Applying for the paid agreement (convenio especial) and its monthly cost

Terms used

• Convenio especial — The convenio especial is a paid agreement that gives you access to public healthcare if you have no other right to it.
• INSS — The INSS is the national Social Security institute that processes convenio especial applications.
• CAISS — The CAISS is an INSS care centre where you apply in person with an appointment.
• Cita previa — The cita previa is the prior appointment you must book before visiting most public offices.
• INGESA — INGESA is the national health body that handles healthcare in Ceuta and Melilla.

Key rules

• Fee by age: Pay 60 euros a month if you are under 65 and 157 euros if you are 65 or over, in any region.
• Where to apply: Apply at the INSS care centre in your province, not at your regional health service.
• Payment: The fee is taken by direct debit from a Spanish bank account in the first days of each month.
• Duration: The agreement has no end date and needs no renewal while you keep paying.

Where to apply

You apply to the national Social Security institute, the INSS, not to your regional health service. Book an appointment (cita previa) at the INSS care centre, the CAISS, in your province. You can book by phone or on the Seguridad Social website. In Ceuta and Melilla, the office that handles it is INGESA.

The route is the same in every region, including Madrid, Catalonia, Andalusia and Valencia. Your regional health service only comes in at the end: once the agreement is approved, it issues your health card and assigns your family doctor. The steps and the papers you need are in the blocks below.

What you pay

The monthly fee is 60 euros if you are under 65 and 157 euros if you are 65 or over. It is the same in every region, because it is set nationally. Regions only deliver the care. Pharmacy co-payments follow the general national rules.

The fee can be revised, so ask the INSS office for the current figure when you book.

How you pay

You pay monthly by direct debit from a Spanish bank account. You set it up when you sign the agreement. The money is collected in the first days of each month, so keep enough in the account. Ask the office for the exact collection day.

Missing payments can end the agreement. The limits are set out in the page on keeping or losing the agreement.

When cover starts

Cover runs from the date of your application or from when the office grants it. Ask which one applies to you. The first payment is normally due from the following month.

The law gives the administration a period of a few months to decide. How long it takes in practice depends on your province. If you hear nothing within that period, the application counts as unanswered, so go back to the office and ask for the status of your file.

How long it lasts

You do not need to renew it. The agreement has no end date. It stays in force while you meet the conditions and keep paying, until you or the administration ends it.

Applying for the convenio especial step by step

• Check your residence and that no other healthcare entitlement applies: Before you start

• Gather your ID or NIE/TIE, empadronamiento certificate and bank account details: Before you book the appointment

• Book an appointment (cita previa) at your INSS care centre (CAISS) by phone or on the Seguridad Social website; in Ceuta and Melilla, contact INGESA: Once your documents are ready

• Submit the application form with your documents and a statement that you have no other cover: At your appointment

• Wait for the INSS to check your file and issue its decision: After you submit

• Sign the agreement and set up direct debit: Once the INSS approves

• Pay the first monthly fee: After signing

• Register with your regional health service to get your health card and family doctor: After the first payment

• If your residence is under one year, wait and apply once you reach it: If you do not meet the residence rule yet

Documents you need for the convenio especial

• The INSS application form for the convenio especial de asistencia sanitaria.

• Identity: your passport, NIE or residence card (TIE). EU citizens can use their EU registration certificate.

• Residence: a certificate of empadronamiento (town hall register) showing at least one year of continuous residence in Spain before you apply.

• Legal residence: a valid residence permit or EU registration certificate. Some offices ask for this as separate proof.

• A signed declaration that you have no right to healthcare by any other route, Spanish or EU/international.

• Bank details for direct debit of the monthly fee.

• Your Social Security number, if you already have one.

• Any foreign document an office asks for, such as a certificate of no coverage in your home country, with an official Spanish translation and, if requested, an apostille.

Checklist

• Work out your fee: 60 euros a month if you are under 65, or 157 euros a month if you are 65 or over.

• Choose a Spanish bank account for the monthly direct debit and have its details ready to sign with the agreement.

• Ask the office when your cover starts and when the first payment is due, which is normally the month after your application.

• Ask the office how long your file will take in your province, and follow up if you get no answer within the legal period.

• Keep enough money in the account in the first days of each month, because the fee is collected then and the agreement can end if you miss payments.

Frequently asked questions

Is the convenio especial fee different in each region?

No, the fee is the same in every region because the national government sets it. The regional health service only provides the care, so moving between regions does not change what you pay.

Do I apply at my regional health service?

No, you apply at the INSS provincial office through its care centre (CAISS), not at the regional health service. In Ceuta and Melilla the body that handles it is INGESA.

When does my cover start after I apply?

Cover starts either from the date of your application or from when the office grants it, and the first payment is due from the following month. The legal period to resolve the file is a few months, and the real time varies by province. Ask your INSS office which start date applies to you.

Does the convenio especial need renewing every year?

No, the convenio has no end date and needs no renewal.