Taking care in Spain
According to a spokesperson for the UK Department of Health, the NHS is a residence-based health care system and, as such, the health care costs of people who leave the UK to live permanently in Spain cease to be an NHS responsibility under our national law.
However, they may have some rights to continuing cover at NHS expense in Spain if they fall within the scope of Regulation (EEC) 1408/71, which coordinates rights available under the social security and health care schemes of the member states.
People moving to Spain permanently under EU law may be entitled to health care in Spain which will be covered financially by the UK government, but it depends on their circumstances. For example, whether they are UK state pensioners or have taken early retirement before reaching pension age.
As every individual case is different we strongly advise that readers refer to leaflet SA 29, your social security insurance, benefits and health care rights in the European Community and in Iceland, Liechtenstein and Norway available from the Department for Work and Pensions. It is also posted on the DWP website at www.dwp.gov.uk - benefits and services and social security agreements with other countries. If they start work for a Spanish employer, they will have to contribute to the Spanish social security system. They must then look to Spain to cover them for all their health care. No UK-issued E form is appropriate.
People moving to Spain for a limited period each year that still retain a home in the UK and spend more than six months a year in the UK, we would regard their time spent in Spain as a visit. Provided they do not work in Spain, they are entitled to a UK-issued form E111 to provide them with emergency health care cover only in Spain.
If they have pre-existing conditions which require ongoing treatment while in Spain, they should apply for a form E112. Further information about both forms is in the leaflet Health Advice for Travellers available in post offices. It is also available on the department’s website at: www.doh.gov.uk/traveladvise
Once you have your E111. The E111 form remains valid indefinitely, so long as you remain ordinarily resident in the UK.
The E111 form covers you, your spouse and your dependent children up to 16 years (or 19 years if they are still in full-time education). Always keep a photocopy of your E111 form with the original.
This is important if you apply for treatment in Spain as a photocopy is required as well as your original E111. You will be given back your E111 but the photocopy will be kept.
If you are living in Spain, you may be covered by the UK for health care for a limited period but if you decide to live permanently or work in Spain you are not entitled to use the E111 form. If you have an industrial injury or occupational disease, and intend taking up residence in Spain, special rules apply.
If you come to work in Spain for up to a year, and it has been confirmed by the DSS or the Social Security Agency in Northern Ireland that you (and your employer if you are an employee) continue to pay UK national insurance contributions, you are entitled to the E128 form. If your employment or self-employment unexpectedly lasts longer than 12 months, and the Spanish authorities agree, you may remain under the UK scheme for a further period of not more than 12 months. If you work in Spain for a non-UK employer, neither the E128 nor the E111 form is appropriate. The E111 form does not cover you for free or reduced-cost treatment if you are coming to Spain specifically for medical care or if you require ongoing treatment for a pre-existing condition. You will need the E112 form, which requires authorisation from the Department of Health.
The Department of Health website also includes useful information about the health system in Spain.
It is essential to establish that the medical practitioner you consult works within the Spanish state health service. Treatment under the E111 arrangements is only provided by practitioners within the Spanish health service, and in some parts of the country, particularly the outlying islands, you may have to travel some distance to attend a surgery (consultario), health centre (centro sanitario) or hospital clinic (ambulatorio) operating within the health service.
Dental treatment is not generally provided under the state system. The costs will not be reimbursed. In Spain, doctors, health centres and hospitals have separate surgery times for private patients and those treated under the health service. If you are asked to pay you are not being treated under the Spanish health service, but privately, and your E111 will not be accepted.
Medicines prescribed by health service practitioners can be obtained from any pharmacy (farmacia). You will have to pay up to 40 per cent of the cost unless you are a pensioner, in which case the medicines will be free of charge.