Health insurance when moving to Spain: the checkpoints

The Spanish health system (Sistema Nacional de Salud) is publicly funded and geared towards universal access; the Autonomous Communities issue the health card (Tarjeta Sanitaria Individual), which is valid throughout the system.

The basic package covers prevention, diagnosis, treatment, rehabilitation and urgent patient transport and is fully publicly funded; additional services of a community are not part of the general funding. You clarify co-payments with the health service of your future community.

In principle, the country responsible for health insurance is the country where you work, otherwise the country where you live; nationality does not count.

Foreigners with lawful, habitual residence in Spain have access to care at public expense if they do not otherwise have to show compulsory cover; anyone who does not meet the conditions can obtain access through a Convenio especial in return for payment.

The Convenio especial is aimed at economically inactive foreigners and, according to the Ministry of Health, requires at least one year of residence (time spent in other EU states also counts), entry in the municipal register (Padrón) and no other public health cover.

Anyone who wants to stay in Spain for more than three months must register in person at the Registro Central de Extranjeros within three months of arrival.

Employees and self-employed people show their activity when they register; anyone who does not work in Spain generally has to show health insurance with cover equivalent to that in Spain, plus sufficient means.

You ask the foreigners’ office (Oficina de Extranjería) which documents it accepts.

How the health services apply the Convenio especial today is something you clarify with them directly before you move. More on the policy under international health insurance.

Before you deregister (Abmeldung) in Germany, you clarify in writing what happens to your current insurance. The questions below apply to any destination country. They are questions, not legal advice: the answers are in your contract documents or come from the body you ask.

Three Spain topics you clarify in advance with your Krankenkasse (your statutory health insurer): the EHIC, a possible S1 (form for entitlement in your new country of residence) and the certificate for the Convenio especial.

If you have statutory insurance: questions for your Krankenkasse

• What happens to my membership when I deregister in Germany, and on what date does it end?
• Can I suspend the membership or take it up again later, and under what conditions?
• What confirmation of my previous insurance periods do I receive, and how quickly?
• What applies to co-insured family members: who stays insured and who does not?
• Is an S1 an option for me, and who issues it?
• Which certificate do I get from my insurer confirming that my entitlement is not exported to Spain?

If you have private insurance: questions for your insurer

• Does my contract end with the move, is it suspended or does it continue?
• Is there an Anwartschaft (a German option to keep certain rights in private insurance while abroad), and what is preserved under it? Ask about the difference between the small and the large Anwartschaft, and whether a new health assessment would be needed on a return.
• Does my contract apply in the destination country, and for how long at a stretch?
• Which documents do I receive in writing before I cancel?
• Does the policy apply in Spain for the entire length of stay?
• Does the insurer confirm scope of cover, area and term in writing?

Do not cancel any contract before it is clarified in writing what applies afterwards. We explain the connections on the pages Health insurance when emigrating and PKV and Anwartschaft. For families, there is more at Health insurance for the family abroad.

1. EHIC as a permanent solution

   The European Health Insurance Card (EHIC) only applies to temporary stays. Ask your Krankenkasse (your statutory health insurer) about the route for a change of residence.

2. Clarifying proof only once you are there

   Anyone who wants to stay in Spain for more than three months must register in person at the Registro Central de Extranjeros within three months of arrival. Clarify cover and documents beforehand.

3. Taking out a policy without checking it

   Have your cover in Spain confirmed and ask the Oficina de Extranjería whether it accepts the policy.

4. Convenio especial as an instant solution

   The Convenio especial (a special agreement for public healthcare access) requires at least one year of residence, entry in the municipal register (Padrón) and no other public health cover. Clarify how you cover the time until this protection begins.