Note on the Special State Insurance (convenio especial)

Note on the Special State Insurance (convenio especial)

Interesting notes about the special agreement on the provision of medical assistance to individuals who do not have insured or NHS beneficiary status.-

According to Royal Decree 576/2013 of 26 July and Order SSI/1475/2014) this special scheme applies only to individuals who:

  • Do not have insured or NHS beneficiary status and,
  • Do not have access to the public health care protection based on any other legal grounds; and, consequently, involving no protection under the European regulations or any bilateral/multilateral international agreement on coordination of Social Security System.

Consequently, this special state insurance (called in Spanish “convenio especial”) will not be applicable to individuals otherwise entitled to public health care protection under the umbrella of European regulations or international agreements.

There are other more specific situations, as a general rule, “Insured status” will be granted, under the Spanish Law, to individuals in any of the following circumstances:

  • Being employed or self-employed, and registered with the Social Security system as an employee.
  • Being a pensioner in the Social Security system.
  • Being in receipt of any other periodic Social Security provision, including unemployment benefits or any others of a similar nature.
  • Having completely consumed unemployment benefits and others of a similar nature, remain unemployed and do not have insured status on any other grounds and residing in Spain. This scenario will not apply to foreigners who are not registered or are unauthorized residents in Spain.
  • Minors subject to administrative guardianship.

The “Beneficiary status” will generally derive, under certain circumstances, from a relative, spouse, cohabiting partner or even an ex-spouse. In the case of being the ex-spouse, beneficiary status will be only considered in cases of dependency based on a compensatory pension entitlement.

Under the scope of this Special scheme, applications for health protection should be registered with the Spanish “INGESA” (National Health Management Institute) and the following requirements should concur:

  • Providing evidence of an effective residence in Spain during a year before the date of applying for the Special scheme.
  • Being registered (empadronado) in any Spanish Town Hall at the moment of submitting the application
  • No entitlement to public health protection under any other scheme, either by application of domestic law or European regulation on Social Security or by bilateral international agreements signed by Spain with other countries.

Monthly fixed fees (which may be periodically reviewed by Government) for applicants under 65 will amount to 60 euros, while fees for individuals over 65 will increase up to 157 euros per month.

Applications under the special scheme will be answered by the authorities within a maximum period of 30 days; the lack of no response for longer than that period, could be understood as a statutory recognition of entitlement (by administrative silence).

The special scheme described ensures access to the basic common portfolio of the Spanish NHS (with identical guarantees regarding extent, continuous care and coverage as for individuals with an insured or NHS beneficiary status), including prevention, diagnosis, treatment and rehabilitation received in public health centers, as well as urgent medical transport.

Nevertheless, supplementary services provided by each Autonomous Community, such as pharmaceutical or orthopedic prescriptions and dietetic products, will not be included unless by express regulation of the Autonomous Communities involved. Extension of services in these cases could result in an increase by the autonomic government of those fixed fees for the basic amount.
Ana Argente
Spanish-qualified lawyer (FERRERO LAWYERS) on behalf of BREXPATS IN SPAIN

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