Healthcare & Disability Benefits in Spain

Posted on Mar 31, 2025 in Law & Jurisprudence

Healthcare Beneficiaries in Spain

  • Workers in the general scheme, members, and those in an equivalent situation.
  • Pensioners and recipients of regular benefits.
  • Dependents of the above (spouse, descendant, parent…) if living with the holder and their dependents, and not performing any paid work exceeding double the IREM.
  • Nationals of EU member states and those to whom the EU scheme applies.
  • Foreigners who reside in Spain with a residence card.

What is Covered?

  • Common illness or disease
  • Accident at work or not
  • Maternity
  • Risk during Pregnancy
  • Risk during Breastfeeding
  • Primary Care
  • Specialty Care
  • Emergency Care
  • Pharmaceutical Benefits
  • Employment injuries and occupational diseases

Disability Protection in Spain

Disease situation Protection: Temporary and permanent disability.

Temporary Disability

  • Common Disease: 180 days in 5 years.
  • Professional Quoted: Requires no waiting period.
  • Accident: Labor or non-labor.

Beneficiaries

  • Those who are affiliated and discharged from Social Security.
  • Those in an equivalent situation:
    • The worker is claiming unemployment benefit.
    • Alleged contributory or transfer of the business outside the national territory.

Base Calculation of the Regulatory (What the Worker Has Quoted Daily)

  • Common Disease: Base listing by common contingencies = base pension quoted / Days (calendar days: daily rate) (30 days: pay monthly)
  • Occupational Accident: Sickness or industrial accident base price of previous month & Quote Overtime (last year) traded / 365 days

Illness or Accident Labor

  • From day 1 to 3: charged 0
  • From 4 to 20: From 4 to 15 or 60% of the base of the company or from 16 to 20 to 60% of the base Social Security
  • From 21: 75% of the base of Social Security.

* Up to 365 days + 180 days of extension (through a court)

Accident or occupational disease, 75% sw l Regulatory Base Social Security from the day following the accident / low. (Directly paid by the employer but then it pays Social Security.)

Whoever gives us the common sick leave is always the physician. On the fourth day of cessation issued the first part of confirmation of the floor, and from that moment, are issued every week, and continues until the time of discharge. In the event that the company has coverage of IT to each other, the mutual must go to the doctor examine you there. If we can not go to remove the provision. The high or low will be granted by the doctor. Commuting: the moment that you’re going to work.

Duration of Temporary Disability

  • Initially lasts 365 days.
  • 365 days to pass by a court of the National Institute of Social Security. INSS has exclusive powers to assess, rate, and review capacity.
  • The INSS may have an expectation that recovery will recognize an extension of 180 days.

“During the first 365 days traded company and pays the benefit.” During the extended pay Social Security (charge) and listed the company. When you start depleting the file extension for the recognition of permanent disability (jurisdiction of INSS). You can extend the deadline to no later than 730 days if it is expected that there will be a recovery. In this period the company is not listed, so from 180 to 730 days, is not listed.

Automatic Discharge

It may be that we are discharged automatically:

  1. If the worker is not subject can express their dissatisfaction with the medical inspection of public health service within 4 calendar days from the date of the official high.
  2. In this case, the inspection issue with the resolution proposed by the review of the decision of the managing body within 7 days.
  3. If the inspection confirming the decision to pronounce medical discharge takes full effect on high.

When you consider that there may be a relapse … Once exhausted the maximum period of temporary incapacity allowance is recognized if a new activity there has been 180 days since discharge.