healthcare

How can I spend the winter in Spain or emigrate to Spain in a healthy way?

You may be one of the many Dutch people who are currently considering the idea of emigrating to Spain or spending the winter there and you are wondering how health care is arranged in Spain.

Healthcare in Spain

Healthcare can be a barrier to emigration to Spain, especially if you are (chronically) ill or in need of care, but in general healthcare in Spain is at least as good as in the Netherlands. Because many things are arranged differently in Spain, this is also the case in healthcare. And that takes some getting used to! To help you with this, CasaLasDunas offers you as a (potential) customer the necessary information. If you choose to emigrate to Spain, CasaLasDunas may provide guidance and mediation in healthcare. The information we hereby offer you covers the following topics:

• Healthcare in Spain in general;
• What to do in concrete situations?
• How can I insure myself and what am I entitled to?

Healthcare in general

In Spain there is a clear separation between state healthcare provided by the government and private healthcare. There are state hospitals, state nursing homes, state general practitioners, etc. and there are also private hospitals, private nursing homes, private general practitioners, private dentists, etc.

The state health care

The government (Ministerio de Sanidad) is responsible for the state healthcare system in Spain, often colloquially called Seguridad Social (INSS). There are in fact 3 possible situations in which you can claim the Seguridad Social in Spain. These situations apply to you and to any spouses and children. Firstly, if you receive a pension or benefit from the Netherlands. In this case, you must request an S-1 form from the CAK for emigration. You will need this form in combination with the necessary documents (including NIE, passport and possibly marriage booklet) when you have made an appointment with the Seguridad Social for registration. Always check in advance which documents are requested. Registration in the Seguridad Social can take a while, so always make sure you have a transition when you come to Spain (for example through travel insurance). In this situation, a deduction will be made from your pension or benefit in the Netherlands for the Seguridad Social in Spain. Secondly, you can claim the INSS if you receive a benefit or pension from Spain or if you work in Spain (in your own company, as a self-employed person or as an employee). In this case, a deduction will be made from your benefit or salary or, as a self-employed person, you will pay a monthly amount for the INSS (approximately €300). Third, you can claim the INSS if you register privately with the Segurdad Social. You will then receive the same coverage as everyone else. However, for this you must be able to demonstrate that you have been living in Spain continuously for at least one year. This is not possible or easy in every region in Spain. Please inquire with us about the possibilities. If you are in the Seguridad Social, you can visit a GP at the GP post (Centro Salud) in your place of residence and you are dependent on a state hospital in your region (if you wish, you can choose a doctor from a GP post in another municipality or go to a state hospital in another region, but that is not easy). The Seguridad Social has general coverage without exclusions. Compared to the Netherlands, it is a basic package and extras are not insured. Dental care is not included in the package (only for children up to 18 years old). Take into account possible longer waiting lists in case of planned medical treatments.

Private healthcare

In addition to your health insurance, you can always take out private health insurance in Spain. You are then entitled to a private GP and in most cases you can go to a private hospital of your choice. The big advantage of private healthcare is that you can always approach a GP who speaks Dutch or is Dutch and in private hospitals you always have access to an interpreter. A disadvantage is that your private insurance does not cover medicines and that you have to rely on the Seguridad Social for this. Present and past conditions are also excluded from coverage. Medical care in the Spanish health insurance fund and private health care is of the same level. You really don't have to worry about that. The organization of care may be different in the Spanish health insurance fund: less service-oriented and with fewer 'bells and whistles'. In a private hospital you get your own room, a choice menu, foreign television and other extras.

If you have decided to move to Spain, it is important to take the following actions:

• Inform your benefits or pension agency about your move;
• Inform your current health insurer when the moving date is known;
• Request the S-1 form from the CAK in a timely manner;
• Register in the population register of the municipality where you live in Spain;
• Register in the Seguridad Social (by submitting form S-1);
• Apply for your health insurance card (SIP card) at the local Centro Salud;
• If necessary, take out private health insurance.

If you do not receive benefits or a pension from the Netherlands, you do not have to inform those authorities (although it is always important that your pension fund has your current address in Spain).

What to do in concrete situations if you have emigrated to Spain?

If you are going to live permanently in Spain, you must be entitled to the provisions of the Seguridad Social in Spain. You can also take out additional insurance through Spanish private health insurance. From the moment you live in Spain, your benefit or pension agency in the Netherlands will withhold a contribution from your benefit or pension. This is generally less than the premiums you have paid so far. If you do not receive a benefit or pension from the Netherlands, the premiums for the Spanish health insurance fund will be deducted from your Spanish salary (if you work in Spain) or Spanish benefit. Below you will see a number of specific situations where you can claim:

• You need a doctor
• You will be referred to a hospital
• You have an emergency
• You need a physiotherapist or a dentist
• You need home care
• You must be admitted to a care or nursing home

You need a doctor

Then go directly to your local GP post (Centro Salud). In the larger municipalities this is always open (24 hours a day) and if this is not the case, you will be referred to a neighboring municipality. Just like in the Netherlands, your GP plays a role in the referral to the hospital. You always take your health insurance card (SIP card) with you for identification. In the event of an emergency, go immediately to the hospital's emergency room or call an ambulance (112). If you are prescribed medication, the prescription will be written for you. If you are younger than 65 years old, you pay the pharmacist 40% of the medicine costs. If you are over 65 years old, the medicines are free for you or you pay a minimum percentage of 5 or 10% with a maximum per month depending on the amount of your pension.

You will be referred to a hospital

If your GP refers you to a hospital, you must report to the state hospital in your region. Your GP will tell you which hospital that is. You also report to that hospital with your health insurance card. Discuss it with your doctor if you would prefer to visit another state hospital. Every state hospital has a Servicio de Atención y Información al Paciente (SAIP) where you as a patient can go with all your questions and complaints.

You have an emergency

You immediately report to the emergency room of the state hospital with your health insurance card. If you call an ambulance, state that you are a member of the Seguridad Social and that you want to be admitted to a state hospital. Spain has two types of ambulances: (1) the trauma ambulance with a doctor present in the event of serious accidents or conditions and (2) the ambulance with only a driver who transports you to the hospital in a stable condition. If you call an ambulance in a serious situation, always try to convey the seriousness of the matter!

You need a physiotherapist or dentist

In Spain, a dentist is not insured by the health insurance fund. You must therefore pay for this yourself or take out private health insurance. There is only limited cover for certain treatments for children up to the age of 18. Physiotherapy is covered and depending on the rehabilitation, you will be referred to the physiotherapist at your Centro Salud or in the hospital. Physiotherapy in the Seguridad Social is usually organized in a more group-oriented manner. Therefore, expect less personal attention.

You need home care

Since January 1, 2007, you are entitled to home care offered by a state institution through the Spanish health insurance fund. However, the practice is not yet set up to implement the associated new law (La Ley de la Dependencia), which means that you may have to wait a considerable time before you are indicated and can receive home care. Just like in the Netherlands, there is a system of indication and urgency: people who need it most receive care first. Unfortunately, there is still a general capacity problem in Spain (too few staff available). Long-term care such as home care and nursing home care do not fall under the Seguridad Social, but under the Social Affairs department of your municipality of residence. If you believe you are entitled to long-term care, you must also report there for an indication.

You must be admitted to a care or nursing home

You are also entitled to admission to a (state) nursing home. Nursing homes do not exist in Spain, at least provided by the state (private nursing homes still exist). It is common that you are only admitted to a nursing home when you no longer have anyone to care for you and when you really need nursing home care. If an admission is urgent, a place will always be found for you, but you have no say in which nursing home. Just like with home care, you may be lucky and the Social Services will refer you to a private nursing home, because they have made agreements with one. There is no option to insure yourself privately for admission to a private nursing home. So suppose you choose to be admitted to a private nursing home, you will have to pay those costs entirely yourself. Take into account an average amount of €2,400 per month, all-in.

What to do in concrete situations if you are temporarily staying in Spain?

If you only stay in Spain for a few months per year, you will remain insured for medical expenses and long-term care in the Netherlands (except if you go to work in Spain). Before you go to Spain, read the policy conditions of your health insurance carefully and contact your health insurer, because it is good to know what you should do when you need a doctor or are admitted to a hospital. Good to know that you are always entitled to private healthcare in Spain through your Dutch health insurance. Before you leave for Spain, also request the European Insurance Card (EHIC) from your insurer. This means you are assured of medical care (in a state hospital). A (continuous) travel insurance is certainly not an unnecessary luxury (because in some cases the Dutch health insurer will reimburse less than the costs incurred in Spain). So you always have 2 options: to a state institution or doctor (reimbursement based on the treaty scheme through your European Insurance Card) or to a private institution or doctor (reimbursement afterwards based on your health insurance in the Netherlands).

• You need a doctor
• You will be referred to a hospital
• You have an emergency
• You need a physiotherapist or dentist
• You need home care

You need a doctor

Go directly to a local (state) GP post (Centro Salud) or visit a private GP. In most cases it is better to visit a private doctor, because he or she will speak Dutch with you, for example. In some – urgent – cases it is better and faster to visit the GP post in your place of residence. If you visit a private doctor, you may have to pay for the consultation. In most cases, you can claim the bill you receive from this doctor from your health insurer in the Netherlands.

You will be referred to a hospital

If you are referred to a hospital, choose a private hospital near you. If you only consult a specialist, you will be asked to pay the costs for that consultation immediately. Here too, you can declare the bill you receive for this in the Netherlands to your health insurer. If you need to be admitted, you will be asked for your insurance papers. In some cases you will be asked to pay a deposit. Once the hospital has received a financial guarantee from your health insurer in the Netherlands, you can request your deposit back. In that case, you no longer have to pay anything for your stay in the hospital. In a limited number of cases, you have taken out health insurance in the Netherlands that reimburses the costs to you and not to the hospital if you are admitted abroad. In that case, you must first pay the costs for your admission to Spain yourself. So always make sure what type of insurance you have taken out in the Netherlands before you go abroad and, if in doubt, always contact your insurer to be sure what to do in case of medical care in Spain. There are currently more and more hospitals in Spain that have an agreement with Dutch health insurers and you only have to show your health insurance card.

You have an emergency

Here again, you have to consider the urgency. Which hospital are you going to? Preferably to a private hospital, but if the problem is very urgent and a state hospital is closer, then you prefer to go to the state hospital. In a number of cases, you will also be asked to pay a deposit in the event of an emergency admission. Fortunately, this does not apply to all private hospitals.

You need a physiotherapist or dentist

Depending on your health insurance in the Netherlands, you can claim the costs you paid for your physiotherapist or dentist in Spain from your health insurer in the Netherlands. Please also inform yourself about this before your departure to Spain.

You need home care

You can contact a private home care institution. You should discuss the question of whether the care they provide will be reimbursed by your health insurer with them or with your health insurer. In most cases, temporary home care is still reimbursed. Always contact your health insurer in advance to avoid any unwanted surprises.

Admission to a care or nursing home in Spain during a temporary stay is generally no longer reimbursed under the Dutch Long-term Care Act. It is best to contact your health insurer about this.

How can I insure myself in Spain and what am I entitled to?

If you are not satisfied with the provisions of the Seguridad Social in Spain, you may consider private health insurance in Spain. Please note that if you receive a benefit or pension from the Netherlands, you will also pay a deduction from your Dutch benefit or pension in addition to the premium for Spanish private insurance. That's double. As compensation, an arrangement has been agreed whereby Dutch retirees receive an EHIC card from the Netherlands and can therefore receive all medical care in the Netherlands. Of course, taking out private health insurance in Spain also has advantages: you can always go to a doctor who speaks your language or has an interpreter and in general the medical care in the state and private systems is the same, but the service that you as a patient receive in private healthcare is always much better than in state healthcare. In Spain you can choose from a large number of private health insurers. Many insurers offer a policy specifically intended for foreigners. However, read the policy conditions carefully, because the benefits do not always apply to you. All policy conditions can be viewed via the website of the relevant insurer. Unfortunately, in many cases only available in the Spanish language and the amount of text does not make it any easier. When choosing a particular health insurer, you should consider a number of things:

• Do you want your insurer to settle directly with your practitioner or hospital?
• Do you want total freedom in your choice of hospital or doctor?
• Do you want a waiting period for treatment or not?

Private health insurers in Spain – just like in the Netherlands – have roughly two types of policies, namely a reimbursement policy and a kind policy. In the case of a reimbursement policy, you pay for your consultation, treatment or admission yourself and the insurer will reimburse you for the costs incurred based on original invoices. With an in-kind policy, your doctor, practitioner or hospital immediately settles the costs with your insurer without you having anything to do with it.

Almost all insurers give you the freedom to choose your own doctor, practitioner or hospital. With many insurers you can also opt for a so-called 'cuadro médico': this means that the insurer has a contract with a number of doctors and hospitals from which you can choose. In the latter case you pay less premium!

Unfortunately, it is not possible to insure yourself today and make an appointment for treatment tomorrow. In almost all cases there is a so-called waiting period. Except in case of emergency of course; then you will be helped in all cases. When choosing private health insurance, it is advisable to compare the waiting times.

In addition to the above, you will of course compare prices, reimbursements, benefits in kind and other important policy conditions. It is also important to know that no private Spanish health insurer covers medicines, except those provided during your stay in a hospital. You can always go to the Seguridad Social for your medicines. This is a difficult side effect of the insurance system in Spain. After all, you must visit your GP in the Centro Salud of your place of residence with the prescription from your private doctor. Especially if it concerns expensive medicines, this doctor will question the necessity and may consider an examination in a state hospital necessary. However, in most cases this is not necessary.

If you have any questions, you can always contact us using the form below.