The Convenio Especial for Healthcare in Spain

What the convenio especial is

The convenio especial de prestación de asistencia sanitaria (special agreement for the provision of healthcare) is a contract between you and your regional health service. You pay a flat monthly fee; in return you are treated in the public system with "the same guarantees of extent, continuity of care and coverage" as an insured person (Real Decreto 576/2013, art. 2.2).

The Ministry of Health describes it as the way for economically inactive foreign residents to join the national health system (SNS) when they need health cover to live in Spain (Ministerio de Sanidad). It is not private insurance, and it is not the same thing as the Social Security convenio especial used to keep up pension contributions, which shares the name.

It matters most to three groups: early retirees from outside the EU who have lived in Spain for a year on private cover; people whose private premiums have become unaffordable with age; and people refused private cover because of their medical history.

Who qualifies

Article 3 of RD 576/2013 sets three conditions, all of which must be met:

1. One year of residence. At least one continuous year of effective residence in Spain immediately before you apply. The Ministry says periods of residence in another EU or EEA state, Switzerland or the United Kingdom also count.
2. Padrón. You must be registered on the padrón of a municipality in the region you are applying to at the moment you apply.
3. No other public entitlement. You must not have access to public healthcare by any other route, whether under Spanish law, EU regulations or a bilateral agreement.

The third condition rules out more people than you might expect. If you work in Spain, receive a Spanish pension, are the registered spouse or child of an insured person, or hold an S1, you are already covered and cannot join. GOV.UK states plainly that you cannot join the convenio if the UK pays for your healthcare through an S1 (GOV.UK). See how to register an S1 if that applies to you.

The Ministry also notes that people with five continuous years of legal residence under EU rules are entitled to public cover and do not need the convenio. GOV.UK says the same for UK permanent residents, who register with their local INSS office with a "legislation letter" confirming they have no UK healthcare cover.

Nationals of EU/EEA countries, Switzerland, the UK, Andorra and Chile must provide a certificate or declaration that their home country does not export healthcare cover to them. Other nationalities do not.

What it costs

These are the figures in article 6 of RD 576/2013. The BOE consolidated text shows no amendment since publication on 27 July 2013, and the fee pages of Madrid, the Balearics and Murcia all still quote €60 and €157 as of October 2026.

Two legal provisions could change this:

• Ministerial revision. Article 6.2 allows the amounts to be revised by ministerial order, after agreement in the Interterritorial Council, in line with the cost of the basic services. IB-Salut repeats that the fee may change. No revision has been made.
• Regional supplements. A region may add services from its own supplementary portfolio and raise the fee accordingly (arts. 2.2 and 6.1). None of the regional pages we checked charges more than the national amounts.

The fee is per subscriber, not per household. A couple where one partner is 66 and the other 62 pays €157 + €60 = €217 a month.

For comparison with private premiums at your age, see how much private health insurance costs in Spain.

What is covered and what is not

Covered: the SNS common basic portfolio of services: prevention, diagnosis, treatment and rehabilitation in primary and specialist care, outpatient and hospital, plus urgent medical transport (Ministerio de Sanidad). The Ministry describes the agreement as having no co-payments and no waiting periods. If you travel to another region of Spain temporarily, you keep the same cover. For temporary stays in the EU, EEA, UK or Switzerland, the INSS issues a Certificado Provisional Sustitutorio (provisional replacement certificate) rather than a European Health Insurance Card.

Not covered: the Ministry states that the following carry a 100% patient contribution:

• outpatient prescription medicines (prestación farmacéutica ambulatoria)
• outpatient orthoprosthetic items (for example, some prostheses and orthopaedic aids)
• dietary products
• non-urgent medical transport

The pharmacy exclusion is the one that changes the maths. If you take regular medication, price your prescriptions at full cost before deciding; see prescriptions and pharmacy costs.

Pre-existing conditions and age

Nothing in the national requirements asks about your health. There is no medical questionnaire, no exclusion for existing conditions, no maximum joining age and, according to the Ministry, no waiting period. That is the main difference from private insurance, where your medical history and age at application shape what an insurer will offer.

That makes the convenio the realistic fallback for anyone refused private cover or offered it only with heavy exclusions, provided they meet the residence, padrón and no-other-entitlement tests. See health insurance with pre-existing conditions and insurance for over-75s.

The convenio and your visa or residence card

Because you need a year of residence first, the convenio cannot be your health cover for an initial non-lucrative visa or digital nomad visa application from abroad. Most people hold private insurance for year one and consider the convenio afterwards.

At renewal, GOV.UK lists the convenio alongside private insurance and Social Security as forms of healthcare cover for residence purposes. Whether the immigration office accepts it for your specific permit is a question for that office, so check before cancelling a private policy. See health insurance for visa renewals.

How to apply

You apply to the health service of the region where you are on the padrón (INGESA in Ceuta and Melilla). The Ministry of Health's page links to each region's procedure.

Documents (Ministry list; regions add their own forms):

• identity document: passport, NIE or residence card
• proof of at least one year's effective residence: police residence certificate, padrón certificate, consular document or other public document
• current padrón certificate (a historical certificate showing the registration date often proves both)
• certificate or declaration of non-export of healthcare, only for EU/EEA, Swiss, UK, Andorran and Chilean nationals
• the regional application form, one per person

The process in four regions we verified:

The Comunitat Valenciana runs the convenio through the Conselleria de Sanitat, which lists it among its health card procedures (Conselleria de Sanitat); Andalucía and Catalonia have their own procedures, linked from the Ministry page. We could not verify their current regional details for this update, so ask your health centre or the regional information line for the forms.

Cover starts on the day the agreement is signed (art. 4.4). With a decision period of up to a month plus a signing appointment, keep any private cover running until the agreement is actually signed.

How it ends

Under article 7.1, the agreement ends if:

• the subscriber dies
• you stop meeting a requirement, gain entitlement as an insured person or beneficiary, or move your padrón out of the region
• you cancel in writing
• you fail to pay the first fee, two consecutive monthly fees or three non-consecutive ones
• you breach its particular conditions

If it ends because you cancelled, stopped paying or breached the conditions, you cannot take out a new convenio for one year (art. 7.3). Moving to another region means a fresh application there, since your padrón must be in the region that signs the agreement.