Step 1 — Understand what the consulate actually requires
Before choosing an insurer or getting a quote, understand exactly what makes a policy acceptable to Spanish consulates. The Non-Lucrative Visa (NLV) requires private health insurance that meets all of the following:
- No copayments, deductibles, or co-insurance — the policy must confirm zero out-of-pocket costs at point of care. Any policy with a "ticket moderador" or franchise is not compliant.
- No waiting periods — coverage must begin from day one of the policy start date. No exclusion periods for general medicine, specialist care, or emergency treatment.
- Full Spanish territory — mainland Spain plus the Canary Islands, Balearic Islands, Ceuta, and Melilla. Regional-only coverage is not sufficient.
- Repatriation cover — medical repatriation to your home country if you become seriously ill must be explicitly included.
- Certificate in Spanish — the confirmation document must be in Spanish and specifically state that all the above conditions are met. English-language documents or standard policy schedules are not accepted.
- Minimum 12 months' coverage — the policy period must run for at least one year from the start date.
- Private insurer — public health entitlement (NHS, GHIC, social security) does not satisfy this requirement. It must be a private insurance policy.
Six mainstream insurers in Spain consistently meet all of these requirements. Sticking to this shortlist is the safest approach.
Step 2 — Choose your insurer
The right insurer depends on your age, health history, budget, and which consulate you are applying through. The key selection guide:
- Sanitas — best overall for most applicants. Premium-priced but instant certificate, widest network, accepts pre-existing conditions on the Residents plan, and accepts new applicants up to age 80. The default recommendation for over-60s, anyone with a health history, and US/Australian/Canadian consulate applicants. From €67.76/month.
- Caser — best value for healthy applicants under 69. Dental included. Strong acceptance at UK and EU consulates. Available via 247expatinsurance.com. From approximately €55/month.
- ASSSA — best for applicants over 70 and US consulate applications at any age. Expat specialist with English-speaking team. Accepts new applicants at 75+. From approximately €55/month.
- Adeslas — largest provider network (44,000+) but requires a 36-month tied contract. Consider carefully before choosing. From approximately €50/month.
- DKV — solid mid-range option. Maximum entry age 65. From approximately €60–80/month.
- ASISA — large hospital network, competitive mid-range pricing. From approximately €55/month.
If you are unsure, use the quote form on this site and we will match you to the most suitable insurer based on your specific profile.
Step 3 — Get a quote
Once you have identified your preferred insurer (or shortlist), get a personalised quote. Quotes are based on your age and coverage tier — not on your health history, which is assessed separately in the health declaration.
You can get a quote via:
- This site's quote form — we compare across insurers and can advise on the best match for your situation.
- Direct to Sanitas — online quote tool available on the Sanitas website.
- Via 247expatinsurance.com — recommended route for Caser, ASSSA, and other insurers.
The quote takes a few minutes and gives you the exact premium before you commit to anything.
Step 4 — Fill in the health declaration honestly
All insurers require a health declaration before they issue a policy. This asks you to disclose existing medical conditions, recent treatment, and medication. Answer honestly — this is critical for two reasons:
- Insurer assessment — the insurer uses this to decide whether to accept your application and whether any conditions will be excluded from coverage. Sanitas has the most flexible approach to pre-existing conditions; others may apply exclusions.
- Validity of your certificate — if you misrepresent your health and the insurer later discovers this, the policy can be voided, which could also invalidate your visa.
For most healthy applicants the declaration is straightforward. For those with medical histories, Sanitas is typically the best route as they assess each case individually rather than applying blanket exclusions.
Step 5 — Choose your policy start date carefully
The policy start date must be on or before your planned travel date to Spain — not simply before your consulate appointment. This is a common point of confusion.
- The consulate checks that the policy covers you from the point you will be residing in Spain — which is when you arrive, not when you apply for the visa.
- Sanitas allows you to set a start date up to 6 months in advance, which means you can arrange coverage well ahead of your consulate appointment and travel plans.
- Other insurers typically allow 1–3 months' advance start dates — check the specific insurer's terms when applying.
- Do not choose a start date after your planned travel date. This is one of the most common reasons certificates are flagged at consulates.
Step 6 — Pay and activate your policy
Most Spanish health insurers require upfront payment — annual or semi-annual. Monthly direct debit is less common and not always available for new visa applicants.
- Annual payment — most common. Pay for a full year upfront. This is the standard approach and ensures your coverage is confirmed for the full 12 months the consulate requires.
- Semi-annual — available from some insurers. Two payments across the year.
- Monthly direct debit — sometimes available but less common. If paying monthly, ensure the annual coverage period is confirmed on the certificate regardless.
Once payment is processed, the policy is activated and you can request your visa certificate.
Step 7 — Request your visa certificate
This step is where many applicants make a critical mistake. You must specifically request the visa certificate — it is not automatically sent with your policy documents.
Ask for the "carta/certificado para visado de residencia no lucrativa" — not the standard welcome pack. The certificate wording is different and specifically designed to satisfy consulate requirements. A standard policy schedule or welcome letter will not be accepted by the consulate.
- Sanitas — instant certificate issued by email upon policy activation. No need to wait or chase.
- Caser, ASSSA, DKV, Adeslas, ASISA — typically 1–3 working days after policy activation. Contact them or your broker and ask specifically for the "carta para visado de residencia no lucrativa".
Step 8 — Check the certificate before you submit
Once you receive the certificate, check each of the following before including it in your visa application:
- Your full name — matches your passport exactly.
- Policy start date — on or before your planned travel date.
- Policy end date — at least 12 months after the start date.
- Full Spain coverage — should reference "todo el territorio nacional" or equivalent.
- No copayments stated — look for "sin copago", "sin franquicia", "sin coseguro" or equivalent language.
- Repatriation — explicitly mentioned on the certificate.
- Insurer stamp or digital signature — the certificate must be officially issued, not a self-printed document.
- In Spanish — the certificate must be in Spanish. English translations are supplementary, not a replacement.
If anything is missing or unclear, contact your insurer before your appointment — do not assume the consulate will overlook it.
Step 9 — Submit with your visa application
The health insurance certificate is one of the required documents in your NLV application package. Include the original certificate (or certified copy, depending on consulate instructions). Keep a copy for your records.
Some consulates ask for the certificate to be apostilled or notarised — check the specific requirements of your consulate before your appointment, as requirements can vary by location.
Common mistakes to avoid
| Mistake | Why it matters | How to avoid it |
|---|---|---|
| Policy with copayments | Any copay, deductible, or franchise disqualifies the policy outright | Check the policy terms — and check the certificate explicitly says "sin copago" |
| Using travel insurance | Travel insurance does not meet any of the NLV criteria | Use only the 6 mainstream Spanish residency health insurers |
| Standard policy schedule submitted | Consulates require the specific visa certificate, not the policy document | Ask specifically for the "carta para visado de residencia no lucrativa" |
| Start date after travel date | The policy must cover you from the point you arrive in Spain | Set the start date on or before your planned travel date |
| Certificate in English only | Spanish consulates require the certificate in Spanish | All 6 mainstream insurers issue certificates in Spanish — request it explicitly |
| Not allowing enough time | Certificate issuance takes 1–3 days for most insurers | Apply for insurance at least 1 week before your consulate appointment |
Frequently asked questions
You need a private Spanish health insurance policy with no copayments, no waiting periods, full Spain territorial coverage, repatriation cover, and a minimum 12 months' duration. The policy must be with a Spanish-authorised private insurer and the certificate confirming these conditions must be issued in Spanish.
You must specifically request a "carta para visado de residencia no lucrativa" — not the standard welcome pack or policy schedule. Sanitas issues this instantly upon policy activation. Other insurers typically take 1–3 working days. Always check the certificate confirms your name, policy dates, full Spain coverage, no copayments, and repatriation cover.
Sanitas allows you to set a policy start date up to 6 months in advance, which means you can arrange your insurance well before your consulate appointment is confirmed. The policy start date must be on or before your planned travel date — not the date of your appointment.
Sanitas is the best overall choice for most applicants — particularly over-60s, anyone with a health history, and US/Australian/Canadian consulate applicants. Caser is the best value option for healthy applicants under 69 applying via EU or UK consulates. ASSSA is the best option for applicants over 70 and US consulate applications at any age.
The most common mistakes are: buying a policy with copayments (ticket moderador), using travel insurance or foreign insurance, getting the standard policy schedule instead of the visa certificate, starting the policy after the planned travel date, forgetting to request the certificate in Spanish, and not allowing enough time before the consulate appointment.
Most visa-compliant insurers will refund your premium if your visa is refused, provided you notify them promptly and within their stated cancellation window. Keep a copy of any refusal documentation and contact your insurer immediately. Sanitas and Caser both offer refunds on unused premium following a confirmed visa refusal.
The certificate must be valid at the time of your consulate appointment. The policy start date should be on or before your planned date of entry to Spain. Some consulates accept near-future start dates; others require the policy to already be in force. If in doubt, start the policy before your appointment date rather than after.
No — the insurer must be authorised to operate in Spain. Foreign insurers, even well-known international ones, are not accepted for Spanish visa purposes. Travel insurance is also not accepted. The policy must be from a Spanish-authorised private health insurer — the six main accepted options are Sanitas, Adeslas, Caser, DKV, ASSSA, and ASISA.
How to get health insurance for the Digital Nomad Visa
The process for getting health insurance for the DNV is very similar to the NLV, but with one important preliminary decision: are you applying as an employed person or as an autónomo (self-employed)? This determines what you need to buy and what options will be available to you at renewal.
Step-by-step: getting DNV health insurance
- Decide: employed or autónomo? If you receive a salary from an employer, you are employed. If you invoice clients as a freelancer, you are autónomo. This affects your long-term insurance options — but for the initial application, both need private insurance.
- Choose your insurer — For employed DNV holders or anyone prioritising speed: Sanitas (instant certificate, accepted everywhere). For best value: Caser Adapta. For dental as standard: Caser or DKV España.
- Get a quote for a future start date — Set the policy start date to coincide with your planned travel date, or earlier to match the date stated in your consulate booking. You do not need to be in Spain yet.
- Purchase the policy and receive your certificate — Sanitas issues instantly. Caser within 1–2 days. ASISA and DKV within 1–2 days. ASSSA 2–3 days. Ensure the certificate is in Spanish and states "sin copagos, sin carencias, sin franquicia."
- Include the certificate in your DNV consulate pack — Along with your employment contract or client invoices (income evidence), passport, criminal record certificate, and other required documents. Check your specific consulate's document list carefully.
- If autónomo — plan for renewal — Once you arrive in Spain and register as autónomo, your Social Security contributions will satisfy the insurance requirement at your first renewal. You may also want to arrange a private top-up at that point. You do not need to register as autónomo before your initial application.
You cannot register as autónomo without an NIE number, and you cannot get an NIE until after your visa is approved. For your initial DNV application, private health insurance is mandatory for everyone — there is no autónomo exemption at this stage. Plan for a private policy covering at least 12 months from your intended travel date.
How to get health insurance for the student visa
Getting health insurance for the Spanish student visa follows the same basic process as the NLV, but with a few important considerations specific to students: policy duration, consulate variation on copayments, and whether your university or language school provides insurance.
Step-by-step: getting student visa health insurance
- Check your consulate's specific student visa requirements — Consulate practice for student visas varies more than for the NLV. Some accept copayment plans; some require the same strict no-copay standard as the NLV. Find your consulate's student visa document checklist before purchasing insurance.
- Confirm your course duration — If your course is shorter than 12 months, most consulates will accept a policy that matches the course dates. This is cheaper than buying a full annual policy. If your course is 12 months or longer, a standard annual policy is the norm.
- Check if your university or school provides insurance — Some Spanish universities and language schools arrange health insurance for international students. If they do, obtain the certificate and check whether it meets your consulate's specific requirements. Do not assume it does — verify directly with the consulate or an adviser.
- Choose your insurer and get a quote — ASISA and Caser Adapta are typically the cheapest for 18–25 year-olds. Sanitas is the safest choice for US consulate applicants or if you are uncertain about consulate standards. Set the start date to match your study start date or earlier.
- Purchase the policy and receive the certificate in Spanish — Ensure the certificate covers your full course period. Include it in your student visa application pack alongside your university enrolment letter, accommodation proof, and financial evidence.
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