Special agreement on healthcare provision

It allows affiliation to the SNS, against payment of a fee and without co-payments or grace periods, to all the healthcare benefits of SNS basic common basket of benefits, which includes the healthcare activities of prevention, diagnosis, treatment and rehabilitation carried out in healthcare or socio-health centres, as well as emergency health transportation. Both in primary and specialised healthcare, as well as in outpatient and inpatient healthcare.

Outpatient pharmaceutical benefit, outpatient ortho-prosthetics benefit, foods for special medical purposes benefit, and non-emergency medical transportation have a 100% contribution by the patient. 

The special agreement allows access by means of a health card in physical and/or virtual format to healthcare in the territory of the Autonomous Community (Region), as well as for temporary stays to other Autonomous Communities (Regions) and the cities of Ceuta and Melilla within the scope of the SNS. Also during a temporary stay in the EU/EEA/Switzerland/United Kingdom by means of the Provisional Replacement Certificate (PRC) in physical and/or virtual format issued by the National Institute of Social Security (‘Instituto Nacional de la Seguridad Social’, INSS).

a) If the signatory is under 65 years of age: monthly fee of 60 euros.

b) If the signatory is 65 years of age or older: monthly fee of 157 euros.

• Identification document of the applicant (Identity card/Foreigner identification number (‘Número de identidad de extranjero’, NIE)/Passport or Residence card).
• Document accrediting effective residence in Spain or in the territory of the other EU Member States, the EEA, the United Kingdom or Switzerland for a continuous period of at least one year immediately prior to the date of the application for the special agreement.

This requirement may be evidenced by a resident certificate issued by the Directorate General of Police (‘Dirección General de la Policia’) or by a city registration issued by a Spanish local town hall. Also, by a document issued by a consulate, a public document of domicile and/or residence issued by an authority of a Member State in accordance with Regulation (EU) 2016/1191 or by any means valid in law in the case of foreign nationals coming from other EU Member States, the EEA, the United Kingdom or Switzerland.

• City registration in a Spanish municipality (registration in the ‘padrón’).

In accordance with the provisions of article 16.2.f of 'Act 7/1985, of 2 April, Regulating the foundations of the Local administration (‘Ley 7/1985, de 2 de abril, Reguladora de las Bases del Régimen Local'), the municipality will request the Foreigner Identity Card (‘Tarjeta de Identidad de Extranjero’, TIE) or, after registration in the Central Register of Foreigners (‘Registro Central de Extranjeros’, RCE), the Certification of Registration of a citizen of the EU for those from the EU/EEA. If these documents are not submitted, the registration in the ‘padrón’ will be carried out with the number of the identity card or valid passport issued by the authorities of the country of origin. Local town halls may not refuse registration in the ‘padrón’ to foreign citizens who habitually reside in the municipality, regardless of whether or not they are legally resident in Spanish territory.

According to Article 18.2: "The registration of foreigners in the ‘padrón shall not constitute proof of their legal residence in Spain nor shall it confer on them any right that is not conferred on them by the legislation in force, especially with regard to the rights and freedoms of foreigners in Spain." (‘La inscripción de los extranjeros en el padrón municipal no constituirá prueba de su residencia legal en España ni les atribuirá ningún derecho que no les confiera la legislación vigente, especialmente en materia de derechos y libertades de los extranjeros en España’)." It is, therefore, a separate register from the Central Register of Foreigners (RCE), which is carried out through registration at Police Stations or Foreigners Offices and for which it is not required to provide a city registration.

• Declaration of responsability or legislation letter (‘certificado de no exportación’) stating that the foreigner citizen is not covered in Spain by the healthcare of his/her country of origin, issued by the competent administration of his/her country, certifying that he/she does not have access to a public healthcare protection system by any other right, either by application of national regulations, European regulations on Social Security or bilateral agreements on this matter that have been signed by Spain with other countries.

This requirement only applies to foreigners from countries to which European Regulations No 883/04 and No 987/09 on the coordination of social security systems (Austria, Belgium, Bulgaria, Czech Republic, Croatia, Cyprus, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Switzerland), the EU–UK Trade and Cooperation Agreement (United Kingdom) or countries with a bilateral social security agreement (Andorra and Chile) apply.

The special agreement on healthcare provision is signed with the Regional Health Service of the Autonomous Community (Region) in which the municipality where the foreign citizen is registered is located or with the National Institute of Health Management (‘Instituto Nacional de Gestión Sanitaria’, INGESA) in the cities of Ceuta and Melilla.

You can access the following link to the websites of the Autonomous Health Services with information on how to sign the special agreement: https://www.sanidad.gob.es/organizacion/ccaa/directorio/home.htm

• Andalucía
• Aragón
• Asturias, Principado de
• Balears, Illes
• Canarias
• Cantabria
• Castilla-La Mancha
• Castilla y León
• Cataluña
• Madrid, Comunidad de
• Murcia, Región de
• Comunitat Valenciana
• Extremadura
• Galicia
• Rioja, La
• Navarra, Comunidad Foral de
• País Vasco
• INGESA

Act 16/2003 of 28 May on the cohesion and quality of the National Health System (‘Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud’ ); article 3 "Holders of the right to health protection and healthcare" (‘Titulares del derecho a la protección a la salud y a la atención sanitaria’)"; paragraph 3 "Those persons who, in accordance with paragraph 2, are not entitled to healthcare charged to public funds, may obtain this benefit through the payment of the corresponding consideration or fee derived from the subscription of a special agreement" (‘Aquellas personas que de acuerdo con el apartado 2 no tengan derecho a la asistencia sanitaria con cargo a fondos públicos, podrán obtener dicha prestación mediante el pago de la correspondiente contraprestación o cuota derivada de la suscripción de un convenio especial ’)"

Regulatorily developed by “Royal Decree 576/2013 of 26 July which sets out the basic requirements of the special agreement for the provision of healthcare to persons who are neither insured nor beneficiaries of the National Health System and amends Royal Decree 1192/2012 of 3 August which regulates the status of insured and beneficiary for the purposes of healthcare in Spain, charged to public funds, through the National Health System (‘Real Decreto 576/2013, de 26 de julio, por el que se establecen los requisitos básicos del convenio especial de prestación de asistencia sanitaria a personas que no tengan la condición de aseguradas ni de beneficiarias del Sistema Nacional de Salud y se modifica el Real Decreto 1192/2012, de 3 de agosto, por el que se regula la condición de asegurado y de beneficiario a efectos de la asistencia sanitaria en España, con cargo a fondos públicos, a través del Sistema Nacional de Salud’).”