Bilateral Social Security agreements and healthcare in Spain
Spain has Social Security agreements with many countries. Hardly any of them answer your insurance question by name, because the real question is what your agreement says about healthcare, for the way you work.
What these agreements do, and what they often don't
A bilateral Social Security agreement, also called a convention, coordinates two countries' systems. Typically it settles which country's rules apply to a person working across both, and how contribution periods in one country count in the other. That is genuinely useful, and it is mostly about contributions and pensions.
Healthcare is a separate matter, and agreements vary enormously in whether they reach it. Some address healthcare; many do not mention it at all. That variation is the whole story, and it is why a tidy country list with yes or no beside each name would be wrong for somebody in every country on it.
Two terms you will meet on official pages. RETA is the part of Spanish Social Security that self-employed people belong to. The UGE is the Spanish unit that handles these applications, and its documentation is what governs an application made from inside Spain.
Does your agreement reach healthcare in Spain?
A certificate issued under an agreement that keeps you in your home country's system answers a contributions question. For your application, healthcare in Spain has to be expressly covered and shown by a document. How to read the document you actually hold is set out in full elsewhere. The question here is whether your agreement reaches healthcare at all.
Three answers are possible, and only two of them are answers. The third means the question is still open.
The agreement reaches healthcare, and something evidences it
The agreement expressly covers healthcare in Spain and the competent institution has issued the document that shows it for your case.
What you submit: that issued document, checked for who issued it, which agreement it invokes, what it says about healthcare and the dates it covers.
The agreement doesn't include healthcare in Spain
Where your agreement does not include healthcare in Spain, that person needs a private policy. An agreement can coordinate contributions perfectly well and still say nothing about healthcare, and silence is an answer.
What you submit: qualifying private cover for that person, meeting the standard the authorities set — not a policy chosen because a country appeared on a list.
You can't tell, or nothing has been issued
If you cannot tell what your agreement covers, or the document has not been issued yet, nothing is settled in either direction. This is a question for the institution that issues it, or for somebody who can read it properly.
What you do: ask your home institution the healthcare question directly, in writing. Do not treat waiting as a decision either way.
Employed or self-employed: the answer differs
If you are employed, an agreement that applies to your situation, together with the certificate actually issued under it, can take the place of registering in Spain — subject to the healthcare question above, which is separate and which still has to be answered.
For the self-employed, the current UGE FAQ states that the bilateral-import route is not available and points to RETA.
Confirm the current wording at source for your own case rather than relying on a summary of it, including ours. How we source and check this.
That difference is why settling how you work comes before everything else. If you are self-employed and believe your agreement covers you anyway, that is exactly the kind of case to have looked at by somebody qualified rather than resolved by a website, and certainly not resolved by buying a policy.
Why there's no list of countries here
It is the most common thing people search for, and a list would be actively misleading. Agreements differ in what they cover, they get amended, and their effect depends on how the individual works. A country-level yes or no would be wrong for somebody in every country on the list, and the person it was wrong for would find out at the worst possible moment.
What works instead is smaller and more reliable: identify your agreement, obtain your certificate, and read it for four things — who issued it, which agreement it invokes, what it says about healthcare in Spain, and the dates it covers.
Spain's Social Security administration publishes the current list of conventions, which is the right place to find out whether an agreement with your country exists at all. What it cannot tell you is what your own documents prove, and that is the question your application asks.
How to get your own answer
- Settle how you work first — employed or self-employed. It decides whether this is even a route open to you.
- Ask your home institution, in writing, whether your agreement covers healthcare in Spain and which document evidences it.
- Ask the same about your family, by name. A document covering you does not automatically cover anybody else.
- Read the issued document for the four points above, and check the dates reach your application and your stay.
- If any step comes back unclear, get it looked at rather than guessing — and rather than buying a policy to make the uncertainty go away.
Start step two early. Institutions differ enormously in how quickly they answer, and the answer often decides whether you need to buy anything at all.
The wording that gets a useful answer
General questions get general answers. Ask narrowly, in writing, and keep the reply.
- Under the agreement between our country and Spain, am I entitled to healthcare in Spain while working there?
- If I am, which document evidences that, and how do I apply for it?
- Does it cover my spouse or partner and my children, and must they be named?
- What dates would it carry, and how long does it take to issue?
- If the agreement does not cover healthcare, could you confirm that in writing?
That last one matters as much as the rest. A clear "no" lets you buy the right policy for the right people with confidence. An unanswered question leaves you buying to feel safe, which is the most expensive way to make a decision.
Agreement in hand, answer unclear?
Work the questions in order: how you work, then which agreement applies, then healthcare. If the answer is genuinely unclear, treat it as a question to be answered rather than a decision already made.
Common questions
Which countries' agreements work for the DNV?
There is no useful list, and the section above explains why. What decides it is your own agreement and your own documents, not your nationality.
My agreement covers contributions. Is that enough?
It answers the contributions question. Healthcare in Spain is the separate test, and it is the one your application turns on.
Can a freelancer use an agreement between countries?
The current UGE FAQ answer is summarised above. Confirm it at source for your own case, and if your situation appears to sit outside it, have it looked at by somebody qualified rather than settled by a website.