# Can I get Spanish state healthcare?



## checkern (Sep 14, 2011)

Hi Everyone,

I recently moved to Mallorca in July with the intention of staying here long term. This is still my intention god willing. I should at this point state that I run my own small UK registered internet company that I am able to run from Mallorca with access to the internet. I pay taxes in the UK both for my company and for my personal income just as I would if I was still living there.

My problem is that around 6 weeks ago I developed a severe herniated (slipped) disc. This is something that also happened to me around 5 years ago that I had several operations for that although not completely curing the pain left me able to conduct a relatively normal life. However, 6 weeks ago it happened again to a different disc and this has left me in the most immense pain 24/7.

I am unable to sit for longer than 5-10 minutes before the pain becomes unbearable, even on the strongest painkillers the doctor will give me. I can walk short distances but standing still is very painful as well. The only position that takes the pain down is lying flat on my back or on my front. It is ruining my life as you can imagine.

I do not have health insurance and would not have been covered anyway for this due to the fact that I have a history of back trouble so I have been paying out of my own pocket to receive treatement from various doctors and orthopaedic specialists to the cost of nearly 2000 euros so far. It has nearly wiped out my savings that were supposed to be a safety net for me in my new life here.

The problem is that the specialist now says that my back is so bad that the only option is to have a discetomy operation in whch they will trim off the part of the disc that is pressing on my nerve and causing the pain down my leg. He has quoted the cost of this operation at between 6000-8000 euros which is way beyond my means.

I am in a catch 22 situation. I cannot fly back to the UK and get this done on the NHS because the flight is impossible due to my inability to sit down. My doctor has seriously advised me against sitting for any length of time due to the pain and the further damage the compression will cause on my disc. Quite apart from that advice I just simply couldnt make the flight due to the pain, I can´t even travel in a car for more than a few minutes so a 3hr flight? Its just out of the question.

My question is as follows:

1. Is it possible to get my operation done on the Spanish state health service.
2. If yes then what exactly do i need to be registered for etc?

I have not registered for a residencia or anything like that yet due to the fact that I haven´t really considered myself as working in Spain. Its more like a long vacation at present (or it was until this happened to me). I have applied for an European Health Insurance Card from the UK which i was told would cover me for care on the state system here but other people have told me it won´t as i do not pay tax in Spain.

Any advice anyone could give me would be very much appreciated, I am very desperate .

TIA.


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## jojo (Sep 20, 2007)

This is the reason why you should be paying your tax etc to the country in which you live. The rule of thumb is that if you live in a country for more than 183 days a year then thats where you pay your taxes etc. Then you would be covered! The EHIC will cover you for emergencies, but not on going problems, altho maybe??? 


I dont know if its possible to change where you pay taxes etc to enable you to be covered in Spain to get this sorted - or whether you could take out private health care??
Jo xxx


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## Sonrisa (Sep 2, 2010)

Isnt' there a way you can stand up during your flight to UK? I think you are required to sit down only during take off and landing???


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## Millie55 (May 31, 2011)

If you are planning to be a resident in Mallorca there is quite a bit of info about obtaining an S1 (previously E106) on HMRC website under Access to Healthcare: S1
The rules don't seem to be straight forward though so might be best to try to speak to them? Tel +44 191 203 7010
There is also info on the following website, but i am not sure how up to date it is
/SNIP/

Hope you get it sorted.
M


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## jojo (Sep 20, 2007)

There also some sort of reciprocal agreement between Spain and the UK, but I think you have to have a social security number in Spain, which means you have to be a resident - I cant say I fully understand it. I just remember when my son tore his ligament, they wanted us to pay for the ongoing treatment, but cos my husband worked and paid taxes in the UK it was covered, but we had to get my son a social security number - or was that cos he was under 16???? One person who would know is one of the other mods on here, but he's away right now. I'm sure some of the other "clever folk" here will give you a more definitive answer tho!!??

But this is the reason why its the law that you pay your dues in the country you live in

Jo xxx


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## Alcalaina (Aug 6, 2010)

checkern said:


> I have applied for an European Health Insurance Card from the UK which i was told would cover me for care on the state system here but other people have told me it won´t as i do not pay tax in Spain.


The EHIC will cover you for emergency treatment. It is a reciprocal agreement designed for EU citizens visiting different EU countries and it doesn't matter whether or where you pay tax.

I´m amazed you didn´t get one before you came to Spain but that is your business. Anyway, since you are clearly in need of emergency treatment it should do the trick, at least enough to get you back to the UK for longer term treatment. Read the information here:

https://www.ehic.org.uk/Internet/frequentlyAsked.do


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## mrypg9 (Apr 26, 2008)

jojo said:


> There also some sort of reciprocal agreement between Spain and the UK, but I think you have to have a social security number in Spain, which means you have to be a resident - I cant say I fully understand it. I just remember when my son tore his ligament, they wanted us to pay for the ongoing treatment, but cos my husband worked and paid taxes in the UK it was covered, but we had to get my son a social security number - or was that cos he was under 16???? One person who would know is one of the other mods on here, but he's away right now. I'm sure some of the other "clever folk" here will give you a more definitive answer tho!!??
> 
> But this is the reason why its the law that you pay your dues in the country you live in
> 
> Jo xxx


It's complicated, though, isn't it....
All my income is covered by Dual Taxation Treaties (apart from a relatively insignificant amount offshore on which I pay UK tax) but as I am resident in Spain and have no UK address I qualify only for emergency treatment in the UK.
This was the case until I became eligible for Spanish health care when I reached retirement age.
OH took out private insurance to cover the gap until she is eligible for Spanish health care.


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## djfwells (Sep 28, 2009)

Your choices are clear...

1) Pay the money for the operation and put it down to experience.
2) Find some way to travel back the Uk as comfortably as you possibly can.

The Spanish healthcare system is based on Contributions and not Residency and therefore yo have no entitlement.

Even if you had the EHIC card that would only entitle you to Emergency cover, which is very limited and I doubt that your problem would be classed as an 'Emergency' and neither would it be entirely free of charge.


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## Sonrisa (Sep 2, 2010)

djfwells said:


> Your choices are clear...
> 
> 1) Pay the money for the operation and put it down to experience.
> 2) Find some way to travel back the Uk as comfortably as you possibly can.
> ...


It certainly sounds like an emergency if he cannot sit or stand by long periods, I aM very surprised that he has been like that for the last six weeks without taking the necessary accion... and since the OP hasn't got an EHIC, I think the only viable option is to travel back to UK and get the much needed treatment before there is any permanent nerve damage. IF it was me I would be right now on the phone with the airlines to see if they can accomodate your requirements. Perhaps there is a way you can fly in a comfortable position, lying flat, standing up. I believe some airlines can accomodate those health requirements.


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## Joppa (Sep 7, 2009)

What you should have done is to get A1 (expected stay up to a year) or S1 (expected stay longer than a year) before leaving UK. I don't know if you can get one retrospectively. Before issuing it, they will look at your Class 1 (or Class 2 and Class 4 for self-employed) contribution record for 3 years prior to the tax year you are leaving UK, and if sufficient contributions have been made, you get your S1, which entitles you to the state health care on the same basis as a local, for up to 2.5 years or before you reach UK state retirement age, whichever comes first. Once you get your A1 or S1, you then need to get your _Residencia_ or register with the _Padrón _ and take your certificates to INS. If you are still paying NI and income tax in UK, it's possible that UK will pay for your ongoing medical cost in Spain. 

Call the Overseas Health Care Team at +44 191 218 1999.


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## lynn (Sep 25, 2008)

Joppa said:


> What you should have done is to get A1 (expected stay up to a year) or S1 (expected stay longer than a year) before leaving UK. I don't know if you can get one retrospectively. Before issuing it, they will look at your Class 1 (or Class 2 and Class 4 for self-employed) contribution record for 3 years prior to the tax year you are leaving UK, and if sufficient contributions have been made, you get your S1, which entitles you to the state health care on the same basis as a local, for up to 2.5 years or before you reach UK state retirement age, whichever comes first. Once you get your A1 or S1, you then need to get your _Residencia_ or register with the _Padrón _ and take your certificates to INS. If you are still paying NI and income tax in UK, it's possible that UK will pay for your ongoing medical cost in Spain.
> 
> Call the Overseas Health Care Team at +44 191 218 1999.


There are two departments issuing S1 certificates. You need to download and complete form CA8454 from the HMRC.gov.uk website. As you are continuing to pay NI in the UK, you will get reciprocal healthcare based on your UK contributions. For those who do not continue making NI contributions in the UK, you can contact Dept for Work and Pensions and get an S1 for up to two and a half years, based on your previous 3 years contributions....The good news with this department is they issue the S1 based on a phonecall. 
We've gone through this before. It takes months to sort, so get on the job straight away. The UK office goes at snails pace, and then the Spanish office takes just as long!


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## xabiaxica (Jun 23, 2009)

Joppa said:


> What you should have done is to get A1 (expected stay up to a year) or S1 (expected stay longer than a year) before leaving UK. I don't know if you can get one retrospectively. Before issuing it, they will look at your Class 1 (or Class 2 and Class 4 for self-employed) contribution record for 3 years prior to the tax year you are leaving UK, and if sufficient contributions have been made, you get your S1, which entitles you to the state health care on the same basis as a local, for up to 2.5 years or before you reach UK state retirement age, whichever comes first. Once you get your A1 or S1, you then need to get your _Residencia_ or register with the _Padrón _ and take your certificates to INS. If you are still paying NI and income tax in UK, it's possible that UK will pay for your ongoing medical cost in Spain.
> 
> Call the Overseas Health Care Team at +44 191 218 1999.


just to add, if they agree that the OP qualifies for an S1 it will take around 3 weeks to arrive in Spain - or at least, that's what they told me when I called them for my dad's, and that's how long it took to arrive


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## mickw (Jun 13, 2011)

i cant help but can be sympathetic,same happened to me in uk just after my divorce,nhs took so long after 3 months i went private,it cost me my divorce money as i couldnt work for 3 months after it(self employed plumber and heating engineer) It cost me £60k with loss of earnings and medical bills,,,, DAM i sympathise as has happened to me again also,depression has set in cos i cant walk,sit,lie or pee properly.ive even tried reiki although a non believer,but it worked to at least give me 1 night without pain,it felt amazing and made me determined to get it sorted,,,i tried everything and was about to give up when i found a Mc Timney practise by chance, 4 visits and i could walk with out resmbling a monkey(first visit i thought it was a load of tosh) but desperate to get better,, Its all about moscles at the end of the day! the way they pull or work,how you conduct yourself when moving,You probably think this is tosh as i did but wot im saying is try another path to follow rather than 1 opinion..good luck and wish you well,Hope to hear that your up and about soon


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## lynn (Sep 25, 2008)

xabiachica said:


> just to add, if they agree that the OP qualifies for an S1 it will take around 3 weeks to arrive in Spain - or at least, that's what they told me when I called them for my dad's, and that's how long it took to arrive


Yes, the Department of Work and Pensions will issue one in around 3 weeks.... but the HMRC is another matter


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## VFR (Dec 23, 2009)

Just off the top of my head ?

Take a boat to the UK, cruise would do it as you can lay down all day if you have a partner to attend to your food etc.

One way minibus hire again if you have someone to drive as you remove some seats to lay a mattress down.


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