USE OF THE SPANISH SECURITY SYSTEM
==================================

In this article, I shall endeavour to unravel the mysteries of the
forms and procedures required for both holidaymakers and residents of
the Costa Blanca region to receive state health care. As the UK is now
in the EU, there is a reciprocal agreement with Spain to provide
medical cover for UK nationals, depending on the individual
circumstance. However, an anomaly currently exists, as apparently the
DHS (formerly the DHSS) say if you are out of the country for more than
three months of the year you are no longer considered resident in the
UK, while Spain go by the more logical timescale of over six months of
the year. In truth, so many individuals are travelling to and from
Europe for varying periods of time, it is very difficult for both the
Spanish or the British offices to keep track, and many individuals who
have a Residencia card in Spain remain on the DHS records in the UK
because they have never officially 'de-registered' by notifying their
health centre or the DHS.

Before we get too lost in this particular
bureaucratic maze, suffice to say there are four main categories for a
UK national to use the Spanish national health services:
A) holidaymakers and people spending occasional periods of time in Spain;
B) pensioners;
C) people of non-retirement age living in Spain who are
unable to work and
D) people intending to live and work legally in
Spain, or who have taken early retirement.

A) If you are a visitor to
the area (and this applies to anyone who has not applied
for a Residencia card, nor has a work contract, nor is self
employed), you should contact the Overseas Department of the
DHS in Newcastle prior to leaving the UK, and request a 
form El11, which entitles you to routine medical treatment. The
E111 is usually issued for a one year period, and you can normally
renew it for a further 12 months. Thereafter, a second renewal will
usually be refused as it is apparent you are spending the majority of
your time out of the UK, and you will be expected to make provision
for medical cover in the country where you are living. If you do need
to visit a doctor or hospital, you should present the El11 to them as
soon as possible

B) If you are of pensionable age, and intend to live 
in Spain. you can contact the DHS and request a form E121. This is
applicable for British men over 65 years old and women over 60 years
old. However, the Costa Blanca will only accept this form if you apply
for, or hold, a Residencia card. The E121 should be handed to the
Seguridad Social (Social Security) office in Denia. It provides
permanent health cover and does not need to be renewed. You will be
issued with a temporary health card, and in due course, will receive a
permanent card and letter confirming the details of your designated
doctor and clinic. This will always be in your area, i.e. if you live
in Javea, you will be assigned a doctor at the Javea health centre. 

C) If you are unable to work, and claim incapacity benefit, you may
also apply for a form E121, regardless of your age. If you
do not claim incapacity benefit, you will not be eligible to use this
form. Again, you must apply for a Residencia card in order for the 
Spanish social security office to accept your request for state medical
care. 

D) If you decide to take early retirement, or wish to
receive medical cover while you are finding work in Spain, you may
apply for a form E106. Please note you are only eligible to this form
if you have been working and/or paying in to the UK system for the last
three years. The E106 provides temporary cover, usually for two years:
thereafter you will not be able to request an extension. If after
expiration of the E106 you have reached retirement age, you can then
apply for the E121 as described above. In all other cases, you will be
expected to provide your own medical cover, either through private
health insurance or by working within the system. With an E106, you do
not receive a medical card; you take your El06 form to your local state
health centre/doctor in the same manner as an E111. Please note that
private doctors, clinics and hospitals do not accept any of the
European (E) health care forms. It is also important to note that the
E121 and El06 forms are regarded as permanent: in other words, you will
be transferring your health provision from the UK to Spain. This means
that you will still be eligible for cover in the UK, but as a visitor.
Should you decide to return to live in the UK, you should contact the
DHS and ask them to re-register you on the British health system.


Turning now to work related cover: at a later date I shall be looking
in closer detail at all the paperwork required for self employed
individuals, but in respect of health provision, cover is provided both
for the worker and their family members by way of a social security
monthly payment. For employees, the employer should provide for their
social security cover by paying the requisite monthly "stamp" at source.
Again, this includes cover for dependents. There is a new system for
registering a dependent of the holder of an E121/E106 form or a self
employed/employed individual. An Assistencia Sanitaria form must be
completed in duplicate, showing the details of both the person with the
health provision and their dependent/s. If the dependent is a
wife/husband, the original Marriage Certificate + copy must accompany
the form. If the dependent is a child, the Birth Certificate + copy
must be produced. If the dependent is a partner, a Certificate of
Convivencia must be obtained from the local Town Hall/Guardia Civil. As
always, when discussing matters that relate to European regulations,
these are evolving as the rules within the EU are refined, and it is
quite possible that the above could be in future be modified. Should
anything significant change in the coming months, I will endeavour to
advise you accordingly.