Going home for treatment while living in Spain

Terms used

• S2 — The S2 is a form from INSS approving planned treatment in another country, with Spain paying the cost.
• INSS — The INSS is Spain's social security institute, which handles S2 authorisation through provincial offices.
• S1 — The S1 is a form that registers you for state healthcare paid by another country, such as the UK.
• TSE — The TSE is Spain's European health card, which covers necessary care during a temporary stay in the EU/EEA, Switzerland or the UK.

Key rules

• S2 timing: Get S2 approval before treatment starts, because it cannot be obtained afterwards.
• Private care: Private treatment abroad is generally not reimbursed by Spain.
• Home charges: Your home hospital may charge you as a visitor unless you are exempt, for example as an S1 holder.
• Health card: The TSE covers necessary care during a visit, not treatment you travel to receive.

The short answer

Going home for care only works if you know who pays before you book. There are three possible payers: Spain (through approved routes), the EU-style health card system, or you. Spain does not generally reimburse treatment you choose to have abroad.

Planned treatment: Spain pays only with approval

If you want planned treatment in another EU/EEA country, Switzerland or the UK, the route is the S2 form. You must get it before you travel. Approval cannot be requested after treatment has started.

1. Ask a specialist in the Spanish public system for a medical report. It must say the treatment is among the benefits Spain covers and cannot be given in Spain within a medically justifiable time.
2. Apply to your provincial INSS office (Spain's social security institute) with that report.
3. If approved, INSS issues the S2 form. You give it to the foreign provider's insurer. You are then treated like a local insured patient and Spain pays the cost.

If the conditions are met, authorisation cannot be refused. Check the current documents with your local INSS office.

There is also an EU cross-border route. It reimburses only what Spain would have paid, and it can require prior approval for hospital stays or highly specialised care. Confirm which route applies before you commit.

Private treatment abroad

Private costs are generally not reimbursed, whichever country you go to. Rare urgent cases may be assessed by your regional health service or INSS. Do not count on it. Travel costs to countries outside these agreements are generally not covered either.

Needed care during a visit

If you fall ill during a temporary stay in the EU/EEA, Switzerland or the UK, necessary treatment is provided on the same terms as for local residents when you show your Spanish health card (the TSE). Costs are settled between the states. This covers necessary care, not treatment you travelled to get.

Will your home hospital charge you?

Once you live in Spain, your home country may treat you as a visitor.

• UK: If you have moved permanently to Spain, you are generally no longer ordinarily resident. The NHS can charge you for hospital and some other services. Exceptions include A&E treatment and some infectious disease treatment.
• Exempt groups: Some people are exempt, including S1 holders and some UK state pensioners. The hospital assesses your status.
• Other EU countries: Former residents are usually treated as visitors. Your health card may cover necessary care.

Ask the hospital in writing, before you travel, whether it will charge you and what status it has on record for you. Other countries have their own rules.

Is it practical?

Going home is realistic if you have S2 approval, or if you are exempt from charges, or if you accept paying yourself. If none of these applies, ask whether the same treatment is available in the Spanish public system. Use the checklist and the questions below to work through it.

Checklist

• Ask your Spanish public-system specialist whether the treatment you want at home is something Spain covers.

• Apply to your provincial INSS office (Spain's social security institute) for S2 authorisation before you travel.

• Check whether your treatment is hospital or highly specialised care, because the EU cross-border route can require prior approval for it.

• Confirm which route pays before you book any private treatment abroad, because private costs are generally not reimbursed.

• Ask the home hospital whether it will charge you as a visitor, and whether your status, such as S1 holder, gives you an exemption.

Frequently asked questions

Will Spain pay for treatment I choose to have back home?

No, Spanish public cover does not generally reimburse treatment you choose to have abroad. The exceptions are planned care approved in advance through the S2 route or the EU cross-border care route, where Spain pays no more than it would have paid at home.

Can I ask for S2 approval after the treatment has started?

No, you must get S2 authorisation from the INSS before treatment, not after. Apply at your provincial INSS office with a report from a Spanish public-system specialist.

Can my old UK hospital charge me when I visit home?

Yes, if you have moved permanently to Spain, NHS hospitals can generally charge you as an overseas visitor. A&E treatment and some infectious disease treatment are exempt.