In Spain, all economically active persons are compulsorily covered by the public healthcare system. As the system is financed through taxation rather than individual health insurance contributions, the healthcare benefits provided are generally the same for everyone. You are covered from the date of registration; however, in order to obtain your Spanish health card, you must apply for it at the healthcare centre (Centro de Salud) corresponding to your place of residence. Once you are registered, eligible family members may also be included as beneficiaries without additional contributions.

Healthcare in Spain

Spain has a public and generally universal healthcare system (Sistema Nacional de Salud – SNS), which provides comprehensive medical care.

Persons covered by the Spanish Social Security system generally have access to public healthcare. This applies in particular to employees whose Social Security contributions are paid through their employment, as well as to self-employed persons registered with the RETA (Régimen Especial de Trabajadores Autónomos).

Pensioners and retirees may also be entitled to public healthcare. Where a pension is received from another EU/EEA Member State or Switzerland, the European rules on the coordination of social security systems must be taken into particular consideration.

Health insurance for German pensioners

German pensioners living in Spain can register with the Spanish public healthcare system and receive treatment in Spain under the same conditions as other persons insured in Spain. Although German statutory health insurance generally remains in place, it is advisable to consider the following points regarding responsibility and registration.

Which healthcare system is responsible for you depends both on your place of residence and on the country from which your pension is paid. In principle, two situations must be distinguished. For most German pensioners wishing to spend their retirement in Spain, section a) applies.

a) You receive your pension exclusively from Germany

If you receive your pension exclusively from Germany, your place of residence in Germany or Spain is generally irrelevant for determining which country is responsible for your healthcare coverage, as the German health insurance system remains responsible. You can therefore register with the Spanish public healthcare system while continuing, where applicable, to make use of the benefits provided by German statutory health insurance.

Under German case law, after registering in Spain it is not necessary to re-establish your residence in Germany in order to receive healthcare benefits there, as pensioners living abroad continue to be entitled to the benefits provided by the German statutory health insurance system.

In this respect, the German Federal Social Court (Bundessozialgericht) ruled in 2005: “A person compulsorily insured under the German pensioners' health insurance scheme (KVdR), who receives a pension exclusively from the German pension insurance system, does not lose their insured status by transferring their residence to another Member State of the European Union (EU).“ (Case No.: KR 2/04 R)

Registration with the Spanish healthcare system therefore does not result in any disadvantage in this respect. In addition to access to healthcare in both countries, you also retain your entitlement to German long-term care allowance (Pflegegeld), which can also be received while living in Spain.

b) You receive a pension from both Germany and Spain

If you worked in Spain for at least one year during your working life and therefore receive a pension from both Germany and Spain, the German health insurance system ceases to be responsible once you transfer your residence to Spain. In this case, as in the previous situation, you will receive a Spanish health card, but you will lose your German health card. In order to regain full entitlement to German health insurance benefits in this situation, it would be necessary to transfer your residence back to Germany. Otherwise, you will be treated as a temporary visitor and the healthcare services available in Germany through the European Health Insurance Card will be limited to medically necessary treatment.

Pensioners previously covered by private health insurance

If you were privately insured in Germany before retirement, you must generally also obtain private health insurance in Spain or voluntarily join the public Social Security system where possible. Another possibility is to receive pensions from both Germany and Spain. If, for example, you work in Spain for one year before retirement, either as an employee or as a self-employed person, you may become entitled to a Spanish pension and consequently be covered by the Spanish healthcare system for life.

Special Healthcare Agreement (“Convenio Especial de Asistencia Sanitaria”): For German pensioners and retirees with private health insurance whose German health insurance coverage cannot be transferred to the Spanish public healthcare system through the European S1 form, it may, subject to certain requirements, be possible to enter into a “Convenio Especial” with the competent health authority of the relevant Autonomous Community in Spain.

Under this agreement, access to the Spanish public healthcare system is provided in return for payment of a fixed monthly contribution. The contribution is generally approximately €60 per month for persons under the age of 65 and approximately €157 per month for persons aged 65 or over. Entering into this agreement does not automatically terminate German private health insurance. Before doing so, it is therefore advisable to determine which benefits will continue to be covered by the German private health insurance policy, to what extent any German Beihilfe benefits should be taken into account, and whether maintaining dual coverage is economically worthwhile.

Registration with the Spanish healthcare system

1. In order to register with the Spanish healthcare system, you must first apply for the S1 certificate (formerly E 121) from your German health insurance provider. Further information on how to obtain the certificate is available from your health insurance provider.

2. With the certificate obtained in Germany, you can register your entitlement to healthcare in Spain with the Spanish National Social Security Institute (INSS). Once registered, you can obtain your Spanish health card, which gives you access to the Spanish public healthcare system.

As lawyers, tax advisers and a registered PAE, our firm will be pleased to analyse your individual situation, carry out the relevant administrative procedures on your behalf and file the necessary tax returns for you. Further information about our services for self-employed persons and businesses can be found in the section Self-Employment.

If you are interested in our services or have any specific questions regarding this subject, please feel free to contact us by email or telephone.

Author:

Christoph Sander
Lawyer and Tax Advisor
CEO, Partner, Director
info@sspartners.es
Tel: (+34) 951 12 13 06
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