As a Belgian in Spain, your right to medical care depends entirely on your residency status. Non-residents (second residents) are covered through the European Health Insurance Card (EHIC) for necessary care, while official residents must register with the Spanish Social Security (Seguridad Social) to obtain a SIP card.
In this article, we explain the exact procedures, rights and pitfalls for both holidaymakers and permanent residents.
1. Situation A: You are not a resident (Second Residence)
If you are not a tax resident in Spain but are a regular visitor there (e.g. wintering), you remain covered by Belgian social security. For medical coverage in Spain, the European Health Insurance Card (EZVK) crucial.
The European Health Insurance Card (EHIC)
You can request this card free of charge from your Belgian health insurance fund. The card proves that you are insured and entitles you to necessary medical care in Spain under the same conditions as Spaniards.
Note: The EZVK is only valid in the public health sector (Centros de Salud and public hospitals). Private hospitals and doctors usually do not accept this card.
What is covered?
- Public hospitals: If you are admitted to a public hospital, the costs are settled directly with your Belgian health insurance fund. You usually do not have to advance anything.
- Limitation: The cover applies to unforeseen and necessary care. It is not a substitute for planned treatments abroad.
The role of Mutas (Urgent Medical Assistance)
Do you not have an EHIC in your pocket or is there a complex situation (such as repatriation)? Then you should contact Mutas.
Mutas is the emergency centre of the joint Belgian health insurance funds. They manage the administrative and logistical handling of urgent care abroad.
- Opinion: Save Mutas' emergency number in your phone before departure. They are in direct contact with local Spanish services and will decide on any repatriation to Belgium.
2. Situation B: You are a resident in Spain (Permanent Residence)
From the moment you officially settle in Spain, your social security situation shifts. You can no longer use the Belgian EHIC for regular care in Spain. You will have to join the Spanish healthcare system (Seguridad Social).
Obtaining the SIP card
As a resident, you are entitled to the SIP card (Tarjeta Sanitaria Individual). This gives you free access to full public health services, including GP visits and specialists.
The roadmap for accessing care:
- Padrón: You register with the municipality (empadronamiento).
- Residencia: You obtain your residence permit.
- Seguridad Social: You register with Spanish social security.
- Centro de Salud: With the above documents, go to the local health centre to apply for your SIP card and be assigned a GP.
Public vs private health insurance
Spain's public healthcare system is highly regarded internationally (often in the top 10 in the world). However, waiting times for specialists can be long.
Many foreign residents therefore opt for additional private health insurance (seguro de salud privado). This offers benefits such as:
- No waiting times.
- Choice of in-house doctors and specialists.
- Access to private clinics with multilingual staff.
- Well-known providers include. Allianz Care, DKV, Sanitas (Bupa) and Cigna.
Read more about Belgian consular assistance.
3. Frequently asked questions (FAQ)
Below are answers to specific questions our clients regularly ask about care in Spain.
1. Does my Belgian hospitalisation insurance cover costs in Spain?
This depends on your policy. Many Belgian hospitalisation insurance policies (such as DKV Belgium or AG Insurance) offer worldwide coverage provided you are a resident of Belgium, but often limited to a multiple of Belgian reimbursement rates. In expensive Spanish private clinics, this may be insufficient. Always check your policy conditions before departure.
2. Is repatriation to Belgium always free of charge?
NeeN. The European Health Insurance Card covers medical expenses, but no repatriation (transport back home due to illness). Repatriation is usually arranged through Mutas (if you are still covered by the Belgian mutual health insurance scheme) or through private travel assistance insurance.
3. Can I use a SIP card to visit a private doctor in Spain?
NeeN, the SIP card only gives access to the public network (Seguridad Social). For private doctors or private hospitals, you have to pay for them yourself or use private health insurance.
4. What should I do in case of a medical emergency in Spain?
Call the general emergency number immediately 112. This number works throughout Spain and they can often speak to you in English. If you go to the emergency (Urgencias), always bring your passport and your EZVK or SIP card.
About the author: Glenn Janssens is a lawyer specialising in Spanish real estate transactions and tax regulations. Since 2017, he has been helping Belgian and Dutch individuals and entrepreneurs to safely purchase and structure real estate in Spain. He guides files from A to Z: from due diligence, ownership and tax control to estate planning and optimisation for residents and non-residents. Thanks to his years of experience, hundreds of handled files and focus on transparent communication, Glenn makes complex Spanish legislation understandable and practically applicable for every property buyer.
