# S1 - how does it work?



## anles (Feb 11, 2009)

ericban said:


> A couple of weeks have now passed and we still have no useful reply. This leaves us without any health cover, even though the UK government are paying the Spanish Government for it from the date of issue of our S1 forms in January 2013!


I have seen several times on the forum, that most people are under the impression that the Spanish government receives a set amount for each person who has registered their S1 forms. I think you will find that this isn't correct. The UK government reimburses the local health authority for the treatment received. Not only is this information available on the NHS sites but there was plenty of news here in Spain about how much money some local health authorities had lost because they hadn't sent the bills to the UK. In any case, if you had not registered your form here, and in the hypothetical case that the UK paid a set figure per form, there would be no way they could pay the Spanish government for you as they wouldn't know which local health authority they had to pay it to!


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## xabiaxica (Jun 23, 2009)

anles said:


> I have seen several times on the forum, that most people are under the impression that the Spanish government receives a set amount for each person who has registered their S1 forms. I think you will find that this isn't correct. The UK government reimburses the local health authority for the treatment received. Not only is this information available on the NHS sites but there was plenty of news here in Spain about how much money some local health authorities had lost because they hadn't sent the bills to the UK. In any case, if you had not registered your form here, and in the hypothetical case that the UK paid a set figure per form, there would be no way they could pay the Spanish government for you as they wouldn't know which local health authority they had to pay it to!


it is, as far as I've always understood, a fixed amount per year per registered S1 user

I'd be interested to see the info on the NHS sites that this isn't the case


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## extranjero (Nov 16, 2012)

I think it's just over 4000 euros per person; The DWP knows exactly how many expats live here-they issue the forms! I have never seen anything that states the UK just reimburses each treatment


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## xabiaxica (Jun 23, 2009)

extranjero said:


> I think it's just over 4000 euros per person; The DWP knows exactly how many expats live here-they issue the forms! I have never seen anything that states the UK just reimburses each treatment


I think it's nearer 3,500 - but I agree with you

I just wish I could find the link I had about it...


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## extranjero (Nov 16, 2012)

The amount has gone up, but I can't find it on NHS sites. Perhaps the consul would know...


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## anles (Feb 11, 2009)

xabiachica said:


> it is, as far as I've always understood, a fixed amount per year per registered S1 user
> 
> I'd be interested to see the info on the NHS sites that this isn't the case


I can't find the link I was reading on the NHS where it states clearly "reimburse" but I have read many articles in the Spanish press about this, it is one of the reasons for the change in the situation, to stop people coming to Spain, getting a Spanish health card to have non urgent operations. 
here is an article:
Más de 127.000 pensionistas extranjeros van al médico a costa del sistema - elConfidencial.com
it states clearly that Spain bills the country of origin. 
As I said before, the fact the the UK government issues these S1 forms, unless people register with the health system there is no way the UK government could pay anything out as they wouldn't know where to pay it, would they? 
The region health authorities send them to the central government who then forward them to the country of origin.


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## xabiaxica (Jun 23, 2009)

anles said:


> I can't find the link I was reading on the NHS where it states clearly "reimburse" but I have read many articles in the Spanish press about this, it is one of the reasons for the change in the situation, to stop people coming to Spain, getting a Spanish health card to have non urgent operations.
> here is an article:
> Más de 127.000 pensionistas extranjeros van al médico a costa del sistema - elConfidencial.com
> it states clearly that Spain bills the country of origin.
> ...


yes, they do bill the UK - so much per year per person who registers with an S1- certainly not for each individual visit or treatment 

come to think of it, it can't be based on S1s issued, since they don't necessarily know where the holder would be going

also - I actually have S1s for myself & my daughters which we don't use - so the UK wouldn't be paying for us - I do that with my autónomo payments

the article mentions Valencia - in actual fact going back some years Valencia did indeed offer free healthcare to ANYONE who moved here - they even advertised it as a reason for foreigners to choose the region

that was cancelled some years ago though - quite suddenly leaving people who couldn't afford private treatment in the lurch

perhaps the UK is slow in 're-imbursing' - but I've also read claims from the UK that Spain is slow in 'billing'


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## anles (Feb 11, 2009)

xabiachica said:


> yes, they do bill the UK - so much per year per person who registers with an S1- certainly not for each individual visit or treatment
> 
> come to think of it, it can't be based on S1s issued, since they don't necessarily know where the holder would be going
> 
> ...


Can you please show me an official site where it says they pay a fixed amount per S1? When I have been translating for people who were waiting for their health cards, they had to provide a photocopy of the S1 for each appointment to accompany the bill (which was to be sent to the central government). I have also read many articles about Spanish people going to other European countries for dental care which is not covered by the Spanish system and the Spanish system has to cover those bills, in which case, if there was a lump sum, it wouldn't matter would it? Another thing I have read is that if you have a treatment that isn't covered by the Spanish system but is covered by the NHS, you may claim reimbursement for what you have had to pay(although they state you may not always be reimbursed). Another situation which wouldn't exist either if there was lump sum. I have only ever read about a set amount on fora, and the amount people estimate anywhere between 3000 and 4500 (not sure if they mean pounds or euros) but it sounds like an urban myth to me . 
The situation in Valencia or where people have obtained free Spanish healthcare because they are "sin recursos" obviously doesn't apply as they were never entitled to be reimbursed for these people. They were getting free *Spanish* healthcare.


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## anles (Feb 11, 2009)

Here is another article:
Si hay un lugar de Andalucía especialmente atractivo para los turistas –incluidos los sanitarios– es la Costa del Sol. Dos tercios de esos foráneos atendidos por la sanidad pública andaluza acuden a un centro de salud u hospital público malagueño.

Esa asistencia, en principio, no es gratuita, ya que la Junta de Andalucía *factura el importe de la atención* y debe recibir el dinero, pero no siempre ocurre así. En esos cobros se encuadran los ciudadanos de otros países que vienen a Andalucía de turismo, a disfrutar de unos días, y que van provistos de la Tarjeta Sanitaria Europea (TSE) o de alguno de los formularios previstos para la aplicación de los reglamentos comunitarios de Seguridad Social. Son personas que están aseguradas sanitariamente en sus naciones de procedencia. Esa acreditación da derecho a la asistencia sanitaria a asegurados desplazados a España en estancia temporal y beneficia a los europeos que viajan dentro del espacio económico europeo, es decir, la UE, Noruega, Islandia, Liechtenstein y Suiza.

En esos casos, en Andalucía, mediante el aplicativo de la facturación internacional de servicios sanitarios –operativo desde noviembre de 2004–, *se cuantifican los gastos generados por la asistencia médica dispensada a ese colectivo de individuos*. Posteriormente, el Instituto Nacional de la Seguridad Social emite a los distintos países la factura en el modelo reglamentario. Andalucía fue una de las primeras comunidades autónomas en implantar ese método de facturación, que está regulado a través del Fondo de Cohesión Sanitaria, sistema que se basa en una compensación a nivel estatal entre el número de extranjeros atendidos en centros sanitarios españoles y el número de españoles asistidos en centros sanitarios en otras naciones.


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## baldilocks (Mar 7, 2010)

Possibly some confusion arises out of: 

the cheats who hadn't got S1 either because they hadn't applied for one or were ineligible (non pensioner or non contributor) but were actually resident and trying to use EHICs. Valencia, I believe, was one of the ACs that stopped accepting EHICs because they were not getting re-imbursed since the UK said, that they were being used illegally. or
people under pension age whose short-term S1 had expired but were still trying to use a tarjeta sanitaria they had obtained through the short-term S1.

I know of no cases where a properly registered S1 from a pensioner has caused problems


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## xabiaxica (Jun 23, 2009)

I've sent a message to the DWP asking for clarification, so hopefully they'll get back with the answer to the confusion..


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## gus-lopez (Jan 4, 2010)

A letter received in reply to the question printed in a local paper some months ago;



Dear Mrs *****,

Thank you for your corre­spondence about healthcare for UK state pensioners resident in Spain. I have been asked to reply.

Under European Union Regulations. member states of the European Economic Area (EEA) and Switzerland are required to meet the cost of any state-provided health­care given to that country's state pensioners when such pensioners choose to live in a different EEA Member State from the one that pays the pension. A member state can do this either by charging the actual cost per health episode or by charging an annual average cost per pensioner.

The UK and Spain choose to bill other Member States for their state pensioners through the average cost option. Therefore, the UK will pay Spain around £3,500 per year for each UK state pensioner's medical care. A very similar charge is levied by the UK for Spanish state pensioners residing in the UK.The yearly average amount paid to Spain is approximately £500 million,, which is approximately €625 million .
I hope this reply is helpful.

Yours sincerely,

PETER WOZNIAK,
Ministerial Correspondence and Public Enquiries,
Department of Health



Estimado Señora *****,
Gracias por su correspondencia sobre asistencia médica para residente pensionistas británico estatal en España. Me han pedido contestar.

Bajo la Unión Europea Regulaciones. requieren los Estados miembros del Área europea Económica (EEA) y Suiza para encontrar el coste de cualquier asistencia médico proporcionada por estado dada a los pensionistas estatales de aquel país cuando tales pensionistas deciden vivir en un Estado miembro diferente EEA del que que pagos la pensión. Un Estado miembro puede hacer esto por cobrando el coste real por episodio de salud o por cobrando un promedio anual cuesta por pensionista.

El Reino Unido y España deciden facturar otros Estados miembros para sus pensionistas estatales por la opción de coste media. Por lo tanto, el Reino Unido pagará España alrededor £ 3,500 por año , aproximadamente 4,250€ para la asistencia médica de cada pensionista británico estatal. Un cantidad muy similar es impuesto por el Reino Unido para pensionistas españoles estatales que residen en el UK.La cantidad anual media pagada a España es aproximadamente £ 500 millones, que son aproximadamente 625 millones de euros.
I esperan que esta respuesta sea provechosa.

Atentamente
PETER WOZNIAK,
Ministerial Correspondence and Public Enquiries,
Department of Health


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## anles (Feb 11, 2009)

gus-lopez said:


> A letter received in reply to the question printed in a local paper some months ago;
> 
> 
> 
> ...


This refers to pensioners. Not to people who are receiving healthcare under the S1. Well now all the forms are S1, which to my mind is more confusing, but the S1 that corresponds to the the old E-106, not the E-121. In this case (for pensioners), what they actually do is offset the difference. As far as I understood, the OP was talking about the UK government paying 3,500 pounds per year for their S1 which as the form was never registered could not be the case. When you apply for this form, you don't have to say which regional health authority you are going to register with, nor even which country you are going to live in, so the UK government would hardly be paying anything out. Doesn't sound much to me in any case. When my mum had cancer, the injections provided by the hospital after chemo were over 800€ each, not the op, nor the months in hospital, nor the chemo, just the injections. Although my mum was in effect a Spanish pensioner as my step father had contributed here and she was a widow. I don't understand what department of health this is from as the Spanish is obviously google translate


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## Pesky Wesky (May 10, 2009)

Meanwhile, back in the land of the Daily Mail...

Getting hospital treatment on holiday | Mail Online
_British tourists have been urged not to rely on the European Health Insurance Card (EHIC), which is supposed to give all EU citizens access to state medical care in member countries.

Hundreds are being held hostage by hospitals who are rejecting the cards and demanding travel insurers cover the cost of medical care. _

It's not the first time we've heard about this, but how much truth is there here?

One thing that is correct and worth pointing out is 
_British travellers are not entitled to the same free treatments as the NHS would offer over here, but what local residents would get in their country.

_

​


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## Pesky Wesky (May 10, 2009)

anles said:


> This refers to pensioners.
> I don't understand what department of health this is from as the Spanish is obviously google translate


True, this is only referring to pensioners.

I don't think this is Google translate. It's much better!


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## baldilocks (Mar 7, 2010)

Pesky Wesky said:


> Meanwhile, back in the land of the Daily Mail...
> 
> Getting hospital treatment on holiday | Mail Online
> _British tourists have been urged not to rely on the European Health Insurance Card (EHIC), which is supposed to give all EU citizens access to state medical care in member countries.
> ...


Re:the Daily Wail article. In some respects it is true because many people who are* residing* here have been trying to use the EHIC for their medical coverage and the UK has refused to re-imburse Spain saying (correctly) that the cards are being used illegally. The consequence is the EHICs of genuine cases are also being refused - the cause : the selfish scroungers who should have got themselves in order before coming to live here - they are always putting those of us who play by the book in a bad light. Of course being the Wail, their figures ae arroneous! 

Now about those who illegally use foreign registered ... Oops! wrong thread!


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## anles (Feb 11, 2009)

Pesky Wesky said:


> Meanwhile, back in the land of the Daily Mail...
> 
> Getting hospital treatment on holiday | Mail Online
> _British tourists have been urged not to rely on the European Health Insurance Card (EHIC), which is supposed to give all EU citizens access to state medical care in member countries.
> ...


I think this stems from the fact that many people were using the EHIC for non emergency treatments and operations. Maybe doctors and hospitals were partly at fault for allowing this to happen, and also the local health authorities who issued Spanish health cards to people who only had EHIC but I think it was due to a lack of knowledge. Consequently, this abuse, which has cost the local health authorities so much money, is now affecting innocent people. 
Five or six years ago, many foreigners who moved here and were registered in smaller municipalities got a card easily under the "sin recursos" option. It was in the interest of the municipalities which had an aging and falling population and were in danger of losing services, but in the long term it has cost a lot of money. 
Some time ago, under a previous regional government, the Xunta sent out informative bills to patients who had received hospital treatment. I thought it was a good idea, but it wasn't a popular measure and it no longer happens, I think. Undoubtedly, so much money has been squandered, I remember when pensioners would get prescriptions for all their family so the medicines were free, as there was no control. Now, everyone is paying the price.


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