Healthcare that follows residence

Spain’s public system is the National Health System (Sistema Nacional de Salud, SNS). Each autonomous community runs it through its own regional health service. Since Royal Decree-Law 7/2018, the right to public healthcare rests on Spanish nationality or legal residence in Spain, not on paying into Social Security.

Workers registered with Social Security (in “alta”), pensioners and people receiving benefits do not have to apply. The National Social Security Institute (INSS) recognises their right, and the individual health card, the tarjeta sanitaria, is then issued at a health centre of the regional health service.

Procedure is regional. The 2018 rules have been applied unevenly across regions, as the preamble to a 2026 royal decree acknowledges. Each community issues its own card and sets its own steps.

Settle who the employer is before anything else

Spanish advisers and legal commentators describe the Workers’ Statute (article 43) as banning the supply of workers to another company except through licensed temporary work agencies (ETTs). They warn that the usual employer of record model can count as unlawful worker supply, cesión ilegal, unless the provider is also a registered ETT.

That means an EOR is not a simple default in Spain. A US company generally either registers as an employer there, through its own entity or registration, or uses a provider whose structure holds up under Spanish law. Once the employer is settled, it registers the worker with Social Security, and that registration is what brings public healthcare. The health coverage for EOR and contractors abroad guide walks through those options side by side.

Social Security contributions, with the 2026 split

The employer registers the employee with Social Security and pays contributions under the General Scheme (Régimen General). For common contingencies (contingencias comunes) in 2026, the employer’s share was 23.60% and the employee’s 4.70%, out of a total of 28.30%. Rates can change, so check the current figure. These contributions fund risks such as sickness and pensions; public healthcare itself is not paid for out of them.

Other contributions, such as unemployment, also apply, and each is charged on a contribution base with a minimum and a maximum for every professional category group. This page is general information, not legal or tax advice, so check contributions, bases and the tax points below with a local adviser or tax professional.

Private health cover as a tax-favoured benefit

Employer-paid health insurance is a recognised benefit in Spain, and the income tax (IRPF) rules give it a specific exemption. Premiums an employer pays to an insurer for the employee’s health cover are not taxed as a benefit in kind when the cover includes the employee, may extend to the spouse and children, and stays within a set annual limit per covered person, with a higher limit for people with a disability. Premiums above the limit are taxed as a benefit in kind.

The legal basis is article 42.3.c of the IRPF Law and article 46 of the IRPF Regulation (Royal Decree 439/2007). The Basque foral territories may apply different rules, so an employee living in the Basque Country is worth flagging early.

For an employee registered with Social Security, public coverage comes automatically with that registration. An international plan therefore does not replace it; it can only sit on top.

Visas that ask for proof of private insurance

Some residence routes require private cover, and consulates are specific about it. For the telework visa, aimed at people working remotely for foreign companies, consulate guidance says the insurer must be on the register of the Directorate General of Insurance and Pension Funds (DGSFP).

For the non-lucrative residence visa, the consulate pages state that the policy must cover the same risks as the public system, with no deductible, co-payment, waiting period or coverage limit, and that travel insurance is not accepted. A global plan from an insurer that is not authorised in Spain may not count for visa purposes, and requirements vary by consulate and visa type.

Family members and care elsewhere in the EU

A worker can add family members to their public healthcare right as beneficiaries: a spouse or registered partner, children and some other relatives. The family members must live in Spain and depend on the worker financially, and children are generally covered under 26, or at any age with a disability of 65% or more.

Social Security also issues the European Health Insurance Card (Tarjeta Sanitaria Europea) for care during temporary stays elsewhere in the EU. For an employee who travels within Europe for work, that card is part of the picture before any private plan is considered.

Requesting a benefits partner introduction

When it comes to health cover, we can introduce you to a benefits partner focused on health coverage for international and remote teams. Fill in the quote form on this page with the region of Spain where the employee lives, the size of your team and whether family members would be covered, and we will send it on to the partner. Who qualifies, which plans are available and what they cost are for the partner and the insurer to decide.

Comparing several countries? The international health insurance overview links each country guide, and the employee benefits hub covers the wider set of employee benefits.

A few useful answers

Common questions

Can a US company use an employer of record in Spain?

Only with care. Spanish advisers read the Workers’ Statute as banning worker supply except through licensed temporary work agencies, and they caution that a standard EOR model may amount to cesión ilegal unless the provider is also registered as an agency.

Does a remote employee in Spain get public healthcare?

Yes, once the employer registers them with Social Security. Workers in “alta” have their right recognised automatically and receive a health card from the regional health service.

Is employer-paid health insurance taxed in Spain?

Premiums for the employee, spouse and children are exempt from tax as a benefit in kind up to a set annual limit per person. Amounts above the limit are taxed as a benefit in kind.

Can an international plan replace Spanish public healthcare?

Not for an employee registered with Social Security, whose public coverage comes with that registration. A global plan can only sit on top of it.

Does Spain’s telework visa accept any health insurance?

No. Consulate guidance says the insurer must be on the DGSFP register of insurers authorised to operate in Spain.

International Health Insurance for Remote Employees in Spain