Special Agreement (Convenio Especial) on Healthcare Provision

The special healthcare agreement for foreign residents in Spain is for those who do not have access to the National Health System and need to ensure their health coverage, such as economically inactive foreigners.

It allows affiliation to the SNS, against payment of a fee, 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.

Requirements, After One year

The requirements are as follows:

Document accrediting effective residence in Spain for a continuous period of at least one year immediately prior to the date of the application for the special agreement. The residence requirement will be understood to be fulfilled when periods of residence in the territory of the other EU Member States, the EEA, Switzerland or the United Kingdom are proven.
Be registered in a Spanish municipality at the time of submitting the application for the special agreement.
Not have access to a public healthcare system by any other means, whether through the application of national legislation, European regulations on Social Security or bilateral agreements signed by Spain in this area.

How much does it cost

The cost is:

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

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

Foreign nationals receiving public pensions do not need to sign the special agreement if they can prove, with the appropriate certificate, that they are entitled to healthcare from the State from which they receive their pension. For example, with S1 form for pensioners from the European Union (EU)/European Economic Area (EEA)/Switzerland/United Kingdom.

How to Apply?

It can be processed by submitting an application along with your National Identity Document (DNI/NIE) and proof of registration at an official registry. The process includes submitting the application, receiving a decision of acceptance or rejection (within a maximum of 30 days), and formalizing the agreement within three months of notification.

Who can apply?
Economically inactive foreigners residing in Spain who need health insurance to meet residency requirements.

Submit the application: Send the application form along with a copy of your DNI/NIE or passport and proof of registration in Spain for at least one year.

Notification of the decision: The competent authority will respond within a maximum of 30 days. If there is no response, the application will be considered approved. Formalizing the agreement: Once the resolution has been notified, you have three months to formalize it.

Effects: The agreement enters into force on the same day it is formalized.

EU Member State Citizens

It must be kept in mind that the European Health Insurance Card (EHIC) only gives access to healthcare in the SNS during temporary stays; it is not a valid document for taking up residence in Spain.

Citizens of an EU Member State or of a State party to the EEA Agreement, and family members who are not nationals of one of these States, who have been legally resident in Spain for a continuous period of five years acquire the right of permanent residence and are therefore entitled to healthcare in the SNS at public expense (1) and do not need to sign the special agreement.

Legal Framework

The special agreement (‘convenio especial’) on healthcare provision allows affiliation to the Spanish National Health System (‘Sistema Nacional de Salud’, SNS), the public health insurance scheme, and is aimed at economically non-active foreigners who need to take out health insurance in order to reside in Spain, in accordance with the provisions of:

Royal Decree 240/2007 of 16 February 2007 on the entry, free movement and residence in Spain of citizens of the Member States of the European Union and other States party to the Agreement on the European Economic Area (‘Real Decreto 240/2007, de 16 de febrero, sobre entrada, libre circulación y residencia en España de ciudadanos de los Estados miembros de la Unión Europea y de otros Estados parte en el Acuerdo sobre el Espacio Económico Europeo’).
Directive 2004/38/EC of the European Parliament and of the Council of 29 April 2004 on the right of citizens of the Union and their family members to move and reside freely within the territory of the Member States.
Royal Decree 557/2011 of 20 April 2011 approving the Regulation of Organic Act 4/2000 on the rights and freedoms of foreigners in Spain and their social integration, following its amendment by Organic Act 2/2009 (‘Real Decreto 557/2011, de 20 de abril, por el que se aprueba el Reglamento de la Ley Orgánica 4/2000, sobre derechos y libertades de los extranjeros en España y su integración social, tras su reforma por Ley Orgánica 2/2009’).