The Truth About S.I.P. (Health) cards
David Wilde • 5 February 2020
Some clarity as to who is entitled and how the card works.
In the past month, due to the uncertainties of Brexit, we have had a lot of our clients ask about the rules of entitlement to a SIP card. To respond, we recently sat down with an expert who works on the front line of the healthcare system in Spain to get some clarity.
Firstly (and especially if you are from the U.K.), many other European countries do not have a card system to access healthcare. We simply turn up at the doctors' or the hospital and we receive treatment. However, Spain DOES use a card system and there is no way around it.
So here goes:
Am I entitled to a permanent SIP card?
Really, the first misunderstanding about the SIP card is that it is permanent.
I know some people have the red and grey plastic card and others have a more temporary paper card. However, just because you have the thicker card, it doesn't mean you are indefinitely entitled to healthcare. The type of card that is issued is irrelevant and depends on the policy your local health centre. I have clients whose circumstances are the same, but they have been issued a different type of card from a different medical centre. This does not affect your cover.
The first condition that gives you access to healthcare is that you work in Spain either as self employed (autónomo) or you have a contract with a company and you or your employer pay social security payments. Without an active contract you are NOT entitled to healthcare. Simple.
The second condition, which applies to many of my clients, is that you have an S1 certificate from another European country, you are a resident (with the green card or certificate) AND you have affiliated yourself in your local social security office (Denia in our case). If you have the S1 certificate but haven't affiliated yourself, you WON'T be covered for state healthcare.
If you are a non-resident in Spain, it is necessary to have an up-to-date European health card. Only when you have this are you entitled to a TEMPORARY SIP CARD (which typically lasts several months). The idea of the temporary SIP card is to provide you with emergency treatment while you are here on holiday and does not cover more permanent treatment. The European health card should not be used if you are here for more than 6 months per year.
It is important to note, if you don't have an in-date European health card or are not affiliated to the social security through active work or the S1 scheme. You will have to pay for treatment. If you no longer work, you will have to pay for treatment.
I thought my SIP card was permanent!
The social security department in Spain continuously audit their system to review who is entitled to healthcare and who isn't. When you walk into the doctors' or the hospital and the receptionist swipes your SIP card, a message appears on their screen. It either says you are covered or that you are 'Facturable' which means you have to pay. There is no point in getting annoyed with the receptionist as he/she are simply unable to change this status. You have to go to your local social security office to resolve the issue.
It is also important to note that if your situation changes, you must inform the social security. Otherwise, it is more than likely that the system will show a conflict and you will not be covered until it is resolved. To give you an example, someone who has worked in Spain and contributed, suddenly reaches retirement age or has access to the S1. They must be very clear that the S1 or pension now covers them and not the social security payments.
To conclude, my final advice would be to make sure you claim your entitlement to Spanish healthcare if you have it and don't wait until you are ill to put things in order. If you haven't validated your entitlement either through working or the S1 system, you WILL have to pay.
Don't hesitate to get in touch if you have any questions about healthcare or if you need help putting your entitlement in order.
Many thanks!