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Beneficiaries / Protected Situations

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Languages available: Castellano

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Languages available: Castellano

Beneficiaries

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.

Protected Situations

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

Maintaining the residency requirement

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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