Information on the Spanish national health care system, with details on who benefits, where and how to register with the authorities and what contributions and benefits to expect.

It is compulsory for all workers resident in Spain to be enrolled with the General Social Security Fund (Tesorería General de la Seguridad Social – TGSS). Provincial social security offices are located throughout the country. The Social Security website has some information available in English.

The National Institute of Social Security (Instituto Nacional de la Seguridad Social – INSS) provides information regarding social security benefits (excluding unemployment benefits), including eligibility. Provincial National Social Security Institute offices are located throughout the country.

Qualifying for Social Security

Any person legally resident in Spain can benefit from the Spanish social security system if they fall into one of the following categories:

  • Employed workers
  • Self-employed workers
  • Students
  • Workers affiliated with a work co-operatives
  • Civil servants or military personnel

There are two different schemes for Social Security:

  1. Contributory
  2. Non-contributory

The contributory scheme is for some civil servants, employed persons who are not eligible for a special scheme and special schemes for the self-employed , mariners and coal miners. All contributory workers will fall into one of six labour categories (régimen), with contribution rates differing from category to category. It is not possible for a person to be registered in more than one scheme for the same occupation.

For employees, a set percentage of earnings is payable and contributions to the social security system will begin as soon as employment begins. Both the employee and employer pay a percentage of the contribution, with the employer paying a larger percentage than the worker. Payments are made towards social security coverage for:

  • Illness
  • Non work-related injuries
  • Retirement
  • Maternity and paternity leave
  • Work-related-injuries and occupational illness
  • Overtime
  • Unemployment
  • Wage Guarantee Fund
  • Occupational Training

Employers make contributions for social security coverage for work-related injuries and industrial accidents.

Self-employed workers receive the same types of social security coverage as employees except they are not covered for unemployment or industrial accidents. Those who are self-employed may choose between a minimum (at least approximately 29 percent of earnings) and maximum contribution amount, and they are responsible for payment of the full amount.

Obtaining a Social Security Affiliation Number

Registration with the social security service is compulsory for everyone working in Spain. Any resident, either salaried or self-employed, is entitled to a social security number. Once a number is obtained, it is valid for life. Periods of employment are referred to as “altas” and periods of unemployment are called “bajos“.

Employers need to request a social security number for the person they are going to employ if that person does not already have one.

Self-employed workers may make the application themselves or hire a gestorto complete the process for them.

The application form and required documentation should be presented to a local office (local to the applicant’s workplace or home) of the Tesorería General de la Seguridad Social. Once the application has been submitted, the worker will receive a certificate of registration (documento de afiliación) and a registration number.

The following documents must be presented:

  • A form of national identification with photocopy; a Número Identificatión de Extranjero (NIE) is sufficient
  • Residency certificate or passport
  • Modelo TA1 (Social Security application form)

In the event a worker is made redundant or otherwise stops working, theTesorería General de la Seguridad Social must be notified immediately. The worker is liable for contributions until the agency is notified.

Health Care Benefits

Once a person is registered with the Social Security administration they will be issued with a certificate giving them the right to obtain medical assistance. With this document they can apply for a health card (tarjeta de seguridad social) at their local health centre.

Once registered a SIP card will be allocated. A SIP card (Sistema de Informacion Poblacional) is issued to each person registered with the Spanish state health system and is should be presented whenever attending a clinic, hospital or collecting prescribed medication from the chemist.

People not qualified or affiliated

Any person who is not affiliated to the Spanish social security system may choose to to take out private health insurance or pay the full amount of any medical costs.

EU Country Benefits

European Conventions and Form S1 (former E121 and E106)

A person who has paid regular social security contributions in another EU country for two full years before coming to Spain can benefit from public health cover for a limited period from the date of their last social security contribution made in the other EU country. To do this, it is necessary to obtain Form S1 (former E106) and present it to the local Social Security office in Spain. Pensioners and those in receipt of invalidity benefits must obtain form S1 (former E121) from their home country’s social security administration.

Retired EU Citizens

EU nationals resident in Spain qualify for retirement when they reach the retirement age as established in their home country (not at the retirement age set in Spain). Retired people receive benefits and pay nothing provided they have a Form S1 (former E121). This form entitles them to the same benefits as a Spanish national. S1 should be obtained from the former country of residence.

It certifies that:

  • appropriate social security taxes have been paid in that country
  • the holder has reached the official retirement age
  • the holder is receiving a State pension.

Note: The European Health Insurance Card  (EHIC) is not valid for healthcare in Spain if the holder is resident in Spain.

Spanish Doctors and Hospitals

To receive medical treatment, those enrolled in the Spanish social security program should visit a public health centre in their area of residence. They will be referred to a specialist if necessary, however there can be waiting lists to see specialists and for non-urgent operations. In case of an emergency go directly to a hospital. A social security card or proof of private insurance should be presented at the hospital.

Retirement and Pension Benefits

The general retirement age in Spain is 65 years old; however, new reforms will see the retirement age increase to 67 years. The change will be implemented gradually from 2013 to 2027. The retirement age will increase by one month per year until 2018, and then by two months per year from 2019 to 2027. Certain professions have younger retirement ages. Residents who have reached retirement age and paid at least the minimum Social Security contribution for at least 15 years, including two years out of the last 15, qualify for a retirement pension (pensión de jubilación) There will also be an increase from 15 to 25 years of Social Security contributions required to determine the regulatory base of the pension. The retirement benefit paid is based on contributions made over the worker’s lifetime. From 2013 to 2027 the calculation will be gradually extended to the contributions made in the last 25 years.

Early retirement

Under new reforms the legal age of early retirement will rise from 61 to 63 years. For early retirement to be possible a minimum of 33 years of social security contributions are required.It may also be possible to retire at age 61 if social security contributions were made for at least 30 years and if registered as unemployed for at least six months prior to the application.

Disabled people and persons registered as unemployed for at least six months prior to the application may be entitled to retire at an earlier age.

How to apply for retirement benefit

A retirement pension application form must be completed and presented along with supporting documents (indicated on the application form) to a provincial National Institute of Social Security (Instituto Nacional de la Seguridad Social – INSS) office (mariners must submit their application to a provincial office of the Social Marine Institute (Instituto Social de la Marina– IMS). Required documents vary from case to case and it is suggested to inquire with the INSS.

The retirement application may be submitted during the three months prior to or following the date employment ends and payment will be effective from the day after retirement. If the application is submitted more than three months after the activity is terminated payment of the pension will begin with a maximum backdating of three months. The pension is paid monthly with two extra payments made with the June and November payments.

The retirement pension is terminated on the death of the pensioner.

Education Benefits

School insurance provides coverage for students for school-related injuries, illness and family crises (such as family bankruptcy or the death of the head of the household). Student under the age of 28, from the third year of compulsory education (ESO) to the third cycle (post-graduate) at university, are covered. The insurance pays for medical services (including pharmaceuticals) and provides financial support for disability and funeral expenses.

In order to be entitled to school insurance applicants must:

  • Be a Spanish citizens or foreigner residing legally in Spain
  • Be under the age of 28
  • Be registered for the studies covered by the insurance, and with the insurance fully paid up
  • Have been covered for at least one year (this does not apply to benefits related to school injury, family crisis and obstetrics or for students who have studied abroad or in the previous year been enrolled in the second year of ESO or special education)

Applicants must submit the school insurance application form and the personal documentation for each benefit as indicated on the application form. Necessary documents include:

  • National ID card or NIE for foreigners
  • Certificate from the education centre for non-university students
  • Proof of registration for university students
  • Specific documentation for each benefit
  • School insurance application form (PDF)

The application form and documentation may be presented at any of the Social Security Information and Support Centres (Centros de Atención e Información del INSS). Amounts vary depending on the benefit.

Recognition of the right to and payment of the benefits is decided by the Provincial Office of the National Social Security Institute (INSS) where the application was submitted. In the case of healthcare benefits, it is the responsibility of the Provincial Office of the INSS for the province in which the medical assistance was given.

Medical benefits must be requested prior to receiving health care except in the case of school-related injury and medical emergencies.

Maternity, Maternity Risk and Nursing Mother Benefit

Paid maternity leave (Permiso de la Maternidad) is available to most categories of employed as well as some self-employed women. Agricultural workers may be able to take temporary disability instead of maternity leave.

Maternity benefits begin from the day of giving birth or the date of the court decision on adoption or the administrative or court decision on fostering. The benefits can begin before giving birth, if it becomes necessary to begin maternity leave before the birth. The daily benefit amount is 100 percent of the average daily wage earned in the month prior to taking the maternity leave.

Eligibility for maternity benefit

To be entitled to maternity benefits it is necessary to have made social security contributions for a required period prior to the birth of the child or the taking of the leave. The minimum contributory periods are as follow:

  • Women under 21 years of age: no minimum period of contribution
  • Women 21-26 year of age: at least 90 days of contributions in the previous 7 years, or 180 days of contributions over their lifetime
  • Women over 26 years of age: at least 180 days within the previous 7 years, or for 360 days in their lifetime

In the case of part-time workers, only the contributions made on the basis of the number of hours worked shall be computed.

If a mother does not qualify for maternity benefit but the father does, the woman may take his available paternity leave as maternity leave. If both parents are employed, the maternity benefit can be shared by both and can be taken part-time.

How to apply for maternity benefit

The Maternity benefit application form is known in Spanish as the Solicitud de prestación de maternidad por nacimiento, adopción o acogimiento del Régimen Especial del Mar. Applications and supporting documents must be submitted to a provincial National Institute of Social Security (Instituto Nacional de la Seguridad Social – INSS) office.

Required documentation varies depending on whether it is a natural birth, adoption or fostering.

The doctor at the Public Health Care service will give the corresponding maternity report to the mother who will give the original copy to her employer. If the mother is treated by a private doctor, they must issue a report to be submitted to the Public Health Care specialist who is the only one with the authority to issue the necessary maternity report. This report will be filled in and returned to the mother. Along with the personal documentation, the application for maternity benefits and maternity report are sent to the Management Centre of the National Social Security Institute (INSS) or the Provincial Office of the Social Marine Institute (ISM).

Duration of maternity benefit

Duration of the benefit is 16 continuous weeks, except in the event of a premature birth or if the newborn must remain hospitalised after birth. In the case of multiple births, the period is extended by two weeks for each child. There is also an additional two weeks if the baby is born with a disability. If time is taken off work whilst pregnant for medical reasons, sixteen weeks of maternity leave after the child is born can still be taken. Maternity leave can be extended for up to thirteen weeks if a baby is born premature of has had to stay in hospital for more than seven days following the birth,

Maternity risk and nursing benefits

A subsidy is also available from the Spanish government for nursing mothers for 9 months after the baby’s birth. This subsidy takes the form of two paid half-hour breaks daily to nurse or pump breast milk.

A subsidy is also available for pregnant women who must leave work when the job poses a risk to the pregnancy. The daily benefit amount is 75 percent of the average daily wage earned in the month prior to taking the maternity leave and is payable from the day the woman leaves work.

Paternity Benefit

A paternity subsidy is available to most categories of employed as well as some self-employed men when they take time off from work after the birth of their child or in the event they adopt or foster a child. The daily benefit amount is 100 percent of the average daily wage earned in the month prior to taking the paternity leave.

The benefit amount is calculated based on the wages and days worked in the previous month.

Eligibility for paternity benefit

Fathers must have contributed to social security for at least 180 days in the 7 years prior to taking the leave, or have made contributions for at least 360 days in their lifetime.

If both parents are employed, the maternity benefit can be shared by both and can be taken part-time. In the event of adoption or fostering, only one parent may take leave.

How to apply for paternity benefit

Applications and supporting documents must be submitted to a local Social Security Information and Support Centres (Centros de Atención e Información del INSS).

Required documentation varies depending on whether it is a natural birth, adoption or fostering.

Duration of paternity benefit

The paternity subsidy is paid for 13 days after the compulsory 2 days (4 days if travel was necessary for the birth) paid by the employer, though can be paid up to 20 days if the baby is being born into a large family (or the birth qualifies the family as being large), in the event of adoption, fostering or if there is a disabled member of the family. For multiple births, adoption or foster care, two additional days are added if a child is disabled or for each child after the second. In 2015 paternity benefit will increase to 30 days.

The paid leave can be taken as entire work days or at least half of a work day, with the approval of the employer. It begins from the end of any paid leave taken for the birth, adoption or fostering of a child until the mother’s maternity leave ends, or from the legal adoption/fostering until the end of the mother’s maternity leave.

Further Information