What Does Sin Copago Mean in Spanish Health Insurance?

What sin copago actually means

A copago (co-payment) is, in DKV's own definition, "a sum of money you pay each time you use your health insurance". A policy sin copago (without co-payments) drops that charge. You pay the monthly or annual premium, and covered consultations, tests and treatment cost nothing more at the point of use.

In practice, most Spanish insurers sell the same product in two or three versions that differ mainly on this point. DKV's range is a clear example:

Source: DKV Integral, October 2026.

Some co-payment products put a ceiling on what you can pay. Adeslas, for example, caps co-payments on its Plena Vital policy at €300 per person a year. Others publish no cap, so the total depends on how often you use the policy.

What sin copago does not change

A no-co-pay policy is still a contract with limits. Three are easy to miss.

Waiting periods still apply

Sin copago and sin carencias (no waiting periods) are separate features. ASISA's no-co-pay policies, for instance, list waiting periods of 6 months for special diagnostic tests, psychotherapy and outpatient surgery, and 8 months for hospitalisation. DKV Integral applies 8 months for surgery and hospitalisation and 12 months for transplants.

Visa products are usually built to be both. Sanitas's Residents Visado conditions describe cover "sin periodos de carencia" (with no waiting periods). If you are switching from another complete Spanish policy held for at least a year, Sanitas offers to remove waiting periods except for childbirth. More detail is in our guide to waiting periods and sin carencias.

Do not assume a policy marketed for residence is free of waiting periods. Sanitas Mas 90, which broker HealthPlan Spain describes as commonly used for residency and visa processes, is sold with zero co-payments (apart from included dental services) but still lists these waits:

Transfers from another insurer waive these for network care. Whether a consulate accepts a policy like this depends on its own wording, so match the product to the checklist for your route.

Pre-existing conditions can still be excluded

Removing co-payments and waiting periods does not mean the insurer pays for conditions you had before you joined. The same Sanitas visa conditions cover illnesses arising after the policy starts and not known to the insured person, with pre-existing conditions defined by reference to the health questionnaire. See pre-existing conditions.

You must stay inside the network

Most Spanish policies work through a cuadro médico (the insurer's directory of doctors, clinics and hospitals). Go outside it on a network-only policy and you normally pay the full private price yourself, co-payment or not. Treatments that need prior authorisation still need it. If you want freedom to choose any doctor, that is a different product type: see network versus reimbursement.

Why visas require no co-payments

When a private policy is your evidence of healthcare for a Spanish residence permit, the authorities want it to stand in for the public system. Since 20 May 2025 the immigration rules have been set by Real Decreto 1155/2024, and the Ministerio de Inclusión asks non-lucrative applicants for public or private health insurance with an insurer authorised to operate in Spain. Consulates turn that into specific product rules:

A policy with co-payments does not meet that wording. Broker HealthPlan Spain, for example, labels Sanitas's co-payment variants not suitable for visa or residency. The certificate wording matters as much as the product: see the health insurance certificate for a Spanish visa and the route-specific guide to the non-lucrative visa.

How much more sin copago costs

Rastreator's December 2025 index put the average basic policy without co-payments at €46 a month and complete cover at €74. Within one insurer's range, the gap between co-pay and no-co-pay versions is clear:

All figures are monthly premiums. Insurers' "from" prices are for the cheapest profile, so an adult's quote will be higher. For full price ranges by age and region, see how much private health insurance costs in Spain.

When a co-payment policy is the better buy

If you do not need the policy for a visa, co-payments can save money. Take DKV's published standard prices:

1. Élite (no co-payment) is €56 a month and Classic (low co-payment) €51: a difference of €60 a year.
2. Classic charges €3.50 per specialist visit, so you would need about 17 specialist visits a year before Élite works out cheaper.
3. Complet is €26 a month, €360 a year less than Élite. At €23 per specialist visit, that saving covers about 15 visits.

Co-payment cover suits people who already have public healthcare (through work, a pension or an S1) and want quicker access to specialists. It suits people with ongoing treatment less well, because frequent tests and therapy sessions each carry a charge. If you expect heavy use but still want a lower premium, look for a product with an annual co-payment cap, such as the €300 per person limit on Adeslas Plena Vital, so your worst-case cost is known in advance.

How to check a policy is genuinely sin copago

1. Read the condiciones particulares (your personal policy schedule), not the sales page. Look for any copago, franquicia (excess) or participación del asegurado (patient share).
2. Check the extras. Dental, optical and travel modules sometimes carry their own fees even on a no-co-pay policy.
3. Ask about waiting periods separately. Get it in writing that the policy is sin carencias if your visa requires it.
4. Match the certificate to the contract. The insurer's certificate for the consulate should state no co-payments and no waiting periods, and the contract should say the same.
5. Confirm the insurer is authorised in Spain using our guide to the DGSFP register.

To compare prices properly, see how to get quotes in Spain.