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New Universal Healthcare Law July 27 2018 FAQS

UPDATE 03/07/2019 . The Convenio Especial in Andalucia, has been reinstated.

UPDATE 31/05/2019: Today a CAB adviser spoke with a civil servant at a SAS office in Andalucia for an update on the law and the fact that in Andalucia, the convenio especial is no longer available for those who wish to contribute to the NHS for healthcare insurance. The response was that healthcare should be provided from public funds to residents. That they should apply to their home country for the “legislation letter” which shows that the applicant is not entitled to healthcare in their home country therefore cannot export the same.. Applicants should provide their ID, updated padron certificate, the application should be made at the residents health centre. As facts do not always mirror the reality, CAB advisers are meeting with the civil servant in the last week in June for clarity for those who are refused registration under public funds.

UPDATE 02/03/2019: The project for a new law, furthering implementation of the Universal Healthcare Law from July 2018, was unfortunately not on the agenda for a vote before the General Courts withdrew for the General Elections, so we expect no further movement on this until after the 28th of April 2019.

5/02/2019: Convenio Especial Andalucia. We have been privy to an email dated February 20 where Salud Response have advised a resident that he can apply for the convenio. CAB called and Salud Response are saying the convenio is available to those who meet the criteria. CAB can only advise members to apply and let us know the response.

Another member has applied for the Convenio Especial and received an email back that should apply with local health centre instead, as per the Universal Healthcare law.

Update 20 February 2019. With emergency General Elections in Spain on the 28th of April, we are not positive about a further implementation of this law in any of the Autonomous Regions before it’s clear which party will rule in Spain after that. We will keep members informed.

We are receiving many questions about the new royal decree which was only published in the State Bulletin on the 30th of July 2018. Universal Healthcare Law 2018 Extracts


Citizens should be aware that the various autonomous regions as well as the INSS, (social security) are making preparations to put out their internal instructions to be able to implement this new law.

Please note that since this faqs, some have followed our instructions and are now in the public healthcare system.

We would like to remind residents in Spain that the use of a law from 2012 by the INSS is considered fraud. Their action in denying ALL residents in Spain (minus those mentioned in one of the answers below) Who are pre or post 2012 residents, from entitlement to healthcare from public funds.

You do have to consider that this is a huge undertaking and not something that they cannot do overnight. Please be patient as residents. Below are some questions and answers.

Q) Is this new law in force at present?
A) Yes the law has been in force since July 31st 2018.

Q) Will everyone who is a resident now receive full NHS care paid for by public funds?
A) No they will not. The following are some of those that need not apply (anew). Those who are entitled to an S1
will continue to use that method. Those who are self employed or in employment will already be covered. Any other resident whose country or employer have the obligation to provide this care.

Q) What about post April 2012 residents who have been employed but contract ended or dismissed? 
A) Those in that situation were always covered for healthcare, as long as they are in a ´legal situation of unemployment´ (excluding those that resigned) and remain registered as unemployed and looking for work. The right should exist even after unemployment benefits ´paro´ or unemployment ´subsidio´ entitlements have run out.

Q) What about those that are registered as Autonomo but cannot afford the contributions, will they be covered when they stop?
A) Yes, they should, provided they are registered or authorised residents. Post April 2012 residents should go to the INSS after 60 days of stopping their employment and make sure that their healthcare continues. You may be asked to provide a “legislation letter”, information on this website.

Q) What about those here on a non-lucrative visa?
A) Those should be covered under the new law as well, provided they applied and obtained residency authorisation.

Q) Does the new law include prescription charges and reductions?
A) Yes it does, including reductions where applicable.

Q) There has already been news from the Junta in Andalucia that the Convenio Especial has been annulled?
A) Yes that is correct, as the law states, the convenio (special agreement) would be abolished on August 1st 2018.

Q) Registered members have received some notification but can CAB assure us that this is the case?
A) We can indeed and will use the words of the Junta Health Department “Indeed, the special agreements that were in force have been extinguished by the Management of the Andalusian Health Service. The interested parties have been informed that they will have public health assistance without payment of fees”.

Update: Over the weeks since the law was published,  numerous members (Andalucia) have advised that they are now registered as receiving healthcare under this law and advised that the payments for the convenio, will no longer be taken.

Q) Does that mean that those of us with the Convenio in Andalucia are now in Healthcare limbo?
A) No it does not, the Junta have told CAB that healthcare will continue. Here is what they wrote to CAB “The Ministry of Health, Consumption and Social Welfare has to develop the new regulation according to the law so we can not yet inform you of the procedures to be followed in each case”.

Update: Since this faqs was published, we have been trying some test cases by suggesting that those registered or not on the convenio, should apply either with the health centres or with the Junta if not accepted. Few already have been entered into the system via their health centres. Caution:We now have evidence that some health centres are registering residents on a temporary basis using the EHIC. This is incorrect and could result in the patient being billed if the UK rightly refuses to cover the EHIC used erroneously.

Q) We have had our DD debit cancelled and are very nervous, should we be?
A) From the Junta “What can be done at this time is to reassure foreign people because in one way or another they have public health coverage in Andalucia”.

Q) We are still paying for our Convenio what should we do?
A) CAB suggests that you wait as you will receive notification from the various Junta (Xuntas). Please note* the update in red above.

Q) We were about to apply for the Convenio. Should we still proceed?
A) We suggest you continue to do so. You will likely be refused but may put your mind at rest to receive instructions which some already have. The response could state that the convenio is no longer being provided but that you are entitled to healthcare under the new law and public funds. Besides applying for the convenio, apply at your health centre but do not use the EHIC as for visitors only.

Q) That is Andalucia but what about Valencia, Murcia and the other provinces?
A) Though a national law, the State has asked each CCAA region to deal with the due process.

CAB Spain is contacting all Autonomous Regions, we will add responses here.

Aragón – message sent to health service – answered that once the Junta has formulised regulations, affected residents  will be informed.

Asturias – Universal Healthcare in place, even before this new law.

Canaries  – message sent

Castilla y Leon – message sent to Junta – referred to Gerencia Regional de Salud

Catalunya – message sent to Junta – referred to Departamento de Salud

Extremadura – message sent to Junta, referred to SES Consejería de Sanidad y Políticas Sociales – message sent.

Madrid – message sent to Junta – referred to Salud Madrid – message sent.

Murcia –  Message sent, no response yet.

Valencia –  Regional Health Department has said that it is waiting for full instructions so that they can implement   the  law. Convenio Especial still in force and several members have let us know that they have been  accepted in August.

Balearic Islands – message sent to each island´s salud dept, no response yet.


Q) What about the Canary and Balearic Islands. Will they have to comply?
A) Again this a national law and all the Spanish autonomous regions have been instructed that it is their responsibility to implement the law.

Q) We are paying into the system as autonomos (self employed). What if we stopped working or even decided to stop paying this expecting healthcare from public funds.
A) If you are continuing your employment as autonomo, our suggestion is to continue to pay. This covers you for healthcare, sick pay, accidents at work, work related illnesses and your pension. If you close your business visit the INSS within 60 or 90 days to make sure they still keep you in the system.

Q) Will this law also provide this healthcare for those with private health insurance?
A) The law makes it quite clear that this is for all residents in Spain.

Q) Our insurance cover is due to run out, should we not renew and wait for healthcare from public funds?
A) It would be irresponsible for CAB to tell anyone that they should be without healthcare cover. We still do not know when the INSS will implement the law. Would some companies provide healthcare on a quarterly basis for example? Also please check your policy as although first contracted at another date, health insurance policy renewals often run from January-December.

Update: We have the first case of residents with private healthcare that we advised to apply for the convenio, have done so at their health centre and today August 17, they have been accepted into the NHS paid for by public funds. Please note that this is rare as the INSS still say they have no instructions.

Update: 17/09/2018 Caution. We now have evidence that some health centres are registering residents on a temporary basis using the EHIC. This is incorrect and could result in the patient being billed if the UK rightly refuses to cover the EHIC used erroneously.

Q) I have no health cover of any sort. I am concerned. Should I apply for healthcare now?
A) We understand that those who for some reason or other are without healthcare are worried. Those can by all means apply at their INSS office. Again you may be told that you will have to wait until the INSS has implemented the new law. At present the authority who are responsible are the health ministry of the regional autonomies. Apply at your health centre. If  residing in Andalucia, read the section on the Convenio Andalucia. Further information on the role of the INSS will be provided when we have it. Note* that pre April 2012 residents can apply at the INSS offices.

Q) Is this law only in place for residents?
A) As CAB has always advised its members, this new law is actually part of the law of 2003. “healthcare paid for by public funds for residents¨. The ruling has been in place since 2003. All residents on Spanish soil have always been entitled to this cover. It has been the INSS who basically chose to interpret the 2012 law which denied healthcare to illegal residents and applied this to registered and/or authorised residents as well.

Update: 13/09/2018  Couple who are nonresidents have been temporarily registered on the database for healthcare from public funds.  We have advised to apply for their health cards and by all means apply for residency. No guarantees of success if the cards are also issued as temporally.

 Update: First test case in Andalucia. Residing here since February and padron since March of 2018. Health centre have registered the UK national and provided the certificate with health number. Waiting for a health card.

Update 03/10/2018. The person above has now been accepted for residency with the certificate which shows healthcare cover.

Q) Will those that apply for free healthcare post July 2018 still be entitled to TSE (Spanish EHIC) cards or temporary certificates?
A) As we understand it, they will NOT. Reference article 3ter.2 from the new law that states that those now entitled do not generate the same entitlement when abroad. We will seek confirmation from INSS, once their regulations on how to implement the new law are in place.

Update: CAB advisers rereading the law have noted that the denial of the TSE (EHIC) as mentioned above it applies to those in article 3 ter, non legal residence. Nothing under article 3 to this effect so please apply for your TSE card or certificate when needed.

Q) Is there a possibility that the INSS would do the same and ignore this further instructions?
A) We are aware that they have their legal teams looking at the royal decree. This time around with all the publicity surrounding this royal decree, I suggest that they will find it difficult to ignore. What they have done since 2012 in refusing residents this cover is tantamount to deception. They also lost cases against their decision in the Spanish courts.

Q) Will this apply to those residents who having been residing in Spain but not residents?
A) The law included those without papers which generally refers to illegal immigrants. It does not differentiate between EU or non EU or how a citizen arrived in Spain. CAB advisers believe it would be discriminatory to leave EU non legal residents out of the equation.

Update:  Andalucia. on August 8, UK national has been registered under the new law at their healthcare centre. Certificate provided and now waiting for a health card.

Update:  03/10/2018. The UK national above has been succesful in using the healthcare cover for residency application and has been accepted.

Q) What about those seeking residency, are they entitled to free healthcare?
A) It is early days yet to answer this question honestly. Consider that those who arrive have the right of 90 days before residency applications need to be made, they are then here legally. The residency law still states that they need proof of cover. We are wondering if there will be an option for these new applicants to apply for healthcare first from the INSS. Again at the moment of making the application, they would neither be illegals or residents. We ask for patience whilst CAB works on the these issues.

Q) Should we visit the INSS to ask about our entitlements?
A) CAB suggests waiting for the INSS to receive their instructions and implement the law. They have nothing to report as yet. Of course we will provide updates for our members whenever we receive more information from our sources at the INSS. To date any actions to implement the law are being taken by the ministry of health of the autonomous regions.

News*  Due the delay in implementing the delay, CAB senior advisers and paralegals Richelle and Myra have arranged a meeting with lawyers for September 19. We will also be holding a CAB advisers meeting to span two days to discuss, the healthcare law, the website and what is needed and funding for CAB. In the meantime, here are our donate options:

Update  12/09/2018.  We have been notified and seen the proof of two residents who have been registered at their health centres for healthcare be it temporarily. Andalucia area.

Update: 13/09/2019.  Couple who are nonresidents have been temporarily registered on the database for healthcare from public funds.  We have advised to apply for their health cards and by all means apply for residency. No guarantees of success if the cards are also issued as temporally.


Important*  On September 19 CAB adviser attened the planned meeting with a lawyer. Here is the outcome.





Legal Ramifications of the RDL




As most regions are not complying with the new law, we can only suggest reading about the legal ramifications above and consider taking legal action. For those interested in this route, contact CAB.

Update 01/10/2018. A CAB adviser had an appointment at one of the INSS offices. The questions asked:

!. Q) have you received any instruction on the implementaton of the new law? A) No. 2.Q) So nothing changes and you continue to provide assistance to those with EU or other country agreements plus pre April 2012 residents? A)Yes.

3. Q) You are aware that the law has put the implementation of the law into the hands of the CCAA /autonomous communities) A) Yes.

4. Q) Are you likely to receive instructions in the near future? A) We do not know.

CAB Spain suggest that any applications should be made to your regional health ministry or and your health centre.

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Update: 6/09/2018.

Congress has voted in the majority to validate the law on Universal Healthcare approved by the government on July 27 and published in the State Bulletin on July 30. We are hoping that this will speed up the implementation of the law in all regions. Further information to be posted.

Update: 28/01/2019. A second lawyer has looked at the information and believes there is a get out clause in the new law. CAB Spain adviser will be meeting with this lawyer for clarification. If we cannot challenge the Royal Decree of July 2018, we can still challenge the refusal of healthcare cover under public funds for legal residents from a previous law.

Update: 31/01/2019.  CAB adviser held a meeting with the lawyer yesterday.  He has reiterated that one of the “resolutions” in the law has allowed the autonomous regions to draft a “reglamento”  (regulation) for their regions. Until they comply, we cannot expect the national royal decree to be upheld.  There is no point taking litigation under this law but yes under the previous laws. We add a video to explain this. The previous laws will only include registered residents.


Right to healthcare


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Please note: The information provided is based upon our understanding of current legislation. It is not legal advice but is provided freely to enable you to be properly informed. We recommend that if you are considering taking action, you should seek professional advice.

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