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WHAT I AM COVERED FOR UNDER THE "CONVENIO ESPECIAL" SCHEME

Posted in: Health
Author: Philip Carroll
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The “Convenio Especial” scheme allows you to pay to be able to access the State Health Scheme if you don’t qualify in any other way. Full details of the ways to qualify for free treatment are detailed in our Library in this document.

If you don’t qualify in any of the ways described in the document then you can pay to access the “Convenio Espeical” scheme. This scheme was launched by the Government in 2013 and is managed by the Autonomous Regions, although it is not yet available in all the Regions. Currently it is available in practically all Autonomous regions with information available on the Regional websites. This is a post about a members experience of obtaining cover in Andalucia.

To qualify to join the scheme you must have been registered as being resident in the 12 months before your application (empadroniamiento, Registro de Cuidadnos de L’Union etc) The cost of joining the scheme is €60 if you are under 65 and €157 if you are over 65. There are no exclusions for pre existing conditions.

Update re requirement of 12 months residency HERE.

In terms of cover, this is specified in the law covering health care which is Ley 16/2003.

The rights to cover are established in article 3.5

5. Aquellas personas que no tengan la condición de asegurado o de beneficiario del mismo podrán obtener la prestación de asistencia sanitaria mediante el pago de la correspondiente contraprestación o cuota derivada de la suscripción de un convenio especial.

Which roughly translates as

5. Those who do not have the status of the insured or beneficiary thereof may obtain the delivery of health care by paying the corresponding compensation or fee resulting from the signing of a special agreement

This is further confirmed in Article 2 of Ley 576/2013 which sets out some of the detail of the “Convenio Especial” in particular

2. El convenio especial permitirá a las personas que lo suscriban acceder, mediante el pago de la contraprestación económica regulada en el artículo 6, a las prestaciones de la cartera común básica de servicios asistenciales del Sistema Nacional de Salud regulada en el artículo 8 bis de la Ley 16/2003, de 28 de mayo, con las mismas garantías de extensión, continuidad asistencial y cobertura de que disfrutan las personas que ostentan la condición de aseguradas o de beneficiarias del Sistema Nacional de Salud, en el ámbito correspondiente a la administración pública con la que se formaliza el mismo y sin perjuicio de lo dispuesto en la disposición adicional primera de este real decreto.

which roughly translates as

2 The special agreement will allow people to subscribe access through the payment of monetary compensation regulated in Article 6, the benefits of basic common portfolio of healthcare services NHS regulated in Article 8a Law 16/2003 of 28 May, with the same degree of extension, continuity of care and coverage enjoyed by people who have the status of insured or beneficiaries of the National Health System, in the relevant field of public administration with which it is formalized and subject to the provisions of the first additional provision of this Royal Decree.

The scope of cover is set out in Art8 a of Ley 16/2003 and is the basic common portfolio of healthcare

1. La cartera común básica de servicios asistenciales del Sistema Nacional de Salud comprende todas las actividades asistenciales de prevención, diagnóstico, tratamiento y rehabilitación que se realicen en centros sanitarios o sociosanitarios, así como el transporte sanitario urgente, cubiertos de forma completa por financiación pública.

which roughly translates as

1. The basic common portfolio of healthcare services NHS includes all healthcare prevention, diagnosis, treatment and rehabilitation carried out in health or health centers, as well as the urgent medical transportation covered completely by public funding .

However, what is not covered, because they are separated out and are not part of 8a, is the provision of the TSE (Tarjeta Sanitaria Europea) which is the Spanish EHIC. So you are not covered if you travel to another European country, except for emergencies, so it is essential that you obtain private travel insurance. In addition, out patient prescription costs are not subsidised, so you will have to pay the full costs of any drugs. Fortunately lots of drugs are quite cheap in Spain, but other depending upon your condition may be expensive.

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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