Health insurance Spain

Anyone living permanently on Mallorca needs health insurance in Spain — proof of cover is mandatory for almost every residence permit. Unlike in Germany, you don't get to choose an insurance fund yourself: your status determines which route is open to you.

Short answer

Employees and self-employed people are publicly covered through their registration with the Spanish social security system (Seguridad Social), and no separate contribution is charged for treatment. Pensioners from Germany and other EU states use the S1 form and are cared for in Spain at the expense of their pension-paying state — however, the German health and long-term care insurance contribution continues to run and is deducted from the pension. Non-working residents without such an entitlement have to rely on a private policy for the first year; only after that does the special agreement with the regional health service, the convenio especial, become available.

How it's calculated

The calculator proceeds in two steps, and the order is not a didactic trick but follows the legal situation: first it is established which route applies to you, and only then is there a figure. A price comparison between the four routes would imply a freedom of choice that does not exist.

Step one: which route applies to you?

The starting point is your status. It determines access to the public health system (Sistema Nacional de Salud, SNS), which on Mallorca is run by the Balearic health service IB-Salut (Servei de Salut de les Illes Balears).

This categorisation is not a list of recommendations from which you pick the cheapest option. Article 3 of Real Decreto 576/2013 only permits access to the convenio especial for those who have no other access to public health protection — explicitly including access via the European coordination rules. Anyone covered via the S1 form has such access and is therefore excluded from the convenio. The distinction matters more than it sounds: a pensioner with an S1 does not choose to forgo the convenio, they simply cannot take it out. Anyone who reads online that they "don't need to take out a convenio especial" is reading a misleading simplification.

Step two: what the assigned route costs

Only once the route is established does the calculator run the numbers. What comes out depends on the route:

• Working professionals. There is no charge for the treatment itself. The monthly social security contribution (cuota) of an autónomo is not a price for health insurance, but an overall contribution that also funds pension, incapacity benefits and other benefits. Anyone who puts it into a comparison as a health insurance premium is comparing two different things.
• Pensioners with S1. No invoice is issued in Spain. The item that almost everyone overlooks appears on the German pension statement: the pensioners' share of health insurance and the full long-term care insurance contribution continue to be withheld. The calculator determines both separately — the equally shared general contribution, the equally shared fund-specific supplementary contribution, and the long-term care insurance borne solely by the individual, capped by the contribution assessment ceiling. Because the supplementary contribution rate differs from fund to fund, it is an input field rather than a stored value; without it, the total remains unknown rather than too low.
• Convenio especial. The monthly contribution is set nationwide and has exactly two tiers, under and from age 65. The calculator shows both so the jump is visible, but does not project it forward into the future. What you additionally bear yourself — outpatient medication above all — is shown as a separate line item and is never factored into the contribution.
• Private policy. Premiums are market prices and appear in no official source. That's why you enter your own premium; the calculator continues to calculate with it as a constant and makes no price forecast.

Cases outside this framework are not covered — for example, voluntary rather than compulsory membership in the German pensioners' health insurance, or other income subject to contributions besides the pension. If this applies to you, the calculator deliberately returns "not determined" rather than a figure that would be too low.

Special cases and common misconceptions

• The European Health Insurance Card as proof of residence. The EHIC (Spanish: TSE) covers temporary stays. It is explicitly not suitable as proof of taking up residence in Spain.
• Planning the convenio especial too early. It requires twelve months of uninterrupted actual prior residence, evidenced by registration at the town hall (empadronamiento) or a residence certificate, plus a current registration at the moment of application. In the first twelve months after moving, this route is open to no one.
• Confusing the waiting period with the start of coverage. Even once the twelve months have been fulfilled, coverage only begins once the contract is formalised — not retroactively, and not from the day the requirement was met.
• Underestimating the coverage gap of the convenio. Treatment, diagnostics and hospital stays are covered without co-payment. Outpatient medication, orthopaedic/prosthetic supplies, outpatient dietary products and non-urgent medical transport, on the other hand, must be paid for entirely out of pocket. Anyone who needs medication on an ongoing basis therefore has a second, separate cost block.
• Not registering the S1. Some pensioners take out a private policy because they don't know about the form — or they request it but never register it with the INSS. Without this registration, no entitlement arises in Spain, even though it exists in principle.
• Regarding the German contribution as having lapsed. The move changes nothing about the German contribution obligation for the statutory pension. It's the healthcare provision in Spain that's free of charge, not your overall coverage.
• Submitting a policy with co-payment for the NLV. For the non-working residence permit, a policy without co-payment (sin copago) and without waiting periods (sin carencias) is required, one that is valid throughout the entire Spanish territory and includes repatriation in the event of illness or death. With a policy that has copago, you pay a small fixed amount per doctor's visit in exchange for a lower premium — but for the permit it is regularly rejected, as is a pure travel insurance policy.
• Overlooking the maximum entry age. Many insurers only accept new customers up to a certain age limit. Anyone who delays taking out a policy may not be able to make up for it later.
• Treating family members the same. In the public system via employment, spouses without their own income and children are co-insured at no extra cost (as beneficiarios). With the convenio especial and with private policies, each person submits their own application, and the S1 must also be issued for every family member who is moving too.
• Confusing the two contracts both called convenio especial. The contract described here concerns healthcare coverage. Sharing the same name but referring to something entirely different is the convenio especial of the Seguridad Social, which is used to fill gaps in pension contribution periods.

Deadlines, forms, responsibility

The common denominator of almost all routes is the empadronamiento, registration at the town hall of your municipality — whether Palma, Calvià, Andratx or Sóller. Without it, there is neither a health card nor the convenio especial. Some Mallorcan municipalities are digitally linked to the IB-Salut, so the paper certificate is no longer needed; you must be registered in any case. Preceding this is an address where you live: what you need to bear in mind when renting short-term and with a long-term rental agreement is covered in a dedicated guide, and how prices are developing in the individual municipalities of the island is shown by the ongoing market report. How the move as a whole works — registration, residencia, taxes — is covered in the comprehensive overview of emigrating to Mallorca described.

The health card (tarjeta sanitaria individual, TSI)

The entitlement arises with the respective status, but the doctor's visit only becomes possible with the card. It is free of charge in the Balearics, is valid for prescriptions at any Spanish pharmacy, and opens access to the nationwide health record.

1. Establish status: alta with the Seguridad Social, an INSS certificate following S1 registration, or a completed convenio especial.
2. Complete the empadronamiento in your municipality of residence.
3. Apply for the TSI at the IB-Salut, either at your assigned health centre (centro de salud) or via its online access. You need to bring your ID and Foreigner Identification Number (NIE), the registration certificate, and a passport photo.How to apply for the NIE in Mallorca and which documents the authority wants to see for it, is a separate step that comes before everything else.
4. Have a centro de salud assigned to you and choose your GP (médico de cabecera).

The S1 route for pensioners

1. Request the S1 in your home country — in Germany from the relevant health insurance fund, in the United Kingdom via the NHS's Overseas Healthcare Service. A separate form is required for each family member moving with you.
2. Register the S1 with the INSS, at one of the citizen service offices (CAISS) in Mallorca or electronically using a digital certificate or Cl@ve.
3. Wait for recognition by the INSS; it identifies you as a person entitled to cover at the expense of the issuing state.
4. Use this certificate to apply for the TSI. Access can be delayed between the move and registration, which is why this step belongs early on and not at the end of your relocation checklist.

The convenio especial with IB-Salut

It is concluded with the regional health service, in Mallorca's case IB-Salut, either electronically with a digital certificate, electronic ID, or Cl@ve, or in person. You must prove uninterrupted prior residence and current registration; each family member submits their own application. The contribution is charged monthly, and cover begins upon signing.

What the non-lucrative residence permit requires

Formally, the consulate's wording allows for both public and private cover. In practice, the route runs via a private policy, because applicants are not permitted to work in Spain and therefore generally cannot demonstrate public entitlement. The immigration authority (extranjería) looks closely at six features, which is where most applications fail:

1. Contract with an insurer authorised to conduct business in Spain.
2. Without co-payment (sin copago) and without waiting periods (sin carencias).
3. Cover equivalent to the public healthcare system: GP, all specialties, diagnostics, hospital care, round-the-clock emergencies.
4. Repatriation in the event of illness or death.
5. Valid throughout the entire Spanish national territory, for the full duration of the permit applied for.
6. An official insurance certificate (certificado) for the consulate or extranjería.

Checklist

• Your own status clarified: employee, autónomo, pensioner with S1, or non-working resident.
• NIE applied for.
• Empadronamiento completed at the town hall.
• If working: alta with the Seguridad Social or, as applicable, with RETA.
• If receiving a statutory pension: S1 requested and registered with the INSS.
• For the non-working residence permit: policy with no co-payments, no waiting periods, including repatriation cover and certificado.
• If a convenio especial is planned: twelve months of prior residence documented, registration currently up to date.
• Family members' status clarified: co-insured or with their own application.
• TSI applied for with IB-Salut and a centro de salud assigned.
• Medication costs and co-payments realistically factored in.

Legal basis and current status

Access via employment follows Article 3 of Ley 16/2003, as amended by Real Decreto-ley 7/2018, which made healthcare provision universal. For pensioners from the EU and the EEA, Articles 24 and 25 of Regulation (EC) No. 883/2004 provide that the pension-paying state bears the cost of healthcare in the state of residence — this is the basis for the S1.

The convenio especial de prestación de asistencia sanitaria is set out in Real Decreto 576/2013, in force since 1 September 2013. Article 3 lists the requirements: no other access to public healthcare cover, one year of continuous actual residence immediately prior to the application, and registration at the time of application. Article 4.4 ties the start of coverage to the formalisation of the agreement. Article 6.1 sets the two contribution tiers: €60 per month under 65 years of age, and €157 per month from age 65 onwards. That the benefits under the convenio cover only the common basic catalogue, excluding outpatient medicines, orthopaedic devices, dietary products and non-urgent medical transport, follows from Article 2.2 of the Real Decreto in conjunction with Articles 8 bis and 8 ter of Ley 16/2003 — this is a derivation from two provisions, not a literal quotation.

There are two caveats to bear in mind. Article 6.2 provides for the amounts to be adjusted by ministerial order; the official analysis of the regulation, as of the current status of this page, shows no such order having been issued, so the amounts have remained unchanged since 2013. And Article 6.1, third sentence, allows the Autonomous Communities to set a higher contribution if they add extra benefits to the agreement. The calculator works with the state amount; a Balearic deviation has been neither publicly confirmed nor ruled out.

The German side of the contribution rests on Sections 241, 242 and 249a of the Fifth Social Code Book — the general contribution rate, the fund-specific additional contribution, and the equal split of the contribution when receiving a German pension — as well as on Sections 55 and 59 of the Eleventh Book for long-term care insurance, the contribution for which the pensioner bears alone. The applicable long-term care contribution rate is not stated in the law itself but in the ordinance issued under paragraph 1, sentence 2 thereof; the rate given in the law has been superseded since January 2025. A different rule on cost-bearing applies to pensions from abroad, which this calculator does not reflect.

You can look all of this up yourself with the relevant authorities:

• What the Spanish Ministry of Health publishes on the requirements and contribution of the convenio especial
• How to apply for the convenio especial in the Balearic Islands, as explained by IB-Salut
• Where to apply for, renew or replace your health card in the Balearic Islands
• How to register your S1 form with the Spanish social security authority

Status of the legal situation and the figures provided: 7 September 2026. This page is for guidance only and does not replace individual legal, tax or insurance advice; requirements from authorities and consulates, as well as rates, may change and may differ in individual cases.

Related calculators

Health insurance is just one of the ongoing costs of moving to Mallorca. Particularly related are the calculators concerning the German pension abroad, which look at the same contribution issue from a different angle, as well as the calculators for Spanish income tax for residents, since a change of residence also shifts taxation rights. Anyone who is still planning their move will find housing costs covered in the calculators for buying and long-term renting.