The rule: two people, two policies, two certificates
For the Spanish NLV, health insurance is assessed per applicant — not per household. Every person included in an application must have their own individual policy, and each policy must generate its own individual Spanish-language certificate (carta para visado). You cannot submit a joint couples policy, and you cannot submit a single certificate listing two names.
This applies even if you apply at the same time, apply to the same consulate, and use the same insurer. Each partner's application is assessed individually. If either certificate is missing, incorrect, or covers a joint policy rather than an individual one, the application for that person will be refused.
Each partner must have their own individual health insurance policy and their own individual carta para visado in Spanish. Even if both are insured with the same company and the same plan, the insurer must issue a separate certificate for each person. Confirm this explicitly when purchasing — do not assume one document covers both of you.
How couple applications work in practice
When a couple applies for the NLV together, the typical structure is:
Applications are usually submitted together at the same consulate appointment. Each partner has their own application file. Simultaneous processing is standard — you are not applying "as a couple" formally; you are two individuals whose applications happen to go in together.
Each partner's application folder contains their own individual carta para visado. This must cover the applicant individually — not jointly. The certificate must be in Spanish and contain the required coverage elements (hospitalisation, urgent care, repatriation, no copayments, no prior-authorisation requirement).
The combined income requirement for two applicants is approximately €36,000/year (€3,000/month) for 2026. This is higher than the single applicant threshold of approximately €28,800/year. Income sources can be pooled — pension, savings, rental income, investments, or a combination.
In theory, each NLV is assessed and issued (or refused) independently. If one partner's application is incomplete, the other's can still proceed. In practice, consulates generally process simultaneous couple applications together.
Income requirements for couples
The 2026 NLV income thresholds for two applicants:
| Applicants | Required annually (approx.) | Required monthly (approx.) |
|---|---|---|
| 1 person | €28,800/year | €2,400/month |
| Couple (2 people) | €36,000/year | €3,000/month |
| Couple + 1 child | €43,200/year | €3,600/month |
| Couple + 2 children | €50,400/year | €4,200/month |
Approximate 2026 figures. Thresholds change annually and vary by consulate. Confirm current requirements with your specific consulate or an immigration lawyer before applying.
What health insurance costs for couples
Because each partner needs their own individual policy, the total insurance cost for a couple is the sum of two individual premiums. Premiums are age-based — both partners' ages matter independently.
| Both partners aged | Sanitas combined (approx.) | Caser combined (approx.) |
|---|---|---|
| Both aged 40 | ~€136–160/month | ~€112–134/month |
| Both aged 45 | ~€155–185/month | ~€130–158/month |
| Both aged 50 | ~€176–210/month | ~€148–178/month |
| Both aged 55 | ~€198–238/month | ~€168–204/month |
| Both aged 60 | ~€226–270/month | ~€190–232/month |
| Both aged 65 | ~€260–310/month | ~€218–268/month |
| One aged 70, one aged 65 | ~€290–350/month | Caser max age 69 — not available for the 70-year-old |
Indicative combined premiums based on two individual policies. Actual premiums depend on exact ages, plan tier, and any promotions at time of purchase. Get individual quotes from each insurer based on your specific ages.
If your ages differ significantly, the older partner's premium will be higher. Run quotes for both partners at their actual ages — don't estimate. A five-year age difference at age 60 vs 65 can mean a €30–50/month difference per person on some plans.
Should couples use the same insurer?
There is no rule requiring both partners to use the same insurer. Some couples split — one with Sanitas, one with Caser — based on individual health needs or age eligibility. That said, there are practical reasons to consider staying with the same provider:
One insurer to deal with for both policies, one renewal date to track, one customer service team to contact. This is a practical convenience advantage, particularly when you are new to living in Spain.
Some insurers offer reduced premiums when multiple household members are insured together. Ask explicitly about this at quotation stage — it is not always advertised. Getting both partners quoted together (rather than separately and sequentially) is the best way to capture any available discount.
If both partners are with the same insurer, you attend the same clinics, can book at the same hospitals, and use the same apps. With different insurers, one partner might have access to a hospital or specialist that the other doesn't.
The main reason to use different insurers is when one partner's age or health profile means only one insurer is available — for example, if one partner is over 69 and Caser is therefore not an option for them.
Age limits: the critical issue for older couples
Caser's maximum new applicant age is 69. If either partner has reached their 70th birthday before the policy start date, Caser cannot issue them a new policy. This is a hard limit — not a case-by-case decision.
In practice, this means:
| Partner ages | Sanitas option | Caser option |
|---|---|---|
| Both under 70 | Both eligible | Both eligible |
| One under 70, one aged 70–75 | Both eligible (max 75) | Only the younger partner eligible |
| Both aged 70–75 | Both eligible | Neither eligible (Caser max age 69) |
| One over 75 | Sanitas max age 75 — not eligible | Caser max age 69 — not eligible |
If one or both partners are aged 70 or over, ASSSA accepts applicants beyond 80 (southeast Spain focus) and may be an option for the older partner alongside Sanitas for the younger. Get explicit age eligibility confirmed in writing before purchasing.
Dental coverage for couples
If dental cover matters to you both, the options are straightforward: both Sanitas and Caser include dental as standard at no extra cost on their visa-compliant plans.
Sanitas includes dental across the Residents Visa, Residents Platinum, and International Students plans — 45+ free dental services across 216+ owned dental clinics, with no waiting periods. Caser includes dental via Sonrisa Esencial. The four other main insurers (Adeslas, DKV, ASISA, ASSSA) do not include dental as standard in their NLV plans.
For a couple where dental access is a priority, choosing Sanitas or Caser ensures both partners have dental included from day one of their policy — no separate dental plan purchase required.
Which insurer is best for couples?
Certificate requirements for both partners
Both certificates must be in Spanish (the consulate does not accept English-language documents). Each certificate must be individual — covering only the named policyholder — and must confirm the required coverage elements for the NLV:
- Full hospitalisation and emergency treatment coverage in Spain
- Repatriation to country of origin
- No co-payments or excess (copayment-free)
- No requirement for pre-authorisation by the insurer before accessing care
- Validity for at least the duration of the initial visa period (typically 12 months, sometimes 6 months minimum accepted)
Sanitas issues certificates automatically and instantly upon policy activation. Caser typically takes 1–2 business days for certificate issuance. Both are issued in Spanish. Have both certificates ready before your consulate appointment — some consulates will not accept provisional confirmation letters in place of the actual certificate.
Common questions from couples
Can we apply on the same day with different insurers?
Yes. There is no rule requiring both partners to use the same insurer. If one partner's profile is better suited to Sanitas (e.g., older age) and the other's to Caser (e.g., under 69, cost-conscious), using different insurers is completely valid. Each certificate is assessed individually. The only requirement is that each individual certificate meets the NLV requirements in its own right.
What if we are civil partners rather than married?
The NLV does not have a marriage requirement. Civil partners, domestic partners, and unmarried couples can apply simultaneously. Each partner applies individually and provides their own health insurance certificate. Some consulates require documentation of the relationship for joint applications — check with your specific consulate for their current requirements. The health insurance requirement is identical regardless of relationship type.
What happens if one partner's visa is approved and the other's is refused?
Each NLV is issued (or refused) independently, even for couples applying simultaneously. If one partner's application is refused — for any reason, not necessarily insurance-related — the other's approval stands. You would need to address the reason for refusal and reapply for the refused partner separately. Health insurance is just one document among several; a refusal could also relate to income documentation, criminal record certificates, or other requirements.
Do we need to be covered from the day we apply or the day we arrive?
The certificate presented to the consulate is the document they assess — coverage typically needs to be in force or commencing from your intended date of residence. In practice, most couples purchase policies starting from around the time of their consulate appointment or their planned arrival in Spain. Sanitas and Caser can back-date or forward-date policy start dates within certain limits. Confirm the exact start date that your consulate requires — some want coverage starting from application date, others accept a near-future start date.
Can we both include a dental plan with our insurance?
Yes — if both partners choose Sanitas or Caser, dental is included as standard in those plans at no extra cost. Each partner's individual plan includes the same dental benefit. The other four main insurers (Adeslas, DKV, ASISA, ASSSA) do not include dental as standard. If dental matters to you both, Sanitas or Caser are the natural starting point when comparing.
What if one partner has a pre-existing condition and the other does not?
Each partner's policy is underwritten individually. The partner with the pre-existing condition may have that condition excluded from their policy; the partner without will receive standard terms. This does not affect the other partner's policy or its visa compliance. Sanitas is the most likely insurer to offer the most favourable terms for the partner with a health history.
Do we need to get our health insurance certificates at the same time?
No — you can obtain certificates at different times, as long as both are valid and in force by your consulate appointment. Applying together at the same time often simplifies the process and ensures matching start dates. Sanitas issues certificates instantly; other insurers take 1–5 business days, so if timing is tight, both partners should use Sanitas.
Can we get a refund on our policies if the visa is refused?
Most visa-compliant insurers will refund unused premium if your visa is refused, provided you notify them promptly. This applies individually to each partner's policy — if both partners are refused, both can claim refunds. Notify the insurer as soon as you receive a refusal decision and within their stated cancellation window. Check the specific refund terms at purchase.
Digital Nomad Visa — couples and the DNV
The DNV is increasingly popular with couples where one or both partners work remotely. There are two distinct scenarios, and the insurance requirements differ between them.
If both partners earn remote income and qualify for the DNV in their own right, both apply as primary DNV applicants. The insurance rule is identical to the NLV: each partner needs their own individual private health insurance policy and their own individual certificate. Combined cost for a couple both on employed DNV: typically €90–130/month per adult on a standard plan, so approximately €180–260/month combined depending on ages. If either partner is autónomo and registers with Social Security, they can use Social Security at renewal as their own health cover — but only for themselves; their partner still needs private insurance if the partner is not also registered.
If only one partner qualifies for the DNV, the other partner joins as a dependant on the main applicant's visa. This is structurally different from a two-primary-applicant NLV application. However, the insurance requirement is the same: the dependant partner still needs their own separate private health insurance policy and their own individual certificate. There is no provision for the dependant to be covered under the primary holder's policy. Each partner's policy stands alone.
Autónomo DNV note: If the primary DNV holder is autónomo and at renewal uses Social Security as their own cover, the dependant partner still needs a private policy. Social Security coverage is personal — it does not extend to family members who are not themselves registered with the system. The dependant partner's private insurance remains necessary at every renewal.
Best insurer pick for DNV couples: Sanitas is the strongest all-round choice — it offers family-tier pricing when insuring multiple household members, issues individual certificates instantly for both partners, and has English-language support via the BLUA app that works equally well for both of you. Caser is a strong value alternative, especially if dental cover for both partners matters: dental is included as standard at no extra cost on every Caser policy, and combined premiums are typically €15–30/month lower than Sanitas at the same ages. When getting quotes, always provide both partners' details in the same session — multi-policy discounts, where they exist, are applied at the point of quotation, not retrospectively.
Student visa — couples where one partner is a student
Student couples in Spain — where one person is on a student visa and the other accompanies them — face a common but sometimes overlooked insurance situation. The Spanish student visa does not permit family reunification, so the accompanying partner cannot be added to the student's visa as a dependant at the initial stage.
In practice, the two most common structures for student couples are:
The student applies on a student visa; their partner applies on the NLV in their own right. Each has their own visa category, their own insurance requirement, and their own policy. The student needs a student-visa-compliant policy (Sanitas International Students, ASISA, or similar); the NLV partner needs an NLV-compliant policy (Sanitas Residents, Caser Adapta, or similar). These are different plan types — confirm at quotation stage that each plan is compliant for its specific visa category.
If both partners are studying in Spain, both apply on student visas independently. Each needs their own student-visa-compliant insurance policy. The insurance requirements are the same as any other student visa applicant — individual policy, individual certificate. Sanitas International Students issues individual certificates and is accepted by Spanish consulates for the student visa.
In either scenario, the key point is the same as for the NLV and DNV: one partner's policy never covers the other. Each person's policy is assessed and valid only for the named policyholder. If you are a student couple navigating two different visa types, using Sanitas for both is administratively simplest — one insurer, two different plan types, individual certificates for each of you issued quickly and in Spanish.
If we're both on the DNV, do we each need a separate policy?
Yes. Even if both partners hold a DNV in their own right, each needs their own individual private health insurance policy and their own individual Spanish-language certificate. The DNV follows exactly the same insurance rules as the NLV: there is no joint or couples policy format accepted by Spanish consulates. If both are employed remote workers, both need private insurance throughout. If one or both are autónomo and registered with Social Security, that individual can use Social Security at renewal — but only for themselves. Their partner still needs private insurance unless the partner is also separately registered with Social Security.
Does Sanitas offer any discount for couples or families?
Sanitas does offer multi-policy pricing arrangements when multiple household members are insured together — but this is not always advertised as a headline discount. The best way to access any available pricing benefit is to request quotes for both partners simultaneously in the same quotation session, rather than applying for each separately. When using an intermediary like 247expatinsurance.com, make clear that you are looking to insure two people together. Caser similarly offers marginal pricing benefits for multi-policy households in some configurations. The savings are not dramatic, but over 12 months across two policies, even a modest per-policy reduction is worth capturing. Always ask explicitly at quotation stage.
Tell us both of your ages and we'll find the right plan for each partner — with individual certificates in Spanish ready for your consulate appointment.