How the copayment works for your spouse and children

Terms used

• Base imponible — The base imponible is your total taxable income as shown on your income tax return.
• IRPF — The IRPF is Spain's personal income tax, filed yearly.
• AEAT — The AEAT is Spain's tax agency.
• INSS — The INSS is the social security body that records pensions and pensioner status.

Key rules

• Holder's income: Your spouse and children follow the insured holder's tier, never their own income.
• Children: Being under 18 does not exempt a child from the copayment.
• Disability: A child with a disability of 33% or more is exempt.

Whose income counts

Your spouse and children follow the holder's tier, not their own. The holder is the person who is insured, usually the worker or pensioner. A spouse's own income does not change their tier.

The tier is set by the holder's total taxable income (base imponible) in the income tax return (IRPF) from two tax years back. The tax agency (AEAT) supplies that figure. Social security (INSS) supplies the pensioner status. The two are matched to assign a code to each person.

If the holder is an active worker

Your spouse or other beneficiary gets the same tier as the holder, based on the holder's declared income.

If the holder is a pensioner

Your spouse or other beneficiary is generally treated as a pensioner too, which means the 10% rate.

What children pay

Children under 18 are placed in the same tier as the holder they depend on. Being a minor does not make them exempt. Their share depends on the holder's income:

• Below 18,000 euros: 40%
• Between 18,000 and 100,000 euros: 50%
• Above 100,000 euros: 60%

A child with a disability of 33% or more is exempt. You need to ask for this exemption.

If the tier looks wrong

First make sure your spouse and children are registered as beneficiaries of the holder. Then ask your health centre to review the tier. Rules are applied region by region, so the way family income is assessed can differ. Ask your regional health service if your case is unusual. The checklist below walks you through the steps.

Checklist

• Find out whether the insured holder is an active worker or a pensioner, because this sets your spouse's and children's tier.

• Check that your spouse and children are registered as beneficiaries of the holder, so they follow the holder's tier.

• Ask for an exemption for any child with a disability of 33% or more.

• Ask your health centre to review the tier if it does not match the holder's income or pensioner status.

Frequently asked questions

Does my spouse's own income change their copayment tier?

No, a spouse who is a beneficiary is placed in a tier by the holder's status and income, not their own.

Are children under 18 exempt from the copayment?

No, children are not exempt just for being minors, because they pay the rate of the holder they depend on. That means 40%, 50% or 60% depending on the holder's income. Children with a disability of 33% or more are exempt.

Which tax return decides the tier for my family?

The tier is based on the holder's total taxable income (base imponible) in the latest income tax return from two tax years back. The tax agency supplies this data, and social security supplies pensioner status. The two bodies match the data to assign the tier.