Health Insurance Glossary Spain
Essential Spanish health insurance terms explained in plain English. Understand your policy, navigate the healthcare system, and know your coverage with confidence.
Policy Types
(4 terms)Seguro de salud
Health insurance
Seguro de salud is the general term for health insurance in Spain. It can refer to either public (seguridad social) or private (privado) coverage. For expats, this typically means private health insurance from providers like Sanitas, Asisa, Adeslas, or DKV.
Why it matters for expats:
When Spanish paperwork asks for 'seguro de salud,' they're asking for proof of health coverage. For visa applications, you specifically need 'seguro de salud privado' (private health insurance).
Seguro de salud privado
Private health insurance
Private health insurance purchased from commercial insurers rather than state-provided coverage. In Spain, private insurance gives faster access to specialists, shorter waiting times, and a wider choice of doctors and hospitals.
Why it matters for expats:
Private health insurance is required for most visa types including non-lucrative, Golden Visa, and student visas. The public system doesn't count for immigration purposes in most cases.
Cuadro médico
Medical/provider network
The cuadro médico is the list of doctors, specialists, clinics, and hospitals that your insurance policy covers. If you visit a provider outside your cuadro médico, you may not be covered or will need to pay out of pocket and claim reimbursement.
Why it matters for expats:
This is the most important term for using your insurance day-to-day. Before booking any appointment, check if the provider is in your cuadro médico. Most insurers have apps or websites where you can search their network.
Seguro sin copago
Insurance without co-payments
A policy where you pay no out-of-pocket costs when visiting doctors or receiving treatment. The insurer covers 100% of costs within the policy terms. These policies are more expensive but required for certain visa applications.
Why it matters for expats:
For Spanish visa applications (non-lucrative, Golden Visa), you typically need a policy 'sin copago' (without co-payments). Standard policies with co-payments may be rejected by immigration.
Financial Terms
(4 terms)Copago
Co-payment
A copago is a fixed amount you pay each time you use a healthcare service—typically €5-20 per GP visit, €10-30 per specialist visit, or €20-50 for emergency care. The insurer pays the rest.
Why it matters for expats:
Policies with co-payments are cheaper but cost more when you actually use healthcare. For visa applications, you usually need a policy without co-payments. Check what copago applies to your plan before booking appointments.
Prima
Premium
The prima is the amount you pay for your health insurance policy. In Spain, this is typically quoted annually and can be paid in full, bi-annually, or monthly. Health insurance premiums increase with age.
Why it matters for expats:
Unlike car insurance, health insurance premiums in Spain increase significantly as you get older. Rates for over-50s can be double those for younger adults, and over-65s pay even more. Lock in coverage early if possible.
Carencia
Waiting period
Carencia is the waiting period before certain coverages become active. Common waiting periods include: 6 months for minor surgery, 8-10 months for maternity, 12-24 months for pre-existing conditions, and 6-12 months for dental.
Why it matters for expats:
For visa applications, you need coverage 'sin carencias' (without waiting periods). This costs more but is essential for immigration. If you're not applying for a visa, waiting periods can help keep premiums down.
Cuota
Monthly installment
The cuota is your monthly payment amount when paying for insurance in installments rather than annually. Monthly payments may be slightly higher than dividing the annual premium by 12 due to administrative fees.
Why it matters for expats:
Paying annually often saves 5-10% compared to monthly cuotas. However, monthly payments are easier to budget. Check what payment options your insurer offers.
Coverage Types
(9 terms)Hospitalización
Hospital admission/inpatient care
Hospitalización covers your stay in hospital for treatment, surgery, or observation. This includes the room, meals, nursing care, and medical treatment during your stay. Most policies cover private or semi-private rooms.
Why it matters for expats:
All private health policies include hospitalisation, but room types vary. Premium policies offer private rooms; basic policies may mean shared rooms. Check what's included before you need it.
Urgencias
Emergency care
Urgencias covers emergency treatment at hospital emergency departments. This includes triage, emergency diagnostics, treatment, and short-term observation. Most policies cover emergencies at any hospital, not just network providers.
Why it matters for expats:
In a genuine emergency, go to the nearest hospital—most policies cover emergencies outside the network. For non-emergencies, using emergency services may incur extra costs or not be covered at all.
Especialistas
Specialist consultations
Access to specialist doctors such as cardiologists, dermatologists, gynecologists, ophthalmologists, and others. In Spain's private system, you can typically book directly with specialists without needing a GP referral.
Why it matters for expats:
One of the main advantages of private insurance is direct access to specialists without waiting for GP referral. Check if your plan requires pre-authorization for certain specialists.
Médico de cabecera
GP/Primary care doctor
Your médico de cabecera is your assigned general practitioner or family doctor for routine care, check-ups, and initial consultations. Some policies assign you a specific GP; others let you choose from the network.
Why it matters for expats:
Having a regular médico de cabecera who knows your health history is valuable, especially for managing ongoing conditions. Ask if English-speaking GPs are available in your cuadro médico.
Maternidad
Maternity cover
Maternidad covers prenatal care, delivery, postnatal care, and newborn care. This typically includes all pregnancy check-ups, ultrasounds, delivery (natural or cesarean), epidural, and newborn pediatric care.
Why it matters for expats:
Maternity coverage has waiting periods of 8-10 months at most insurers. If you're planning a family, take out insurance before getting pregnant. The newborn is typically covered automatically for the first 30 days.
Salud mental
Mental health cover
Coverage for psychiatric consultations and psychological therapy sessions. This typically includes a limited number of sessions per year (often 15-30), with some policies offering more comprehensive mental health support.
Why it matters for expats:
Mental health coverage in Spanish policies is often limited. Check the number of sessions included and whether you need a referral. Some insurers offer teletherapy options with English-speaking psychologists.
Preexistencias
Pre-existing conditions
Preexistencias are health conditions you had before taking out insurance. Insurers typically exclude or impose waiting periods on pre-existing conditions. You must declare all existing conditions when applying.
Why it matters for expats:
Be honest about pre-existing conditions—undisclosed conditions can void your policy if discovered. Some insurers offer coverage for pre-existing conditions after waiting periods of 12-24 months.
Segunda opinión médica
Second medical opinion
Many policies include the right to a segunda opinión médica—an independent review of your diagnosis or treatment plan by another specialist. This is especially valuable for serious conditions or major surgery decisions.
Why it matters for expats:
If you're facing a major health decision, use this benefit. Some insurers even offer international second opinions from specialists abroad for complex cases.
Asistencia en viaje
Travel medical assistance
Coverage for medical emergencies when traveling outside Spain. This can include emergency treatment, medical evacuation, and repatriation. Coverage varies by policy—some include European travel, others worldwide.
Why it matters for expats:
If you travel frequently, check what asistencia en viaje your policy includes. For extended trips or certain destinations, you may need separate travel insurance for adequate protection.
Claims & Process
(3 terms)Autorización previa
Prior authorization
Autorización previa is approval you must obtain from your insurer before receiving certain treatments, tests, or procedures. Without prior authorization, the insurer may refuse to pay for the service.
Why it matters for expats:
Always check if your planned procedure needs autorización previa. Common examples: MRI/CT scans, surgery, physical therapy sessions. Your doctor's office can often request this on your behalf.
Reembolso
Reimbursement
Reembolso policies allow you to see any doctor (not just network providers), pay out of pocket, and claim reimbursement from your insurer. Reimbursement is typically 80-90% of costs up to set limits.
Why it matters for expats:
Reembolso policies are more expensive but give you freedom to see any doctor. They're useful if you want to continue with a specific doctor who isn't in your network, or when traveling.
Parte médico
Medical report
A parte médico is an official medical report or certificate. This can be required for insurance claims, work absence, or official purposes. Doctors may charge separately for detailed medical reports.
Why it matters for expats:
You may need a parte médico for sick leave, insurance claims, or administrative purposes. Private doctors typically provide these faster than public healthcare, which is one advantage of private coverage.
People & Roles
(3 terms)Asegurado
Insured person
The asegurado is the person covered by the insurance policy. Family policies can have multiple asegurados (spouse, children). Each insured person is covered according to the policy terms.
Why it matters for expats:
Check who is listed as asegurado on your policy. For family policies, ensure all family members are correctly registered. Adding or removing insured persons may require policy amendments.
Beneficiario
Beneficiary
The beneficiario is the person who benefits from the insurance. In health insurance, this is usually the same as the asegurado (insured person). In life insurance, beneficiaries receive payments upon the insured's death.
Why it matters for expats:
For health insurance, you and your asegurado family members are the beneficiaries. Ensure everyone who needs coverage is properly listed on the policy.
Tomador
Policyholder
The tomador is the person who takes out the policy and is responsible for paying the premiums. The tomador can be different from the asegurado—for example, a parent taking out insurance for adult children.
Why it matters for expats:
As tomador, you're responsible for premium payments and policy administration. Companies can be tomadores for employee health insurance. The tomador receives all policy communications.
Documents
(3 terms)Tarjeta sanitaria
Health card
Your tarjeta sanitaria is your health insurance card, which you present when visiting doctors and hospitals. It identifies you as a policyholder and allows providers to verify your coverage and bill your insurer directly.
Why it matters for expats:
Keep your tarjeta sanitaria with you at all times. Most providers now also accept digital cards via insurer apps. Without your card, you may need to pay upfront and claim reimbursement.
Póliza
Policy document
The póliza is your insurance contract document detailing all coverage terms, exclusions, limits, and conditions. It's the legal agreement between you and the insurer that governs your coverage.
Why it matters for expats:
Keep a copy of your póliza for reference and for visa applications. It specifies exactly what's covered, what's excluded, and any waiting periods or limits that apply.
Certificado médico
Medical certificate
A certificado médico is an official certificate from a doctor confirming health status, fitness for work, or absence of contagious diseases. These are often required for work permits, driving licenses, or official purposes.
Why it matters for expats:
You'll need certificados médicos for various administrative processes in Spain. Private insurers typically don't cover these as they're not medical treatment—you'll pay separately (usually €30-60).
Related Health Insurance Guides
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Read guideReady to get health insurance in Spain?
Now that you understand the terminology, let us find you the right coverage. We explain everything in English and handle all the Spanish paperwork.
Get Health Insurance QuotesHealth Insurance Glossary FAQs
What's the difference between cuadro médico and reembolso policies?
Cuadro médico policies require you to use doctors within the insurer's network—they bill the insurer directly. Reembolso policies let you see any doctor, but you pay upfront and claim back 80-90% of costs. Cuadro médico is more common and usually cheaper.
What does 'sin copago' mean and why does it matter for visas?
Sin copago means 'without co-payments'—you pay nothing when visiting doctors. Spanish immigration typically requires policies sin copago for visa applications. Standard policies with co-payments may be rejected even if they provide good coverage.
What is carencia and how does it affect my coverage?
Carencia is the waiting period before certain coverages activate. For example, maternity typically has 8-10 months carencia. For visa applications, you need coverage 'sin carencias' (without waiting periods), which costs more but is required by immigration.
Do I need autorización previa for all treatments?
Not for routine consultations, but yes for many procedures, tests, and treatments. Common examples: MRIs, CT scans, surgery, extended physiotherapy. Always check before booking—your doctor's office can usually request authorization for you.
How do I check if a doctor is in my cuadro médico?
Most insurers have apps or websites where you can search their cuadro médico by specialty and location. You can also call your insurer's helpline. Using doctors outside the network means paying out of pocket (unless you have a reembolso policy).
What are preexistencias and do I have to declare them?
Preexistencias are health conditions you had before taking out insurance. Yes, you must declare them—failing to do so can void your policy. Insurers may exclude pre-existing conditions or cover them after waiting periods (typically 12-24 months).