EHIC, TSE, SIP, S1

Vital documents to obtain healthcare cover in Spain

EHICs, SIPs and TSEs
Ensuring you have access to health care is one of the most important priorities for anyone moving to, or even visiting Spain. There is a lot of confusion around entitlements to cards and what can be accessed with which card.

There are two different issues: temporary care for holidaymakers, be they English nationals now resident in Spain and travelling back to the UK for a holiday, or permanent care for those resident in Spain.

There are three main public health cards that you might have access to if you live in Spain:

EHIC = European Health Insurance Card
TSE = Tarjeta Sanitaria Europea (European Health Insurance card issued by the Spanish government)
SIP = Sistema de Información poblacional (Spanish health card)

EHIC

The EHIC has been widely abused in the past by those who come to Spain for several months at a time, but do not actually live here. The EHIC is the health card which you would use as a non-resident in Spain if you needed emergency medical treatment here, but is ONLY to be used as a temporary measure and is NOT designed to offer permanent cover for those who may have taken early retirement or are physically resident in Spain.

Everyone visiting Spain should ensure that they have an up to date EHIC, but it’s astonishing how few of those coming over to visit family in Spain carry up to date EHIC cards. A short spell standing in a doctor’s surgery on an ex-pat urbanisation highlights just how many holidaymakers come here without an EHIC, and then face hefty medical bills when requiring medical care. It is also important to stress to visiting family that they MUST take travel insurance when coming to visit, as should a serious accident occur, for example something which requires overland transportation back to the UK, then this is NOT covered with an EHIC and this type of incident can end up costing thousands.

UK State Pensioners who live in Spain, must now also obtain an EHIC card if they themselves are travelling back to the UK for a holiday. Under the previous system, those living over here would apply for a TSE card, but now the onus of which country pays for medical cover has been defined as being the country from which the individual receives their pension, so most of the pensioners living here in Spain will need to obtain their EHIC card from the UK, NOT a TSE card.

So if you are a pensioner with a UK state pension travelling back to the UK for a visit, then you will need an EHIC rather than a TSE.

If you are already registered in the Spanish healthcare system, have an S1 form, and would like to apply for an EHIC card, it is necessary to contact the NHS Overseas healthcare team, on 0191 218 1999, who issue EHIC cards from the UK. Although pensioners have access to the full health service in Spain, this is subsidised by the NHS as they do not pay directly into the social security system here.

More Info: Overseas healthcare Team: Tel: 0044 191 218 1999

Web: www.gov.uk/dh

TSE

The TSE is the Spanish version of the EHIC, and only those who are fiscally resident in Spain and drawing their pensions from the Spanish system, or those working in Spain and paying into the Spanish social security system will be entitled to receive this card. So those paying their social security contributions in Spain and travelling to the UK for a short visit will require a TSE in order to receive medical care in the UK should an accident occur. Again, it cannot be stressed enough how important it is to take out travel insurance as the same rules apply: repatriation back to Spain in the case of a severe accident can cost thousands.

TSE cards can be obtained directly from Spanish Social Security offices, and applicants should take NIE documentation, Passport and valid medical card (SIP) (Social Security Office- Click for list of Social Security offices in Murcia)

SIP: Spanish medical card for self-employed or employed workers

If you are employed or self-employed and don´t yet have your Spanish medical card, then register the contract of employment or autonomous worker registration with Social Security. The Treasury will then issue a Certificate of Registration to Social Security and provide a document for the Health Centre. You can then obtain a SIP card with this, your NIE, passport and residence certificate at the appropriate Health Centre.

S1 and SIP for retirees

Many retired expats have made their home in Spain and would like to receive treatment using the Spanish system. Due to an arrangement between EU Governments, EU citizens are entitled to receive the same level of healthcare, no matter where they live, but they must register their location properly so that the governments can recompense each other financially for the healthcare treatment they give to foreign nationals residing in their country.

In order to do that, expats receiving a pension from the UK had to obtain an S1 until July 2014, when the pensions office in Newcastle changed its procedures.

Residents prior to 16th April 2012

Retirees who were already Spanish residents prior to 16th April 2012, with existing SIP cards, who have an annual income of less than €100,000 and are not covered for healthcare though any other means, should speak to their local  INSS office (Social Security Office- Click for list of Social Security offices in Murcia) in order to obtain their health cards.

Pensioners who are living in Spain and are still receiving their pensions from the UK government can now no longer apply for the residual S1 (formerly residual E106) which previously provided temporary healthcare to early retirees moving to other EEA countries. In the past this document effectively told the Spanish government that you were no longer entitled to healthcare in the UK and were requesting that your right to healthcare be transferred to Spain.

The NHS in the UK now advises that “before moving to live abroad, it is important that you check how the healthcare system works in that country and what your entitlement will be if you intend not to work, as this varies from country to country. This means that you will have to access that country’s health system under their rules”.

“If you are moving abroad on a permanent basis, you will no longer be entitled to medical treatment in the UK under normal NHS rules. This is because the NHS is a residence-based healthcare system. Most people will also not be entitled to use a UK-issued EHIC card to access healthcare abroad”.

It is important to note that if you already have a residual S1 this will not affect you – it will continue to be valid until its original expiry date.

If you are a UK state pensioner these changes will not affect you – S1 forms will still be issued to state pensioners.

With the S1, your residency certificate, passport and Padrón you can register with the Spanish Social Security and they will issue a Certificate of Registration, which can be taken to your local Health Centre in order to obtain a SIP (Spanish Medical Card).

If you are an early retiree and have recently made national insurance contributions in the UK, contact the Overseas Healthcare Team on +44 191 218 1999 to see if you have entitlement to a residual S1 form (previously E106) for a limited time. Once issued, register the S1 form with your local INSS office, before you register with your local GP surgery.

More information: www.healthcareinspain.eu

www.gov.uk/healthcare-in-spain