Holders/Requirements

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.
  

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. 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.

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. 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. Be 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.
  

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.