Healthcare in Spain for British citizens living in Spain before 31/12/2020
After the introduction of Brexit on March 29 2019, the United Kingdom officially withdrew from the European Union on the 31 December 2020. The terms under which the exit took place were regulated in the Withdrawal Agreement, which allowed the UK a transitional period ending on December 31 2020.
This scenario, along with the insecurity of health cover in Spain, forced many British expats living in Spain to return to the UK, forcing the NHS to prepare for their return. According to the Spanish Statistical Office (INE), since Brexit has been announced, the number of British Citizens registered in Spain has fallen by 50,000.
From 1 January 2021, the United Kingdom has officially separated from Europe as a member state and is now considered a ‘third country’ for all purposes. As provided in the Withdrawal Agreement, any British expatriates residing in Spain since before 31 December 2020 will maintain their rights of residence, work, study and social security in Spain.
For British expatriate pensioners, the country responsible for health cover is the country of residence, rather than the country of nationality. Therefore, British expatriates who have been residing in Spain since before 31 December 2020 will continue to have the right to access to medical assistance, as confirmed in the Trade and Cooperation Agreement between the EU and the United Kingdom.
They will continue to have access to the Spanish Public Health System (State Healthcare) under the same conditions as Spanish citizens, as long as they have registered with the INSS (National Institute of Social Security) office through the S1 registration form.
What is an S1 form and how to get it?
The S1 form is a necessary document to transfer the health benefits from your country of origin to your new country of residence. The document certifies that your healthcare cost will be covered by the British health service (NHS), thus reimbursing the cost to the Spanish State.
British expats residing in the autonomous community of Andalusia in Spain, who are not beneficiaries of the S1 form in their country of origin, can access the public health insurance scheme in Andalusia through the Convenio Especial, which we will discuss later on.
Need a professional consultation regarding healthcare in Spain?
UK pensioner residing in Spain
For British citizens who receive a UK pension, who reside abroad such as Spain before 31 December 2020, the following situations, among others, may apply:
- You will receive medical care in the country where you live as long as you are entitled to medical care in the country you receive your pension from, such as a State Pension or Government Pension. You must apply for the S1 form in the UK when you arrive in Spain. You must hand in the S1 form to the INSS office in order to access free healthcare in Spain.
- If you are unable to obtain the S1, there is the possibility of subscribing to the Andalusian Health Service (SAS) public health insurance scheme through the Convenio Especial. The requirements and fees to be able to access this scheme are the following: This Convenio Especial has been created for those who don’t have a right to medical care in their country of origin. The public insurance scheme costs €157 a month for people aged 65 and over, and €60 for those under the age of 65. It does not include prescriptions. It is only possible to apply to this scheme if you do not receive Spanish nor UK medical care.
For more information regarding the requirements and procedure, please contact email@example.com.
To briefly summarise your tax obligations as a tax resident, you will have to pay tax on your worldwide income in Spain through a Tax Return. The double taxation agreement between Spain and the United Kingdom will apply to you here, as well as obligatory tax documents such as form 720.
Healthcare in Spain for British citizens living in Spain from 01/01/2021
The Social Security Coordination Protocol of the Trade and Cooperation Agreement between the European Union and the European Atomic Energy, and the United Kingdom of Great Britain and Northern Ireland, include the vast majority of social security benefits currently covered by Community Regulations.
Therefore, British Citizens who enter Spain from 1 January 2021, and who want to reside in Spain for more than 180 of the year, must apply for Spanish residence through any of the available visas, such as the Non-Lucrative Residence Visa and the Golden Visa.
In regards to medical coverage, the following options are available:
- As long as you are eligible for medical coverage in the country that pays your pension (both State Pension or Government Pension), you will be able to receive medical coverage in the country where you live. To access this coverage, you must apply for the S1 in the UK before you arrive in Spain. You must then hand over your S1 form to the INSS office in Spain to finalise the process.
- If you are unable to provide the S1 form, you can either opt for private medical coverage or subscribe to the Andalusian Health Service (SAS) through the Convenio Especial – this incurs a monthly fee. The SAS public health insurance scheme can only be accessed by those not entitled to healthcare in their country of origin.
It is also important that you do not forget your tax obligations as a resident of Spain. Generally, you will be considered a tax resident if you stay over 183 days in Spanish territory in one calendar year or your primary area of economic interest and activity is in Spain, under article 9 of the IRPF Law. If you are considered a tax resident of Spain under either of these criteria, the following is a summary of the tax implications that may apply to you:
- Tax return in Spain
- Personal Income Tax: Your worldwide income will be taxed in Spain. This includes income such as UK pensions, rental income, shares, dividends etc. The double taxation agreement between Spain and the country where your income comes from will be applied here so that you can avoid double taxation.
- Wealth Tax – Form 714: The threshold for Wealth Tax in Spain is €700,000. Any amount that exceeds this number will be taxed. You must include all global assets within this tax return. Wealth Tax should be declared using Form 714.
- Assets Declaration – Form 720: Overseas assets held outside of Spain must be declared by any Spanish resident when the value exceeds €50,000. Declaration of these assets should be submitted via Form 720.
Spanish government measures to soften Brexit impact on healthcare
In addition to the Social Security Coordination Protocol of the Trade Agreement mentioned above, the Spanish government – to counteract the undesirable repercussions of Brexit – approved the Royal Decree Law (RDL) 28/2020 at the end of the transitional period on 30 December 2020, which regulates social security and healthcare matters, among others.
However, these are temporary measures, valid until their end date indicated in each case or even earlier if bilateral agreements governing relations with the United Kingdom and areas are reached. These should then cover the aspects of the RDL.
The RDL 38/2020 states that as long as the United Kingdom acts in a reciprocal manner with Spanish citizens until 30 June 2021, those entitled to healthcare in the UK under the NHS will receive healthcare from the Spanish National Health System, on the same terms and conditions established before 1 January 2021.
If you are a permanent resident in Spain
From 01 January 2021, British citizens who are pensioners and are entitled to healthcare from the UK’s NHS may transfer their right to free healthcare to Spain using the S1. This procedure involves presenting your S1 Form to the INSS office in Spain, as well as having previously applied for a Non-Lucrative Residence Visa at the Spanish General Consulate in London.
British citizens who have lost the right to receive health coverage in their country of origin and therefore are unable to apply to S1 can access health care through private health insurance, or access Andalusia’s public health insurance scheme through the Convenio Especial.
If you are a non-resident of Spain
From 01 January 2021, any British citizens who wish to spend short periods of time in Spain do not need a Visa, as long as their stay in Spain is limited to 90 days out of a 180 day period. This can be spent in one large or several shorter visits.
Thanks to the Social Security Coordination Protocol of the Trade Agreement and the Royal Decree Law 38/2020, in order for non-residents to receive emergency medical treatment during their temporary stay, all they need is the free Global Health Insurance Card (GHIC) from the United Kingdom, or use their current European Health Insurance Card (EHIC). The EHIC card is valid until 30 June 2021, or until its expiry, if the date exceeds the 30 June 2021.
For more information regarding the coverage offered by these health insurance cards, please visit the foreign travel advice of the UK Government. Have you visited this page because you are interested in purchasing a property in Spain after Brexit and need legal advice about various aspects (such as health coverage, residence procedures, tax implications and the costs of buying in Spain)? Our team of lawyers and advisors at Tejada can provide you with full support.
The contents of this article intend to give you a general overview of information relating to various legal issues. It should not be considered as direct legal advice. If you are seeking legal advice, please contact a suitably qualified professional.
Healthcare in Spain after Brexit - Frequently Asked Questions
For British citizens temporarily visiting Spain (less than 90 days in half a year), the Royal Decree Law (RDL) 38/2020 states that the EHIC card will be valid for British citizens until 30 June 2021, or, until its expiry if it is later than this date. Once this period has passed, the EHIC card will be void, and you must apply for the Global Health Insurance Card (GHIC).
Yes. In order to access Spain’s National Healthcare System, you must apply for the medical card (Tarjeta Sanitaria) at your nearest health centre.
Nothing will change for British expatriates who were permanently residing in Spain before 31 December 2020 after the transitional period. The withdrawal agreement has stated that these residents will maintain the rights that existed before Brexit, such as rights of residence, work, health and social security.
This depends on various factors. For the autonomous community of Andalusia, you can explore the possibility of joining the public health insurance scheme through the Convenio Especial. We recommend consulting with the managing body of this scheme through a professional. Depending on your circumstances (such as whether you have access to medical coverage in your country of origin), this scheme may incur a monthly fee.
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Author: Rosana Tejada
Biographical Info: Rosana Tejada Crespo is a tax advisor holding a Master’s Degree in International Taxation. She specialises in companies and freelancers, tax regulations concerning foreign employees (Beckham Law Spain), non-resident tax, inheritance tax and Spanish income tax. She is one of the founders of Tejada Solicitors, which comprises a group of English speaking solicitors, economists and architects.
Tejada Solicitors is an English-speaking law firm based in Malaga and Costa del Sol, specialised in property conveyancing, inheritance tax, residence for foreigners, self-employed tax declarations and most legal and financial aspects of relevance to foreigners and expats living in Spain. For any questions and enquiries regarding the Spanish market, don’t hesitate to contact us either by phone or e-mail.