# Healthcare - question for any Irish people living in Spain



## Art Vandelay (May 7, 2021)

Hey all, new member...first post!
I've a question regarding healthcare in Spain - most of the information I found is more relevant to UK or even US expats, but I wanted to try reach out *specifically to anyone that had moved over to Spain from Ireland** please*:

My wife and I are planning to move to Spain late next year
- We will be retiring early, and will not be working over there
- We will be both in our late 50's at that point
- We're both Irish citizens

From what I can glean, we will need to budget for Private Health Insurance to cover us at least for the entire time until we reach retirement age..._or_....possibly we have the option to use the Public Health system if we pay into the "convenio especial" scheme.

DFA Website seems to indicate the need to have Private insurance - but I was wondering if, being from the EU, there might actually be some sort of bilateral setup that might somehow magically allow us to avail of the Public System there in Spain???

We intend to move over lock stock and barrel, and become permanently resident there. No intention to come back here to Ireland.

If the only options are PMI or the 'convenio especial', I wonder if anyone here already pays either...and so roughly what sort of cost that might be?
I got some wild quotes from one or two insurance companies - not far off what we pay here in Ireland actually (and in my job we have a really good healthcare scheme with very high levels of cover, so these quotes seem to be off the charts for basic coverage....possibly the lovely insurance industry making a few bucks off peoples backs I guess!). Maybe there are local companies in Spain that we could avail of?
We've a LOT to sort out in the meantime, but we need to get an idea for budgeting - a couple of grand a year adds up to a lot over the 10yrs or so until we reach retirement age.
Hope you can help!

Thanks in advance,
Andy


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## MataMata (Nov 30, 2008)

As Irish citizens you are effectively in the same position as UK citizens were prior to Brexit and that means PHI for the first 12 months and then Convenio Especial thereafter.

Cost per person is €65/mth until age 65 then €157/mth thereafter. 

In neither case is the cost of medicines covered other than for those prescribed and administered during a stay in hospital.


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## KVP (Apr 16, 2017)

MataMata said:


> In neither case is the cost of medicines covered other than for those prescribed and administered during a stay in hospital.


In Ireland we pay for all medications anyways, so us Irish are used to that  I always read with envy about how there seems to be free or low cost medications on the NHS?

I pay €65 for 1 Dr visit. I can claim €25 of that back from my health insurance. Do you need to pay for a Dr visit with the PHI or Convenio Especial or is part of the monthly fee?

Sorry to hijack your post Art!


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## Joppa (Sep 7, 2009)

KVP said:


> In Ireland we pay for all medications anyways, so us Irish are used to that  I always read with envy about how there seems to be free or low cost medications on the NHS?


In countries other than England, all medications are free on NHS. In England, free to over 60s, children and those on low income. There are exemptions for certain life-threatening conditions, and you can buy pre-payment certificate for £30.25 for 3 months and £108.10 for a year.



> I pay €65 for 1 Dr visit. I can claim €25 of that back from my health insurance. Do you need to pay for a Dr visit with the PHI or Convenio Especial or is part of the monthly fee?


Your policy must cover all costs other than medication without co-payment/excess to be acceptable for residency. There is no extra to pay with Convenio Especial other than medication.


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## KVP (Apr 16, 2017)

Joppa said:


> Your policy must cover all costs other than medication without co-payment/excess to be acceptable for residency. There is no extra to pay with Convenio Especial other than medication.


Yes I know about the no co-pay/excess. Just curious about if had to pay for a Dr visit once one has either PHI or Convenio Especial. Sounds like not. (I'm so used to paying for a visit to the Dr that I just assumed we would also have to even if had PHI in Spain..so was factoring it into my costings  )


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## Lynn R (Feb 21, 2014)

We had PHI for 12 years here in Spain until we cancelled it at the end of last year, and never paid a cent for anything except for our monthly premiums (and that included my open heart surgery in 2018). We never knew how much any visit, test or procedure cost as the bills were sent directly to the insurance company. We didn't need prior authorisation from the company to visit a GP or most specialists (only for what they termed altas especialidades such as neurologists, oncologists or surgeons) but did need authorisation for any tests or hospital admissions. Don't look for "international travel insurance for expats" when searching for a quote, go directly to Spanish companies such as Sanitas, Adelas, Mapfre, ASSSA, DKV - and I am sure other forum members will be able to suggest more.


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## MataMata (Nov 30, 2008)

Although often translated as 'excess' the 'no co-payment' requirement for PHI actually means no payments to see a doctor or specialist so with a fully compliant PHI policy the question should not arise.


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## Roy C (Sep 29, 2012)

We pay in the region of 214 € for both of us per month, no ongoing conditions age 59 & 63 we are restricted by time limits for scans and various tests in the first year but i think this is their way of checking you really have no ongoing conditions etc. I'm not sure how it works if you decide to change companies after the first year if you have the same restrictions applied for the first year again. We are with Sanitas as no problem with the language, unfortunately we couldn't go with one of the companies because of the language barrier ( i forget it's name) but ASSSA look good for a quote.


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## Art Vandelay (May 7, 2021)

Thank you so much for the replies - really appreciate you taking the time to reply! Some great information in there which is really useful. 

Could I ask...if you are paying into the Public system via the Convenio Especial, do you have to pay for just a regular normal GP visit, or are they fully covered under that scheme?


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## Lynn R (Feb 21, 2014)

No, you would not have to pay anything for a GP visit (or hospital treatment) if paying into the public health system via the Convenio Especial, but would need to pay 100% of the cost of any medications you might be prescribed. I have seen it suggested that the Convenio would not cover what are called "prótesis" (things like artificial knee or hip joints, replacement heart valves, etc - spare parts, basically  ) but I'm not 100% sure about that.

You would need to have been registered as resident in Spain for at least one year before being able to pay into the Convenio Especial, though, so would need private health insurance for your first year here at least. The big advantage of the Convenio is that any/all pre-existing conditions are covered.


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## Art Vandelay (May 7, 2021)

super! thanks for that - again, really appreciate the help folks!!


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## Joey Testa (Jan 5, 2021)

where in Spain are you moving to? some CA have their own healthcare policies.


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## Art Vandelay (May 7, 2021)

Joey Testa said:


> where in Spain are you moving to? some CA have their own healthcare policies.


To Almería region - inland a bit, hopefully in the area south of Arboleas/Albox. Do you happen to know if they might have a different policy to the 12-month on PMI, followed by the option to keep that going or pay into the Public System?
thanks!
Andy


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## xabiaxica (Jun 23, 2009)

Joey Testa said:


> where in Spain are you moving to? some CA have their own healthcare policies.


Which CCAA offer healthcare policies?


I haven't heard of this, unless you mean the _convenio especial._


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## Art Vandelay (May 7, 2021)

xabiaxica said:


> Which CCAA offer healthcare policies?
> 
> 
> I haven't heard of this, unless you mean the _convenio especial._


For "healthcare policies", I actually understood it to mean that the policy (or approach) of a particular local authority might be different in some regions, and that it might not be possible for example to pay into the convenio especial after 12 initial months of having Private insurance. Some CA might have a different approach.
I didn't read it as an actual Healthcare Policy (as in, healthcare cover) being offered by CA
Maybe I mis-read it though


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## Alcalaina (Aug 6, 2010)

A


Art Vandelay said:


> To Almería region - inland a bit, hopefully in the area south of Arboleas/Albox. Do you happen to know if they might have a different policy to the 12-month on PMI, followed by the option to keep that going or pay into the Public System?
> thanks!
> Andy


Almeria is one of the eight provinces in the autonomous community (AC) of Andalucia, which was one of the first regions to operate the _convenio especial_. Like everywhere else, you have to be legally resident for one year before you can apply. Full details here.









Convenios especiales para la prestación de asistencia sanitaria







www.sspa.juntadeandalucia.es


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## xabiaxica (Jun 23, 2009)

Art Vandelay said:


> For "healthcare policies", I actually understood it to mean that the policy (or approach) of a particular local authority might be different in some regions, and that it might not be possible for example to pay into the convenio especial after 12 initial months of having Private insurance. Some CA might have a different approach.
> I didn't read it as an actual Healthcare Policy (as in, healthcare cover) being offered by CA
> Maybe I mis-read it though


One of us has read it wrong, for sure.

I thought he meant health insurance policies. 

Every CCAA does indeed have a slightly different approach to the management of healthcare, & I believe that I'm right in saying that some still don't offer the _convenio especial. _


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## Overandout (Nov 10, 2012)

xabiaxica said:


> One of us has read it wrong, for sure.
> 
> I thought he meant health insurance policies.
> 
> Every CCAA does indeed have a slightly different approach to the management of healthcare, & I believe that I'm right in saying that some still don't offer the _convenio especial. _


This may be true, but the requirement to have health care cover as a requirement to register as an EU Citizen resident in Spain is not a local competence, it is set out by national immigration legislation which is universally applicable.


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## xabiaxica (Jun 23, 2009)

Overandout said:


> This may be true, but the requirement to have health care cover as a requirement to register as an EU Citizen resident in Spain is not a local competence, it is set out by national immigration legislation which is universally applicable.


THAT is true. 

I was referring to the delivery of healthcare, in response to the OP.


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## how now (Jun 11, 2021)

I was referring to the delivery of healthcare, in response to the OP.
[/QUOTE]

Are prescription costs more or less expensive than Ireland, generally as I appreciate ot depends on the particular item and whether generic or original. Thanks


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## Lynn R (Feb 21, 2014)

how now said:


> I
> 
> Are prescription costs more or less expensive than Ireland, generally as I appreciate ot depends on the particular item and whether generic or original. Thanks


Just Google "precio de xxxxxx (name of medication) en España" and you will be able to find out how much the medications you take would cost, at full price (look for PVP next to the price). Then the cost of a prescription in the public health system (if you are covered under the public system)depends on whether you are retired and a pensioner (in which case you pay 10% of the cost, capped at €8 per month if your income is below €18k per annum, or at €18 per month if your income is between €18k and 100k (I believe pensioners in the Valencia are exempt from these charges, but that doesn't apply in other areas), or if you are of working age - if so you would pay 40% or 50% of the cost depending on your income, unless the medication is one of those considered to be treatment for a chronic condition.









Co-Payment Prescription Charges In Spain - Sanitas Health Plan Spain


If you live in Spain or are in the process of moving to Spain, it is important that you are aware of the new prescription charges that came into effect in June 2012.




www.healthplanspain.com


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## KVP (Apr 16, 2017)

I can't answer that but I'd be highly surprised if they were more expensive in Spain than in Ireland.


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## KVP (Apr 16, 2017)

Lynn R said:


> Google "precio de xxxxxx (name of medication) en España" and you will be able to find out how much the medications you take would cost, at full price (look for PVP next to the price).


Interesting, my blood pressure tablets are about 13-15 euros cheaper on that site than they are here in Ireland


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## MataMata (Nov 30, 2008)

Lynn R said:


> I believe pensioners in the Valencia are exempt from these charges, but that doesn't apply in other areas


Not quite correct. If you are a pensioner on a low income, and therefore a non tax payer, then your medications are free, crucially though you must submit at least an initial tax return in order for the system to know that. Without that return you will always pay 10% but with caps as appropriate.

BTW _everybody_, regardless of income is obliged to submit that first return after becoming resident, it's the last step in becoming fully and completely legal.

On the broader topic of reciprocal health care, reciprocal does _not_ mean equal.

When enrolled in another EU countries state system you are entitled to the same level of care as their nationals, no more, no less, so if they have to pay for something then so do you.

A good example of this is France where the general rule is that 70% of the cost of treatment is covered by the State with the remaining 30% paid by the patient or from an optional top up insurance policy termed a 'mutuelle' and for an immigrant joining that system via an S1 that is the scope of the cover they too would receive. GP appointments have to be paid for and are not reimbursable or covered by mutuelles, from memory that fee stand at €25.

Logically that's how it has to be otherwise you would end up with immigrants (Brits in this case) enjoying health care benefits superior to a countries own citizens!


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## paulhe (Jan 2, 2018)

MataMata said:


> Not quite correct. If you are a pensioner on a low income, and therefore a non tax payer, then your medications are free, crucially though you must submit at least an initial tax return in order for the system to know that. Without that return you will always pay 10% but with caps as appropriate.
> 
> BTW _everybody_, regardless of income is obliged to submit that first return after becoming resident, it's the last step in becoming fully and completely legal.
> 
> ...





MataMata said:


> Not quite correct. If you are a pensioner on a low income, and therefore a non tax payer, then your medications are free, crucially though you must submit at least an initial tax return in order for the system to know that. Without that return you will always pay 10% but with caps as appropriate.
> 
> BTW _everybody_, regardless of income is obliged to submit that first return after becoming resident, it's the last step in becoming fully and completely legal.
> 
> ...


If one is a pensioner on low income (and therefore not liable for tax) would that person be able to access free health care in the Spanish health system as occurs in UK through NHS or does that person have to pay convenio especial ? It occurs to me that such a person would be destitute having to pay 157 euros per month (assuming over 65).


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## Lynn R (Feb 21, 2014)

MataMata said:


> Not quite correct. If you are a pensioner on a low income, and therefore a non tax payer, then your medications are free, crucially though you must submit at least an initial tax return in order for the system to know that. Without that return you will always pay 10% but with caps as appropriate.
> 
> BTW _everybody_, regardless of income is obliged to submit that first return after becoming resident, it's the last step in becoming fully and completely legal.


Do you mean medications are free for pensioners in the Valencia region if on a low income? Because that certainly isn't the case in other regions. There have been years (whilst covered under the Spanish public health system with an S1) when I haven't paid any tax as my income was below the threshold, but I have still had to pay 10% of the cost of my medications, in Andalucia.

BTW, when the time arrived when I was due to submit a first Declaración de la Renta in Spain, I made an appointment at my local Hacienda office for them to complete it there. I went along and explained that I had been resident in Spain since xxxxx, did not have any income but was living off capital and that would be the case until I started to receive my pensions in 8 years' time. You don't need to submit a return, I was told, come back when you start to draw your pension. Directly from the mouth of the Agencia Tributaria's own staff was good enough for me, and when I did go back to make a return the year after I started to get my occupational pension, there were no questions asked as to why no returns had been submitted for previous years and certainly no suggestion that I hadn't been completely legally resident in Spain.


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## kaipa (Aug 3, 2013)

Lynn R said:


> Do you mean medications are free for pensioners in the Valencia region if on a low income? Because that certainly isn't the case in other regions. There have been years (whilst covered under the Spanish public health system with an S1) when I haven't paid any tax as my income was below the threshold, but I have still had to pay 10% of the cost of my medications, in Andalucia.
> 
> BTW, when the time arrived when I was due to submit a first Declaración de la Renta in Spain, I made an appointment at my local Hacienda office for them to complete it there. I went along and explained that I had been resident in Spain since xxxxx, did not have any income but was living off capital and that would be the case until I started to receive my pensions in 8 years' time. You don't need to submit a return, I was told, come back when you start to draw your pension. Directly from the mouth of the Agencia Tributaria's own staff was good enough for me, and when I did go back to make a return the year after I started to get my occupational pension, there were no questions asked as to why no returns had been submitted for previous years and certainly no suggestion that I hadn't been completely legally resident in Spain.


Agree. Since when did you need to submit tax declarations if you were below income threshold? If you get investigated you simply show them your income levels you dont get fined. There seems to be alot of people posting comments on tax affairs which are simply not true and are clearly designed to try and worry people. If in doubt you go straight to the horses mouth and get it from the hacienda in Spanish not from some non- Spanish speaking pensioner with nothing better to do than masquerade as a tax expert.


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## Lynn R (Feb 21, 2014)

Ah - I see from the article I linked to earlier that there was a change from 1st January 2021 to exempt pensioners from paying the 10% charge for prescriptions if their income is below a certain level (€5,635) or because they are not obliged to submit a tax return (but anyone receiving income which has not been taxed at source, eg pensions from another country, is obliged to make a return anyway).


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## tebo53 (Sep 18, 2014)

Lynn R said:


> *Do you mean medications are free for pensioners in the Valencia region if on a low income?* Because that certainly isn't the case in other regions. There have been years (whilst covered under the Spanish public health system with an S1) when I haven't paid any tax as my income was below the threshold, but I have still had to pay 10% of the cost of my medications, in Andalucia.
> 
> BTW, when the time arrived when I was due to submit a first Declaración de la Renta in Spain, I made an appointment at my local Hacienda office for them to complete it there. I went along and explained that I had been resident in Spain since xxxxx, did not have any income but was living off capital and that would be the case until I started to receive my pensions in 8 years' time. You don't need to submit a return, I was told, come back when you start to draw your pension. Directly from the mouth of the Agencia Tributaria's own staff was good enough for me, and when I did go back to make a return the year after I started to get my occupational pension, there were no questions asked as to why no returns had been submitted for previous years and certainly no suggestion that I hadn't been completely legally resident in Spain.


My OH and myself have had free prescriptions since we came to live here in Benidorm even though we also have been paying taxes on our income since our first year here. My tax on income has risen (slightly) this year so free prescriptions are not just for pensioners who's income is less than the tax threshold. 

Steve


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## xabiaxica (Jun 23, 2009)

Lynn R said:


> Do you mean medications are free for pensioners in the Valencia region if on a low income?


Yes, in the comunidad valenciana, since January 2 2016, pensioners with an income below 18.000€ - which is 'tracked' by tax returns - do indeed get all prescription medications free.


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## MataMata (Nov 30, 2008)

Lynn R said:


> Do you mean medications are free for pensioners in the Valencia region if on a low income?
> 
> *Yes, but as I said ONLY if you have submitted a tax return proving your income. Note it took some 8 months between my wife submitting her nil tax due initial return and suddenly one day getting her medicines free at the pharmacy instead of paying 10%.*
> 
> ...


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## MataMata (Nov 30, 2008)

xabiaxica said:


> Yes, in the comunidad valenciana, since January 2 2016, pensioners with an income below 18.000€ - which is 'tracked' by tax returns - do indeed get all prescription medications free.


I would question the figure of €18k, have you got a link?

My first return in 2019 was for less than that and to date I'm still paying a capped amount each month.


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## kaipa (Aug 3, 2013)

Yes and it's TRUE that the hacienda can check any period with a 4 year. It doesn't mean you are guilty of something. It is a check. 2016 is the present check year and anyone who is fresh on the system in 2017 can be checked as Hacienda does not directly link with extranjero office. So basically they ask you why you havent made a declaration as they can see all your uk incomes. Once you provide proof of residency plus your centre of financial interest it is up to them to assess whether they think you owe tax. The idea that you will be charged with tax avoidance is forum- melodrama


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## MataMata (Nov 30, 2008)

kaipa said:


> Agree. Since when did you need to submit tax declarations if you were below income threshold? If you get investigated you simply show them your income levels you dont get fined. There seems to be alot of people posting comments on tax affairs which are simply not true and are clearly designed to try and worry people. If in doubt you go straight to the horses mouth and get it from the hacienda in Spanish not from some non- Spanish speaking pensioner with nothing better to do than masquerade as a tax expert.


In plain English for the (majority) non Spanish speakers.

*Who has to pay tax in Spain?*
*Spanish tax for residents*
If you have been living in Spain for six months (183 days) or more of the calendar year (not necessarily consecutively) or you have your main vital interests in Spain (for example, your family or business is in Spain), then you are classed as a Spanish resident for tax purposes.

As a Spanish resident, you must submit a Spanish tax return and pay Spanish income tax on your worldwide income in the following cases:


your annual income from employment is more than €22,000;
you’re self-employed in Spain or run your own business;
you receive rental income of more than €1,000 a year;
you have capital gains and savings income of more than €1,600 a year;
*it is your first year declaring tax residency in Spain.*
In addition, you must declare all your assets abroad worth more than €50,000 (using _Modelo _720, or Form 720). Your taxable income is the income left after deductions for contributions to social security in Spain, pension, personal allowance, and professional costs. Spanish tax rates are progressive.

Taxes in Spain: an introductory guide for expats | Expatica


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## MataMata (Nov 30, 2008)

kaipa said:


> The idea that you will be charged with tax avoidance is forum- melodrama


I don't think anybody said WILL but the idea that you COULD be charged with tax avoidance is certainly not forum-melodrama!


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## Lynn R (Feb 21, 2014)

MataMata said:


> In plain English for the (majority) non Spanish speakers.
> 
> *Who has to pay tax in Spain?*
> *Spanish tax for residents*
> ...


The article you link to says:-
"You will need to register to pay tax in Spain with the _Agencia Tributaria_, the Spanish tax authority, whether you are a resident or non-resident. First, you’ll need your Foreigner’s Identity Card (NIE) number, which you can get through the local Foreigner’s Office (_Oficina de Extranjeros_) or police station within 30 days of arrival in Spain.
Fill out _Modelo 30_ to register your obligation to pay Spanish tax as a resident or non-resident for the first time, or to change your details. "

However, when my husband first started to receive his pension, we got an appointment at the Hacienda office so that he could submit the Modelo 030 before submitting his first tax return the following year. We turned up and were told that there was no need for the Modelo 030, they already had his details on their system - and he turned his screen around to show us, and they did indeed, including his bank account details. He had never been either a non resident or resident taxpayer before, as I owned 100% of our property.

In the section regarding Spanish tax allowances, the article makes no mention of the €2,000 general allowance against earned income, nor the low income allowance. It does not, therefore, seem a very reliable source to me.


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## xabiaxica (Jun 23, 2009)

MataMata said:


> I would question the figure of €18k, have you got a link?
> 
> My first return in 2019 was for less than that and to date I'm still paying a capped amount each month.


My mistake - I meant to write 12.000€ a year.







Detalle - Conselleria de Hacienda y Modelo Económico - Generalitat Valenciana







hisenda.gva.es





no idea why I wrote 18k!


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