the corresponding Social Security scheme.
  • That they do not fall under any of the following Social Security schemes:
    1. That they are a worker employed by another person or self-employed worker, affiliated and in a situation of registration or assimilated to that of registration.
    2. That they are a contributory pensioner under these schemes.
    3. That they are in receipt of any other periodic benefit from these schemes.

For these purposes, the following shall be considered as persons assimilated to descendants:

  • Minors subject to the guardianship or legal foster care of an insured person as policyholder, of their spouse or of their unmarried partner.
  • Sisters and brothers of the person insured as policyholder.
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