Recognition of the Right to Public Healthcare for Foreigners Without Legal Residence in Spain

A translation of the law with some notes added by Citizens Advice Spain.

The Spanish Constitution of 1978, in Article 43.1, recognises the right to health protection, entrusting public authorities with organising and safeguarding public health through preventive measures and the necessary services and benefits. The Spanish Constitution also, in Article 149.1.16, recognises that the State has exclusive competence in matters of external health, the basic principles and general coordination of healthcare, and legislation on pharmaceutical products.

Since its inception, the National Health System has been characterised by a steady increase in healthcare coverage for the population entitled to public healthcare, moving towards universal access. This universality is one of the fundamental principles of our healthcare system, as enshrined in Law 14/1986 of April 25, the General Health Law, Law 16/2003 of May 28, on the cohesion and quality of the National Health System, and Law 33/2011 of October 4, the General Public Health Law.

The growing trend of incorporating more population groups into health coverage within the National Health System was cut short in 2012 with the approval of Royal Decree-Law 16/2012, of April 20, on urgent measures to guarantee the sustainability of the National Health System and improve the quality and safety of its services, which removed the right to health care from people included in some population groups, the most significant being that of undocumented migrants, limiting their access to the health system to people under eighteen years of age and restricting access for the rest of this group to the area of ​​urgent care and assistance for pregnancy, childbirth and postpartum.

Following the approval of this legislation, numerous cases of unmet healthcare needs were identified, linked to the healthcare exclusion induced by Royal Decree-Law 16/2012 of April 20, particularly among undocumented migrants. The exclusion of certain groups, such as migrants, from healthcare leads to vulnerability to health problems, generating health inequalities across the population. Furthermore, this exclusion does not result in a more efficient use of healthcare resources, as it only allows access to services in emergency situations, preventing better control and monitoring of illnesses through primary care, which could reduce complications and avoidable hospitalisations. Since the healthcare system is financed through taxes, migrants residing in Spain also contribute to the maintenance of the National Health System. Finally, from an ethical and justice point of view, the protection of health and care for people in a vulnerable situation due to illness, regardless of their personal or social characteristics, should be a principle that guides the actions of public authorities to improve the health of the population as a whole.

In 2018, Royal Decree-Law 7/2018, of July 27, on universal access to the National Health System, was approved. Its first article amended several articles of Law 16/2003, of May 28, which allowed for a return to growth in the proportion of the population with health coverage under the National Health System. This was achieved through a system of recognising the right to healthcare based on residency in Spain, recognising the right to health protection and healthcare for individuals not registered or authorised as residents in Spain under the same conditions as individuals with Spanish nationality, as established in Article 3 ter.1.

However, following the publication and entry into force of Royal Decree-Law 7/2018 of July 27, inconsistencies in its application across different regions have persisted, along with additional administrative barriers beyond those established in the law for recognising the right to health protection and healthcare. These findings have also been corroborated by civil society organisations working in the field of healthcare inclusion for migrants.

CAB note: (While Royal Decree-Law 7/2018 was intended to restore universal access to healthcare based on residency, the practical application of the law continues to vary significantly between autonomous communities, even several years after its adoption. In many regions, additional administrative requirements have been introduced that are not explicitly provided for in the legislation, creating barriers to access for some applicants. Civil society organisations have documented these inconsistencies, confirming that the law is not being applied uniformly. As a result, despite the intention of the reform to ensure universal coverage through the Spanish National Health System, many residents who should in principle qualify under the law still encounter delays or refusals when attempting to obtain recognition of their healthcare rights.

On the other hand, the aim is to extend the right to publicly funded healthcare to Spanish citizens residing abroad during their temporary stays in Spain, and to their accompanying family members, when, according to EU regulations coordinating social security systems or bilateral agreements covering healthcare, they are not already covered. Currently, in accordance with Article 26 of Royal Decree 8/2008 of January 11, which regulates benefits for Spanish citizens residing abroad and returning to Spain based on need, only pensioners and workers are entitled to healthcare. Therefore, individuals who have not found employment abroad are not entitled to publicly funded healthcare during their stays in Spain).

This regulation governs the procedure for recognising the right to publicly funded healthcare, without requiring a minimum length of time in the country, thus ensuring uniformity in the effectiveness of the right to health protection. It also extends the right to healthcare to a group of people (Spanish citizens of origin residing abroad who are not employed) that is not currently covered.

It has also been observed that people with disabilities and their families, due to their particular vulnerability and greater healthcare needs, are disproportionately affected by territorial inequalities and bureaucratic barriers to accessing healthcare. Therefore, this Royal Decree also aims to ensure that the universality of the system is fully inclusive, addressing the specific barriers faced by this group, in accordance with the mandates of the International Convention on the Rights of Persons with Disabilities.

The modification of Royal Decree 1506/2012, of November 2, which regulates the supplementary common portfolio of orthoprosthetic services of the National Health System and establishes the bases for setting the maximum amounts of financing for orthoprosthetic services, is included, in order to automatically equate the groups exempt from orthoprosthetic contributions with the categories of users and their beneficiaries exempt from outpatient pharmaceutical services.

The Royal Decree incorporates, in its first final provision, the modification of Royal Decree 8/2008, of January 11, which regulates the benefit for reasons of need in favor of Spaniards residing abroad and returning, to extend the right to health protection and healthcare at public expense for Spanish people of origin residing abroad during their trips to Spanish territory and for the family members who accompany them, as well as the criteria for defining compliance with the requirements for its recognition.

Finally, the repeal of the second section of the second additional provision, as well as the first, third, fourth, fifth, sixth, eighth and ninth additional provisions of Royal Decree 1192/2012, of August 3, which regulates the condition of being insured and beneficiary for the purposes of healthcare in Spain, charged to public funds, through the National Health System, is incorporated, and its content is incorporated into this royal decree.

The royal decree is structured in the following parts: title of the provision; preamble; operative part consisting of four articles; and a final part divided into six additional provisions, a single transitional provision, a single repealing provision, and five final provisions. An annex is also included.

The Royal Decree complies with the principles of good regulation contained in Article 129 of Law 39/2015, of October 1, on the Common Administrative Procedure of Public Administrations (principles of necessity, effectiveness, proportionality, legal certainty, transparency, and efficiency), as it pursues a general interest by applying certain aspects of Law 39/2015, of October 1, and Law 40/2015, of October 1, on the Legal Regime of the Public Sector, which will facilitate the effective use of electronic means by the Administration in the procedure for recognizing the right to healthcare within the National Health System. The regulation is in accordance with the principle of proportionality, as it contains only the provisions essential for achieving the aforementioned objectives. Likewise, it complies with the principle of legal certainty, being consistent with the rest of the legal system and establishing a stable, integrated, and clear regulatory framework.

The principles of necessity and effectiveness are demonstrated to the extent that the standard has been observed, seeking to establish the documentation and procedure necessary to demonstrate compliance with the requirements that regulate the recognition of the right to health protection and healthcare for the persons contemplated in Article 3 ter of Law 16/2003, of May 28, this being the most appropriate tool to establish an effective and homogeneous mechanism that allows facilitating the recognition of the right to this group, guaranteeing an equitable approach when protecting the health of the population.

In accordance with the principle of transparency, the objectives of the regulation are justified in the preamble, and during the drafting process it underwent prior public consultation and public hearing and information procedures, and representative entities of the affected sectors were consulted. Furthermore, it was reviewed by the Advisory Committee of the National Health System and the Interterritorial Council of the National Health System, and the autonomous communities, the cities of Ceuta and Melilla, the National Institute of Health Management, and civil servant mutual insurance societies were consulted.

The principle of efficiency is demonstrated to the extent that the established application procedure seeks to minimize administrative burdens, facilitating a debureaucratisation of the regulated process.

The royal decree is issued under the provisions of Article 149.1.16 of the Spanish Constitution, which attributes to the State the competence over the “basics and general coordination of health.”

Therefore, at the proposal of the Minister of Health and the Minister of Inclusion, Social Security and Migration, with the prior approval of the Minister for Digital Transformation and the Civil Service, in accordance with the Council of State, and after deliberation by the Council of Ministers at its meeting of 10 March 2026,

I HAVE AVAILABLE:

Article 1. Purpose.
This royal decree aims to regulate the procedure for recognising the right to health protection and healthcare at public expense for foreign nationals who are in Spain but do not have legal residence in Spanish territory, as well as the method of accrediting the requirements set out in article 3 ter.2 of Law 16/2003, of May 28, on cohesion and quality of the National Health System.

Article 2. Documentation to be provided to obtain recognition of the right to health protection and healthcare at public expense for foreign persons who are in Spain but do not have legal residence in Spanish territory.
1. In order to obtain recognition of the right to health protection and healthcare at the expense of public funds, applicants must provide the declaration of responsibility regarding the requirements of article 3 ter.2 of Law 16/2003, of May 28, established in the annex of this royal decree before the competent administrations in the processing units enabled for this purpose of the autonomous communities and the National Institute of Management.

For the signing of the declaration of responsibility, persons with disabilities who require support to exercise their legal capacity will be provided with the necessary support measures, in accordance with civil and procedural law. The Administration will facilitate understanding of its content and consequences by providing the information in accessible formats, and will allow the participation of persons who support the person with a disability in decision-making.

If the applicant comes from a country with which Spain applies an international social security standard that includes health coverage, in order to prove the requirement provided for in article 3 ter 2. b) of Law 16/2003, of May 28, the applicant must additionally provide a certificate issued by the competent health care institution of said country, proving that the export of the health coverage at their expense is not appropriate.

2. In order to submit the declaration of responsibility referred to in the previous section, the applicant must prove their identity and habitual residence in Spanish territory by providing the documentation indicated in sections 3 and 4, respectively.

3. To verify the identity of the applicant, the following documentation must be provided:

a) Passport or official identity document, issued by the Administration of your country of origin. In the absence of the above, the presentation of another document issued by the Administration of your country of origin that can prove the identity of the person containing at least one photograph will be valid.

b) In the case of minors without a passport or official identity document, identity may be proven through a birth certificate, a family book issued by the competent body of the country of origin or the General State Administration or through official documentation that proves guardianship or custody by a public entity for the protection of minors or a legal guardian appointed judicially.

4. To prove the applicant’s habitual residence in Spanish territory, the following documentation must be provided:

a) Certificate or up-to-date registration form in a municipality of an autonomous community or in the cities of Ceuta and Melilla.

b) If the applicant cannot prove their habitual residence by means of the corresponding registration certificate, it will be considered proven by providing any of the following documents:

1. Certificate of enrollment in a public or subsidised educational centre of the autonomous community or of the cities of Ceuta and Melilla.

2nd Certificate of schooling of dependent minors in a public or subsidised educational center of the autonomous community or of the cities of Ceuta and Melilla.

3. Travel letter issued by the consulate.

4. Visit registration certificate issued by a basic social service of a local entity, an autonomous community or autonomous city, or by registered social workers who provide their services in non-governmental organisations declared to be of public utility pursuant to the provisions of Organic Law 1/2002, of March 22, regulating the Right of Association.

5. Bills for electricity, gas, water, telephone or Internet services, in the name of the applicant, that prove an address.

6. The registration certificate issued by the National Police or a resolution from the Prosecutor’s Office regarding the determination of age.

7. Consular registration document.

8th Certificate issued by a center of the public network of migration centers.

Article 3. Procedure for requesting recognition of compliance with the criteria for the recognition of the right to health protection and healthcare at public expense for foreign persons who are in Spain but do not have legal residence in Spanish territory.
1. The procedure by which the requirements set out in article 2 of this royal decree may be accredited shall be initiated by application of the interested person, or a third party expressly authorised, and its processing shall be in accordance with the provisions established in Law 39/2015, of October 1, on the Common Administrative Procedure of Public Administrations with the specificities resulting from Law 39/2006, of December 14, on the Promotion of Personal Autonomy and Care for people in situations of dependency.

2. Upon submission of the application, the applicant will be given a provisional document confirming that their application has been submitted, regardless of any subsequent requests for additional documentation. This provisional document confirming the submission of the application will allow, on a provisional basis until the application is resolved, access to publicly funded healthcare.

3. Health and social services must inform and assist, to the extent possible, in the processing of applications and must guarantee that, from the first service provided to the interested party, they have the effective possibility of initiating the accreditation procedure for the right provided for in Article 3 ter of Law 16/2003, of May 28, at the center itself. Likewise, the procedure must be initiated ex officio when, due to the nature of the healthcare, the person is unable to do so.

4. In cases of temporary relocation between autonomous communities, the transfer of the right to health protection and healthcare at public expense, as regulated in this Royal Decree, will be treated the same as the temporary affiliation established for insured persons. In neither of these cases will it be necessary to re-apply for healthcare coverage in the new autonomous community, nor will any type of care be billed prior to the formalisation of the affiliation.

5. The resolution of the procedure on the recognition of the right to health protection and healthcare at public expense, regardless of its meaning, must be notified to the interested party.

The decision regarding the case must be issued and notified to the interested parties within a maximum period of three months. For the purposes of establishing when the three-month period begins, in proceedings initiated at the request of the interested party, the date of entry of the request in the electronic register of the competent Administration will be used; and in proceedings initiated ex officio, in accordance with the provisions of paragraph 3, the date of the initiation agreement will be used. After this period has elapsed, the request initiated by the interested party will be considered approved by administrative silence pursuant to Article 24.1 of Law 39/2015, of October 1, and any subsequent decision may only be confirmatory as established in Article 24.3 of Law 39/2015. In requests initiated ex officio, the effect of silence will be considered a rejection pursuant to Article 25.1.a) of Law 39/2015, of October 1.

In cases where the decision is favourable, the health card or document certifying the healthcare coverage of the interested party will be issued. In the case of an unfavourable decision, the notification will comply with the provisions of Law 39/2015, of October 1.

Cases of denial will not entail billing for services previously provided, including those provided before the submission of the application, if the interested party subsequently proves that, on the date of their service, the material requirements of article 2.1 were met. In other cases, billing for the health care received will proceed, which will be adjusted to the procedures in force in each autonomous community and, where appropriate, by the National Institute of Health Management.

6. The document certifying the right to health protection and healthcare at public expense will not expire, remaining valid until the interested party obtains the right to healthcare through another means.

Article 4. Groups requiring special protection.
The right to healthcare for the following groups will be recognised and made effective in accordance with their specific regulations:

a) Persons under eighteen years of age, in accordance with Organic Law 1/1996, of January 15, on the Legal Protection of Minors, as well as foreign persons under eighteen years of age not registered or authorised as residents in Spain referred to in Article 3 ter of Law 16/2003, of May 28, shall have the right to public health care by the National Health System with the same extent recognised to persons who are in any of the cases provided for in Article 3.2 of Law 16/2003, of May 28, the type of contribution of the user for the benefits of the portfolio of services of the National Health System being that which is required of persons who are in said cases.

b) Foreign pregnant women not registered or authorised as residents in Spain shall have the right to receive pregnancy, childbirth and postpartum care from the National Health System to the same extent recognised for persons in any of the cases provided for in Article 3.2 of Law 16/2003, of May 28, with the user’s contribution rate for the services of the National Health System being that required of persons in those cases.

c) Applicants for international protection, in accordance with Regulation (EU) 2024/1348 of the European Parliament and of the Council of 14 May 2024 establishing a common procedure in matters of international protection in the Union and repealing Directive 2013/32/EU, shall receive health care from the moment of formulating the application for international protection, with the extension provided for in the basic common portfolio of healthcare services of the National Health System regulated in Article 8 bis of Law 16/2003 of 28 May.

Applicants for stateless status, based on the Regulation for the recognition of stateless status, approved by Royal Decree 856/2001, of July 20, will receive healthcare from the date of submission of the application.

Likewise, necessary care, medical or otherwise, will be provided to applicants for international protection with special needs.

d) Applicants for temporary protection, in accordance with Council Directive 2001/55/EC of 20 July 2001 on minimum standards for the granting of temporary protection in the event of mass influx of displaced persons and measures to encourage a fair effort between Member States to host such persons and to bear the consequences of hosting them.

e) Victims of gender violence, as well as their sons and daughters, in accordance with Article 31 bis of Organic Law 4/2000, of January 11, on the rights and freedoms of foreigners in Spain and their social integration, in relation to Article 19 bis of Organic Law 1/2004, of December 28, on Comprehensive Protection Measures against Gender Violence.

f) Victims of human trafficking during the recovery and reflection period will receive, while they remain in this situation, health care with the extension provided for in the basic common portfolio of care services of the National Health System regulated in article 8 bis of Law 16/2003, of May 28.

Likewise, necessary care, medical or otherwise, will be provided to victims of human trafficking with special needs.

g) Victims of sexual violence, in accordance with Organic Law 10/2022, of September 6, on the comprehensive guarantee of sexual freedom.

h) In the case of diseases that are subject to mandatory reporting in accordance with Law 33/2011, of October 4, General Law on Public Health.

i) Foreign women not registered or authorized as residents in Spain who request access to voluntary termination of pregnancy in accordance with Organic Law 1/2023, of February 28, which modifies Organic Law 2/2010, of March 3, on sexual and reproductive health and voluntary termination of pregnancy.

j) All those that have a specific protection regime recognised for access to the right to health care by other regulations.

Additional provision one. Model of responsible declaration for the accreditation of compliance with the requirements set out in this royal decree.
The annex contains the model of the declaration of responsibility that must be submitted by the interested party in accordance with the provisions of this royal decree.

Additional provision two. Report on accreditation of special vulnerability.
In accordance with the provisions of Article 3 ter.3 of Law 16/2003, of May 28, in those cases in which foreign persons are in a situation of temporary stay in accordance with the provisions of Organic Law 4/2000, of January 11, on the Rights and Freedoms of Foreigners in Spain and their Social Integration, the issuance of a prior favorable report from the competent social services of the autonomous communities will be mandatory.

Third additional provision. Collaboration of institutions with people in need in the processing of applications.
Health and social services will inform and assist, as far as possible, in the processing of applications regulated in article 3, especially when applicants do not speak Spanish or the co-official language of the autonomous community where they are located, as well as in the case of those with a disability.

Fourth additional provision. Accessibility of the procedures for requesting recognition of the right to health care.
With regard to the procedures regulated in this Royal Decree, all procedures, forms, telematic platforms, communication channels and registry assistance offices must be fully accessible, providing, where necessary, easy-to-read formats, augmentative and alternative communication systems, sign language interpretation, hearing loops and the personal assistance necessary to ensure equal conditions in the exercise of the right.

Fifth additional provision. Data protection.
The collection and processing of personal data will be carried out in compliance at all times with the provisions established in Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data and repealing Directive 95/46/EC (General Data Protection Regulation), in Organic Law 3/2018 of 5 December on the Protection of Personal Data and Guarantee of Digital Rights and other regulations on the protection of personal data that may apply.

Sixth Additional Provision. Healthcare for people with disabilities.
With regard to healthcare for people with disabilities, the provisions of the consolidated text of the General Law on the rights of people with disabilities and their social inclusion, approved by Royal Legislative Decree 1/2013, of November 29, and Royal Decree 383/1984, of February 1, which establishes and regulates the special system of social and economic benefits, will continue to apply.

Seventh additional provision. Personal identification and management of clinical data of foreign persons not registered or authorised as residents in Spain and of the groups of special protection included in article 4.
For the sole purpose of the necessary personal identification and management of their clinical data, foreign persons not registered or authorised as residents in Spain and the groups of special protection included in article 4 of this royal decree who receive health care from the National Health System, will be assigned a personal identification code (CIP-SNS) which will be unique and common to all health services of the National Health System and which will be permanently associated with their clinical information.

Single transitional provision. Minimum period for access to the transplant waiting list for foreign persons referred to in Article 3 ter of Law 16/2003, of May 28.
To access the transplant waiting list, foreign persons covered by Article 3 ter of Law 16/2003, of May 28, must prove a minimum period of residence in Spain of two years by means of the certificate or registration slip updated in a municipality of an autonomous community or of the cities of Ceuta and Melilla, or by means of any of the documents contemplated in Article 2.4.b) that allow proof of said seniority.

This provision will cease to have effect upon the entry into force of the order contained in the second final provision of Royal Decree-Law 7/2018, of July 27, on universal access to the National Health System.

Single repealing provision. Repeal of regulations.
The second section of the second additional provision, as well as the first, third, fourth, fifth, sixth, eighth and ninth additional provisions of Royal Decree 1192/2012, of August 3, which regulates the status of insured and beneficiary for the purposes of healthcare in Spain, charged to public funds, through the National Health System, as well as any provisions of equal or lower rank that oppose, contradict or are incompatible with the provisions of this royal decree, are hereby repealed.

Final provision one. Amendment of Royal Decree 8/2008, of January 11, which regulates the benefit for reasons of need in favor of Spaniards residing abroad and returning.
Article 26 of Royal Decree 8/2008, of January 11, which regulates the benefit for reasons of need in favor of Spaniards residing abroad and returning, is amended to read as follows:

“Article 26. Healthcare assistance for Spanish persons of origin residing abroad temporarily displaced to the national territory and for the family members who accompany them on their temporary displacements or in case of return to Spain.
1. Spanish persons of origin residing abroad, during their temporary stays in Spain, shall be entitled to healthcare through the National Health System when, in accordance with the provisions of Spanish Social Security legislation, or the International Social Security rules or Agreements established for this purpose, they do not have this coverage provided for.

2. Family members of Spanish persons of origin, residing abroad, who accompany them on their temporary trips to Spain, as well as family members of Spanish persons of origin who have returned and who settle with them in Spain, will also have the right to health care in Spain, through the National Health System, when, in accordance with the provisions of Spanish Social Security, or the international Social Security rules or Conventions established for this purpose, these family members do not have this coverage provided for.

3. For the purposes indicated, the following shall be considered family members entitled to healthcare:

a) The spouse or the person who lives with the Spanish person of origin with a relationship of affection analogous to that of a conjugal couple, constituting a de facto couple.

b) The descendants of Spanish persons of origin or those of their spouse or those of their civil partner, who are dependent on them and are under 26 years of age or over that age with a recognized disability of 65 percent or more.

4. The recognition of the right to healthcare in all these cases corresponds to the National Institute of Social Security, which will issue the document certifying the right.

The decision regarding the application must be issued and notified to the interested parties within a maximum period of three months from the date of entry of the application in the electronic register of the National Social Security Institute. After this period, the application will be considered approved by administrative silence pursuant to Article 24.1 of Law 39/2015, of October 1, on the Common Administrative Procedure of Public Administrations, and any subsequent decision may only be confirmatory as established in Article 24.3 of said law.

5. Those interested in obtaining recognition of the right to healthcare during their temporary stays in Spanish territory must provide the corresponding documentation:

a) Valid identity document or passport of the applicant.

b) Birth certificate, showing the Spanish nationality of origin.

c) Certificate of the Register of Spaniards Resident Abroad (PERE).

d) Declaration of responsibility stating that the right to health care cannot be exported from another country and, additionally, if residing in a country with which Spain applies an international social security standard that includes health coverage, a certificate issued by the competent health care institution of said country of residence, attesting that the export of the health coverage at their expense is not possible.

e) Documentation proving the status of family member of Spanish persons of origin, residing abroad, who accompany them on their temporary trips to Spain.

f) Certificate or document proving that you have a disability of a degree equal to or greater than 65 percent for people over 26 years of age with a disability.

6. Family members of returning Spanish citizens who settle with them must provide the corresponding documentation to prove the following elements:

a) Documentation proving the status of family member of the Spanish person of origin who is returning to Spain.

b) Documentation proving that the procedures for obtaining a residence permit have been initiated in the case of foreign persons.

c) Documentation proving that you have started the procedures for establishing your habitual residence in Spain at the same address as the Spanish person of origin who has returned.

d) Declaration of responsibility stating that the right to health care cannot be exported from another country and, additionally, if it comes from a country with which Spain applies an international social security standard that includes health coverage, a certificate issued by the competent health care institution of said country attesting that the export of the health coverage at its expense is not possible.

e) Certificate or document proving that you have a disability of a degree equal to or greater than 65 percent for people over 26 years of age with a disability.

f) Consular certificate showing the registration and deregistration of the returned Spanish person of origin in the Registration Register issued by the consulate of the country of origin.

7. The validity period of the right to healthcare benefits granted to Spanish citizens of origin residing abroad who travel temporarily to Spain, and to their accompanying family members, will coincide with the planned period of temporary stay in Spain, as declared by the beneficiary. The benefit will automatically cease on the date of termination of the planned stay. In any case, the validity of the right will have a maximum duration of three months from the effective date of its recognition, with the possibility of a single renewal for another three months. To this end, an application for renewal of the right to healthcare benefits must be submitted to the National Social Security Institute.

The duration of the right to healthcare benefits regulated in this article may not exceed six months within a one-year period, counted from the effective date of the initial recognition of the right. In the case of family members of returning Spanish nationals who settle with them in Spain, the right to healthcare benefits regulated in this article will be extinguished before the expiration of the aforementioned six months when they are granted the right to healthcare benefits through another means.

Final provision two. Amendment of Royal Decree 1506/2012, of November 2, which regulates the supplementary common portfolio of orthoprosthetic services of the National Health System and establishes the bases for setting the maximum amounts of financing for orthoprosthetic services.
Article 9 of Royal Decree 1506/2012, of November 2, which regulates the supplementary common portfolio of orthoprosthetic services of the National Health System and establishes the bases for setting the maximum amounts of financing for orthoprosthetic services, is amended to read as follows:

«Article 9. Contribution of users.
1. In general, the supplementary orthoprosthetic benefits package is subject to a user contribution, with a scheme similar to that of pharmaceutical benefits, using the product’s offer price as the basis for calculation. The user’s contribution percentage will be governed by the same rules that regulate pharmaceutical benefits, but the same contribution limit will not apply.

2. Consequently, the user’s contribution percentage will be as follows:

a) 60 percent of the Offer price of the product for users and their beneficiaries whose income stated in the boxes of the general taxable base and savings of the Personal Income Tax return is equal to or greater than 100,000 euros.

b) 50 percent of the Offer price of the product for persons who hold the status of active insured and their beneficiaries whose income stated in the boxes of the general taxable base and savings of the Personal Income Tax return is equal to or greater than 18,000 euros and less than 100,000 euros.

c) 40 percent of the Offer price of the product for persons who hold the status of active insured and their beneficiaries and are not included in sections a) ob).

d) 10 percent of the Offer price of the product for persons who hold the status of insured as Social Security pensioners and their beneficiaries, with the exception of persons included in section a).

e) 10 percent of the Offer price of the product in the products belonging to the reduced contribution subgroups that appear in the annex.

3. By order of the Minister of Health, after a report from the Interterritorial Council, the maximum limit of the contribution to be paid by the users referred to in the previous sections b), c), d) and e) will be established.

4. Users and their beneficiaries who, at the time of dispensing, belong to one of the categories exempt from contribution in pharmaceutical services will be exempt from contribution.

5. Holders or beneficiaries of special Social Security schemes managed by civil servant mutual societies shall contribute 30 percent, up to the limit set for users in section 2 c), except for products belonging to the reduced contribution subgroups, in which the provisions of section 2 e) shall apply, and for treatments resulting from accidents on duty or occupational diseases, which shall be exempt from contribution.

Final provision three. Competence title.
This royal decree is issued under the provisions of Article 149.1.16 of the Spanish Constitution, which attributes to the State exclusive competence in matters of basic principles and general coordination of health.

The provisions subject to modification by this royal decree will continue to be protected by the competence title expressed therein.

Final provision four. Development power.
The Minister of Health is authorized to issue the necessary provisions for the implementation of this royal decree.

Final provision five. Entry into force.
This royal decree will come into force the day after its publication in the “Official State Gazette”.

Given on March 11, 2026.

FELIPE R.

The Minister of the Presidency, Justice and Relations with the Courts,

FÉLIX BOLAÑOS GARCÍA

EXHIBIT
Declaration of responsibility for the recognition of the right to health protection and healthcare at the expense of public funds
Mr./Ms. ……………………………………………………………………………………………………….. with identity number ………………………………. and address ……………………………………….

For the purposes set out in Article 3ter.2 of Law 16/2003, of May 28, on the cohesion and quality of the National Health System, regarding access to healthcare at public expense for foreign nationals not registered or authorized as residents in Spain, residing in the Community of

I DECLARE RESPONSIBLY:

☐ Not being required to have health insurance.
☐ Not having public health insurance coverage through any other means.
☐ Not being able to export the right to healthcare provided by another country.
☐ That there is no third party obligated to pay for my healthcare.
☐ I do not have a valid stay visa, nor am I registered in the Register of Citizens of the European Union, nor do I have a valid Foreigner Identification Card.
I HAVE BEEN INFORMED THAT:

☐ This provisional document certifying the application that grants access to healthcare at public expense does not generate the right to healthcare outside of Spanish territory.
☐ The Administration may carry out the necessary checks to verify the validity and truthfulness of the information I provide.
☐ The Administrations may require at any time that the documentation proving compliance with the aforementioned requirements be provided, and the interested party must provide it.
☐ In the event of detecting any inaccuracy, falsehood or omission of an essential nature in any data or information included in this declaration of responsibility, the provisional document accrediting the application that grants access to healthcare at public expense will be rendered ineffective from the moment these facts are established, without prejudice to any criminal, civil or administrative liabilities that may arise, including the reimbursement of the amount of healthcare services received since the application thereof.

In Spanish.

ANEXO
Declaración responsable para el reconocimiento del derecho a la protección de la salud y a la atención sanitaria a cargo de fondos públicos
Don/Doña ……………………………………………………………………………………………………….. con número de identidad ………………………………. y domicilio ……………………………………….

A los efectos previstos en el artículo 3ter.2 de la Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud, para el acceso a la asistencia sanitaria con cargo a fondos públicos de las personas extranjeras no registradas ni autorizadas como residentes en España, con residencia en la Comunidad de

DECLARO RESPONSABLEMENTE:

☐ No estar obligado a suscribir un seguro médico de enfermedad.
☐ No contar con cobertura de asistencia sanitaria pública por ninguna otra vía.
☐ No poder exportar el derecho a la asistencia sanitaria a cargo de otro país.
☐ Que no existe un tercero obligado al pago de mi asistencia sanitaria.
☐ Que no dispongo de un visado de estancia en vigor, ni estoy inscrito en el Registro de Ciudadanos de la Unión Europea ni dispongo de Tarjeta de Identificación de Extranjero en vigor.
HE SIDO INFORMADO DE QUE:

☐ Este documento provisional acreditativo de la solicitud que da acceso a la asistencia sanitaria con cargo a fondos públicos no genera derecho a la atención sanitaria fuera del territorio español.
☐ La Administración podrá llevar a cabo las verificaciones necesarias para comprobar la validez y veracidad de la información que aporto.
☐ Las Administraciones podrán requerir en cualquier momento que se aporte la documentación que acredite el cumplimiento de los mencionados requisitos y que la persona interesada deberá aportarla.
☐ En caso de detectarse inexactitud, falsedad u omisión, de carácter esencial, de cualquier dato o información que se incorpore en esta declaración responsable, el documento provisional acreditativo de la solicitud que da acceso a la asistencia sanitaria con cargo a fondos públicos quedará sin efecto desde el momento en que se tenga constancia de estos hechos, sin perjuicio de las responsabilidades penales, civiles o administrativas a que hubiera lugar, entre las que se encuentra el reintegro del importe de las prestaciones sanitarias recibidas desde la solicitud del mismo.

CAB Note: Understanding Your Rights Under the 2018 Universal Healthcare Law

This note provides guidance for residents and others who may not currently have access to healthcare under the law. It is intended to help you understand your rights and how to claim them.
Even though the 2018 Royal Decree-Law 7/2018 was intended to guarantee universal access to healthcare based on residency, many residents and other individuals in Spain still face difficulties when trying to access their rights. In some regions, additional administrative requirements have been introduced that are not explicitly provided for in the law, creating barriers for people who should, in principle, be entitled to healthcare.

If you are living in Spain and do not currently have access to healthcare under the Universal Healthcare Law, it is important to know that the law is designed to grant coverage based on residency, not nationality or formal registration. This means that as a resident, you have the right to receive health protection and healthcare through the Spanish National Health System.

You may encounter situations where local procedures require documents or impose conditions that go beyond what the law states. If this happens, you should assert your rights under the 2018 law and, if necessary, seek advice or support from organisations familiar with healthcare inclusion for residents. Civil society organisations have documented these inconsistencies and can provide guidance on how to access healthcare even when regional practices differ.

Remember that the law applies to all residents who meet the criteria, so being aware of your rights is the first step in ensuring you can receive the healthcare you are legally entitled to.

CAB Note: Healthcare Rights for Minors and Pregnant Women

Individuals encountering administrative barriers should be aware of their legal entitlements and can seek advice or support from organisations familiar with healthcare inclusion for residents.

Information on the right to healthcare as residents

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.