Health

El derecho a la asistencia sanitaria en España está recogido en el artículo 43 de la Constitución Española, y se concreta en normativa específica como la LO 4/2000 (art. 12), el RD 1192/2012 (condición de asegurado/beneficiario) y, desde 2018, el Real Decreto‑Ley 7/2018, que reinstaura la sanidad universal desligando el derecho de la residencia legal y vinculándolo a la residencia efectiva.

Spain offers a public health system that can be accessed by both national and foreign citizens. Depending on your legal situation in the country, you will be entitled to full or limited medical services.

The Spanish public health system is designed to provide care to all residents of the country, regardless of their origin. Foreigners, whether legal residents or not, have certain rights in the Spanish system. 

• Legal residents have full access, similar to that of Spanish citizens. 
• On the other hand, foreigners in an irregular situation have limited rights, but still have access to basic and essential services.

Foreigners with legal residence; TS (Health Card)

Based on the implementing regulations, the National Institute of Social Security (INSS) is the competent body to recognize the right to health care from public funds. It is managed in the CAISS-INSS (Social Security Care and Information Centres). Once the INSS has recognized this right, you must go to the health center that corresponds to you according to your address (in principle, the nearest one), to request your health card.

If recognition of this right cannot be obtained by the INSS, the health benefit may be obtained by paying the corresponding fee derived from the subscription to the Special Agreement for the Provision of Health Care to the health care service corresponding to your autonomous community of residence. Once you have signed this agreement, you will be able to receive healthcare throughout Spain. It is not valid outside Spain and the subscription of the same does not entail the issuance of a health card.

If the foreign person is in a regular situation, but has an obligation to have medical insurance (students, holders of non-profit residence ...), he will not be able to obtain recognition of this right.

Foreigners without legal residence

Foreigners in an irregular administrative situation cannot obtain the IST (Individual Health Card), but they can acquire the corresponding health care document for immigrants without legal residence in Spain issued by the autonomous community in which they reside, with the same effects as the IST. This document is only valid in Spain and will have to be presented whenever you go to a health center, as well as in the pharmacies. Thanks to this document, you will be able to access all the benefits of the National Health System, including medical prescriptions, with a contribution of 40% of its price.

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

• Not have the obligation to prove the compulsory coverage of the health benefit by other means, under the provisions of European Union law, bilateral agreements and other applicable regulations.
• Not being able to export the right to health coverage from their country of origin or provenance.
• There is no third party obliged to pay.
• Accredit continuous residence in Spain for at least three months.

The Autonomous Communities, within the scope of their competences, will establish the procedure for the application and issuance of the certification document that proves that the foreign person in question is entitled to receive the aforementioned assistance. In those cases in which foreign persons are in a situation of temporary stay, it will be mandatory to issue a favorable preliminary report from the competent social services of the autonomous communities.

The minimum registration time in Spain to be accredited is three months. If you have previously resided in another autonomous community, you must prove it by means of the corresponding registration form. In case of manifest impossibility of registration or delay in its issuance, a report issued by a social worker of the Public Administration (City Council, Units and Centers of Public Social Services, Primary Care Centers, etc.) may be provided stating the reason for the lack or delay in issuing the registration certificate, and the date of entry into Spain.

The validity of this document will be two years, it will be renewable as long as the requirements are still met. The procedure, requirements and documentation for the renewal of the document are the same as those required when it was first requested.

For Community citizens, from Andorra or Chile, access to the National Health System will be given by accrediting the assistance in their country; the European Health Insurance Card (EHIC) or other European document for EU citizens or the existence of a bilateral agreement if it comes from Andorra or Chile.

Derogation: If you are not registered with the Social Security of your country of origin (European Union, Chile or Andorra) and this Agency issues you a Certificate of Non-Export of the Right to Health Care, you can request the health care document for foreigners without legal residence in Spain. In this case, you must also present the certificate of not being able to export the right to health care from your country of origin (if you come from a Community country, Andorra or Chile) issued by the Social Security office of your country.

Health care for applicants for international protection; IST or document for the healthcare of applicants for international protection

If your identity document of applicant for international protection authorizes you to work and you obtained a job that provided its corresponding registration in Social Security, you could apply for the health card at your reference health center.

If you are not registered as a worker in the Social Security System, the health care document as an applicant for international protection will be valid as long as there is no final decision regarding your procedure. This document is only valid in Spain and must be requested from the corresponding Ministry of Health once the application for international protection has been accepted for processing.

You will have to present yourself whenever you go to a public health center and pharmacy offices. With this document, you can access all the benefits of the National Health System, including medical prescriptions, with a contribution of 40% of its price.

The validity of the healthcare document shall be the same as that of the applicant’s red card or white card. The procedure, requirements and documentation necessary to renew it, are the same as to request it for the first time. When obtaining residence authorization, as a result of the favourable decision of the application for international protection, the assistance provided for asylum seekers cannot be applied for, so the INSS must be requested to recognize the right to assistance from public funds and, once obtained, process the health card in your health center.

If you have been denied international protection, you have access to assistance from public funds through the health care document for foreigners in an irregular administrative situation.