Which copayment tier you start in as a new resident

Terms used

• TSI 002 — TSI 002 is the working-age copayment code, where you pay 40% of covered medicine prices.
• TSI 003 — TSI 003 is another copayment code that some regions give new residents until income data is available.
• IRPF — The IRPF is Spain's personal income tax, filed with the tax agency each year.
• INSS — The INSS is Spain's national social security institute, which holds pension and benefit records.
• Receta electrónica — The receta electrónica is the electronic prescription system pharmacies use to see your prescriptions and copayment percentage.

Key rules

• Default tier: With no Spanish income data you most likely start in TSI 002, paying 40%, though some regions use TSI 003.
• No application: The health service sets your tier for you, and the pharmacy sees it automatically.
• Review: Your tier is reviewed once a year and when your situation changes.
• Tax return: Filing your IRPF on time is what moves you off the default tier.

Regional practice for new residents varies and review timing is not fixed, so confirm your code and review date with your regional health service.

Which tier you start in

You will most likely start in TSI 002, the default working-age tier, where you pay 40% of the price of covered medicines. Some regions start new residents in TSI 003 until income data arrives. Your regional health service decides, so the code on your paperwork is the only reliable answer.

Why you get a default

Your tier normally depends on your income. It is based on the total taxable income (base imponible) in your Spanish income tax return (IRPF) from two tax years back. As a newcomer you have no Spanish return yet, so the system has nothing to measure. It gives you a default until real data exists.

Who assigns it

The social security body (INSS) assigns the tier. It uses tax agency data and its own records, including pensioner status and benefits. It then sends the result to the regional health services. They load it onto your health card and into the electronic prescription system (receta electrónica). You do not need to apply.

How to see your tier

Look at your health card or the registration documents from your regional health service. They show the code, such as TSI 002. If it is not clear, ask at the admin desk of your health centre (atención al usuario).

At your first pharmacy visit

• Show your health card and your prescription as usual.
• The pharmacy sees your code and percentage in the system when it dispenses. You do not need to tell them your tier.
• Keep your receipts. You will need them if the percentage turns out to be wrong.

When it changes

Your tier is reviewed once a year, once the tax data for the reference year is available. Changes normally take effect in the middle of the year. It can also change during the year if your situation changes, for example if you retire or your benefit changes. Tell your health centre when that happens. Ask your regional health service for the current timing.

Later tiers depend on your tax return, so file your IRPF when it is due. Once you have a return on record, your tier follows your income instead of the default.

If the percentage looks wrong

If you are being charged more than your income justifies, follow the process below to correct it and ask for a refund. Refunds may be limited in time and the rules differ by region.

Choosing between options

Which tier will you start in as a new resident with no Spanish income data?

• TSI 003: Your region applies this tier until your income data is available.

Your regional health service decides. Your health card or registration documents show the code you were given.

Fixing a wrong copayment percentage at the pharmacy

Fixing a wrong copayment percentage

• Keep your pharmacy receipts and gather proof of your income or pension: as soon as you notice the percentage looks wrong

• Ask at the admin desk of your health centre (atención al usuario), or contact your regional health service, to have the tier on your health card corrected: as soon as you have your proof and receipts

• Submit a written request with your proof of income or pension, so the tier is updated on your health card: when you ask for the correction

• Ask your regional health service for a refund of improper charges (devolución de ingresos indebidos), attaching the receipts and proof of the right tier: once the tier is corrected, and within four years, the general limit for claims against the administration

• Expect to recover only what your receipts show, since refunds can be limited in time and the rules differ by region: when you file the refund claim

Documents you need

• Your health card or the registration documents from your regional health service, which show the tier code assigned to you.

• Your latest Spanish income tax return (IRPF), from the tax agency, once you have filed one. It is the income basis for your tier in later years.

Checklist

• Look at your health card or registration documents for the tier code assigned to you.

• Check whether your code is TSI 002 (40%) or TSI 003, since regions differ for new residents with no income data.

• Tell your health centre if your situation changes, for example retirement or a change of benefit, so the tier is updated.

• File your Spanish income tax return (IRPF) when due, because later tiers are based on the return from two tax years back.

Frequently asked questions

Which income decides my tier once I have been in Spain a while?

Your tier is based on the total taxable income (base imponible) in your income tax return (IRPF) from the tax year two years back. The tax agency (AEAT) supplies that figure. Pensioner status and benefits come from the social security institute (INSS).

Do I have to tell the pharmacy my tier?

No, you do not have to tell the pharmacy your tier, because it sees your code and percentage when it dispenses. The INSS sends the tier to your regional health service, which loads it into your health card and electronic prescription (receta electrónica). If the percentage looks wrong, ask your health centre.

Can my tier differ from another new resident's in a different region?

Yes, your starting tier can differ by region, because some regions apply TSI 003 until income data is available while others use TSI 002 (40%).