Universal Healthcare – Legal Ramifications

CAB advisors Myra and Richelle have had a meeting on the 19th of September with a lawyer from prestigious lawfirm in Fuengirola. The discussion was about the legal ramifications of the Universal Healthcare law that came into force on July 31st this year. So far the Royal Decree has not been implemented. We could say that it has been partially implemented in some Autonomous Regions.

Our first question was about the legality, or legal correctness of  allowing the Autonomous Regions to be the competent authority  to implement the new law and without a fixed date to do so. Unfortunately, as Spain is a state with Autonomous  regions, there are laws that state the responsibilities of the Central Government, the Autonomous Governments and Local Governments and the issue of healthcare is indeed the competence of the Autonomous Governments, the department of ´salud´ or ´sanidad´of each Junta or Xunta.

Furthermore though a Royal Decree law is a type of law that goes through a rapid approval process to suit the urgent character of  its content, not putting a deadline by which implementation should be realised sounds contradictory, but it is not illegal and even quite common.

Our second question was about the cancellation of the Convenio Especial, and the fact that so far only one region has acted upon this and informed those subscribed, stopped the direct debits and arranged for free healthcare with discounts on prescriptions.

According to the lawyer we spoke to, the decision to stop the cover of the Convenio Especial for those that are, (according to the new law) covered for healthcare paid for by public funds, is a decision from the Central Government and it is not up to the Autonomous Regions to choose to adhere or not. So all those that meet the requisites of the new law (proven residency  EU and non EU citizens by whatever means (residency certificate or TIE, padrón), no entitlement to public healthcare by any other means, so not working, not Autonomo, no possibility to ´piggy back´ on entitlement of spouse or parents, no pension so no S1 but instead the ´no entitlement ´or ´legislation letter´), but have not received any notification from the health department of their Junta/Xunta and whose accounts are still debited for the monthly payments, have a case to demand free healthcare under the new law. Also the option to claim reimbursement of the payments taken for cover after August 1st 2018, with interest. You will have to instruct a lawyer to present your case. Each case will have to be reviewed on its own merits, it is not possible to just fill out personal data on a template letter.

What about those that have been registered temporarily, on the back of their EHIC´s? Same story, you will have to instruct a lawyer to protest and demand to be accredited healthcare cover paid for by Spanish public funds.

Can CAB Spain help those that want to take their case through the administrative appeal procedures the law offers? Yes we can, we have been assigned a lawyer from the same firm to take on these cases. For more information, please post on the Ask for Advice section on our website.

What about registered (EU) / authorised (nonEU) or not yet registered or authorised residents, should both be covered under the new law? Yes they should, as long as they can prove their residency, so residency certificate or TIE, or registration on padrón. And bring the ´no entitlement´ or ´legislation´ letter from their home country to prove they are not entitled to public healthcare elsewhere.

So should we able to get our medical cards before we register as residents with the National Police? You should if you can prove you are resident, but until the Junta or Xunta of your region has formalised instructions for the medical centres on how to deal with applications, you will have to fight for it through the legal system if your medical centre refuses to register you or registers you erroneously on the back of your EHIC. So to be able to use this new law to register or apply for residency is likely to be slow. We cannot predict a time frame.

So should we indeed go to the medical centre in our town to apply for free healthcare? Yes, as they ´fall directly under´ the Salud or Sanidad department of your region´s Junta/Xunta and they are responsible for implementation of the law.

So what about the INSS? They deal with transfer of entitlements from other EU countries, either through EU or bi-lateral conventions. So through S1, for example.

Summarising, even though the Autonomous Regions have not yet established their regulations on how to accredit the entitlement of foreign residents to free healthcare under this new law, the cover is there, by the same law, even if you have not yet been able to get it accredited, have not been able to register for it and have not received a medical card to prove it. We advise everyone in an uncertain situation with regards to healthcare cover, to quote the law in case your healthcare administrations are not aware of it or if they refuse to provide free healthcare or want to bill you once you have received it. For those with private healthcare in place, we cannot advise you to cancel before your entitlement to free healthcare has been confirmed, that would be irresponsible on our part. And remember, emergency care is always provided, without cost.

We suggest that you quote the law.  ´Real Decreto-ley 7/2018, de 27 de julio, sobre el acceso universal al Sistema Nacional de Salud´.

For further guidance on how to proceed, contact us via the Ask for Advice section of this website.

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.