Compulsory student insurance

• Students entitled to coverage
• Conditions
• Risks covered
• Benefits in the event of a study-related accident
• Benefits in the event of illness
• Benefits in the event of economic hardship
• Compatibility
• Submission of applications
• Applicable regulations
• Official website of the Spanish Social Security Administration (Ministry of Labour and Social Security)

Students entitled to coverage

Compulsory student insurance covers all Spanish students aged 28 or under who are taking the following studies in Spain:

• Years 3 and 4 of compulsory secondary education, and upper secondary education.
• Lower, intermediate, higher and special vocational training.
• Repeat examination for phased out upper secondary courses (COU and BUP).
• Social guarantee programmes.
• Courses at specialised primary and secondary schools that teach music and dance.
• Bachelor’s, master’s and doctoral degrees.
• Higher vocational training in music.
• Higher vocational training in dance.
• Drama courses.
• Theology courses at schools run by the Catholic Church.
• Second year of secondary education courses for adult learners.
• Work placements as part of official university studies.
• Official training programmes for transition to adult life.

Coverage is also extended to students who are nationals of countries belonging to the European Union and the European Economic Area and, in general, all foreign students living in Spain under the same conditions as Spanish students who are taking the aforementioned studies in Spain and are under the age of 28.

If you are not included in these groups or you don't fulfill the conditions to be protected by the compulsory student insurance, please take a look to the range of private insurances at UPC Univers service.

Conditions

• Students must be under the age of 28 at the time of enrolment (they are covered for the remainder of the year in which they reach this age).
• Students must be Spanish nationals or legal residents in Spain.
• Students must be enrolled for studies in Spain included in the list above.
• Students must have paid the corresponding student insurance fee.
• Students must have been enrolled at a school or centre covered by the terms of the insurance for at least one year.

The final requirement does not apply to benefits in the event of accident, economic hardship due to death of the head of household or for obstetric care.

Risks covered

• Study-related accident: A study-related accident shall be defined as any injury suffered by the student during activities directly or indirectly related to his/her studies, including sports activities, meetings and group activities, and travel for academic purposes, as part of a work placement or related to the preparation of a final project/thesis, provided that these activities are organised by the school or centre at which the student is enrolled.
• Economic hardship: Circumstances in the student’s home life that prevent the student continuing with the course of study, including death of the head of the household and family bankruptcy.
• Illness.

Benefits in the event of a study-related accident

In the event of an accident, students will be entitled to the following benefits:

Medical care and pharmaceutical assistance

• Duration:

  - From the occurrence of the accident until date of discharge, certification of medical fitness or certification of disability (if the accident results in total permanent disability or severe disability).
  - From the occurrence of the accident until such time as the student feels capable of returning to the course of study, up to a maximum of one year if the accident results in temporary disability.

• Choice of doctor and healthcare centre:

  - If for practical reasons the student cannot be treated by a public or collaborating doctor or healthcare centre, any costs incurred as a result of the accident will be reimbursed in full.
  If urgent care is provided by a private centre, either because the student is medically unfit to choose a healthcare centre or because of the distance to the nearest public or collaborating centre, the costs incurred will be reimbursed in full.
  - Travel expenses will only be reimbursed in the event of life-threatening emergencies.

• All pharmaceutical costs are covered.
• The following medical care is covered:

  - Hospital admission and surgery.
  - Supply and replacement of any prosthetic and orthopaedic devices required.
  - Rehabilitation treatment.
  - Medical tests required for diagnosis or treatment.

Disability compensation and benefits

• In the event of an accident that results in total permanent disability, compensation of between 150.25 euros and 601.01 euros is awarded for studies already started. The exact sum is proportional to the length of time since enrolment and the loss of capacity to perform professional activities.
• In the event of an accident that results in severe disability and prevents the student performing basic everyday tasks, a lifetime disability benefit of 144.24 euros per year is awarded.

Compensation for bereavement

• In the event of a fatal accident, family members will receive 30.05 euros for burial expenses.
• If the accident occurs outside the family home, a sum of between 30.05 and 120.20 euros will be awarded.
• If the deceased had a dependent spouse, children, direct relatives over the age of 65 or unfit for work, or siblings below the age of majority or with total disability, an additional sum of 300.51 euros will be awarded.

Validity

• Claims for benefits corresponding to study-related accidents must be made within one year of the date of the accident.

Benefits in the event of illness

Benefits in the event of illness include pharmaceutical assistance, compensation for burial expenses in case of death, medical care including hospital admission when required (comprising the services listed below) and preventive medicine.

Medical care

• Duration:

  - Medical care will be provided from the moment notification of the illness is received until the student is cured or until the end of the academic year, if the student has not re-enrolled.
  - Notification of illness should be made by submitting the standard form or any other similar official document.

• Choice of doctor and healthcare centre:

  - If treatment is not provided by a public or collaborating doctor or centre where one is available, the insurance will cover all or part of the expenses incurred, at a standard rate. Any outstanding sum must be paid by the student.
  - If urgent care is provided by a private centre, either because the student is medically unfit to choose a healthcare centre or because of the distance to the nearest public or collaborating centre, the costs incurred will be reimbursed in full.

• Medical care, which includes hospital admission when necessary, comprises general surgery, neuropsychiatry, treatment of pulmonary and osseous tuberculosis, and obstetrics:

• General surgery:

  This includes all specialities except purely aesthetic surgery, and covers accommodation and food, surgical fees, medical care and pharmaceutical assistance, and replacement prostheses (not orthopaedic devices).

  
  

  Hospital expenses from the day of admission to discharge, as well as diagnostic costs prior to surgery.

  Neuropsychiatry:

  This includes inpatient or outpatient treatment of all neuropsychiatric conditions of a severity that affects the student’s ability to continue with the course of study. Psychological development disorders, behavioural and emotional disorders commonly beginning during childhood or adolescence are not covered.

  
  

  Psychotherapy sessions with psychologists are included provided that they are prescribed by a psychiatrist.

  Obstetrics:

  This covers neonatal obstetric visits, medical fees (obstetrician, anaesthetist, nurse and midwife) and hospital expenses (similarly to general surgery).

  
  

  New-born care is not covered.

  Tuberculosis:

  For pulmonary tuberculosis, coverage includes accommodation and food in an appropriate healthcare centre, medical care, minor and major chest surgery and pharmaceutical care.

  
  

  For osseous tuberculosis, coverage includes accommodation and food in an appropriate healthcare centre, medical-surgical treatment and pharmaceutical care.

  
  

  The period of admission or treatment is set at 18 months, which can be extended in 3-month periods up to a maximum of three years (this does not have to be a continuous period).

  
  

  In certain cases, coverage may also include physiotherapy, cobalt therapy, renal replacement therapies, radiotherapy and maxillofacial surgery.

  Physiotherapy:

  This is covered when medically justified in postsurgical treatment or following trauma caused by a study-related accident.

  
  

  Treatment is restricted to 30 sessions, although this number may be exceeded in exceptional cases, subject to approval by the official medical advisor.

  
  

  Payment will be made according to standard rates.

  Chemotherapy, radiotherapy and cobalt therapy:

  Coverage includes treatment sessions, medication, hospital pharmacy expenses, disposable materials, laboratory tests, blood transfusions, radiology and diagnostic tests and the hospital stay.

  
  

  Reimbursement will cover 30% of the total bill submitted, only for the items listed above and up to a maximum of 1,502.53 euros.

  Maxillofacial surgery:

  Includes medical care and pharmaceutical assistance, hospital admission and food.

  
  

  Orthodontic and dental treatments are not covered.

Pharmaceutical benefits

• Coverage applies throughout the period of medical care.
• In the case of hospital admission, all pharmaceutical expenses are covered.
• In the case of outpatient treatment, the reimbursement will cover 70% of the total cost. The remaining 30% is paid by the student.

  In the case of pharmaceuticals prescribed by a public doctor within the Social Security system, the student will only be entitled to the difference between the 40% paid as a beneficiary of Social Security coverage and the 30% payable under the student insurance coverage.



• Medication to which the student is not entitled as a Social Security beneficiary will not be covered.

Benefits in the event of economic hardship

Aim of benefits

• Benefits for economic hardship are intended to ensure that the student can continue with the course of study (including doctoral studies) until its completion, in the event of economic circumstances in the student’s home life that would otherwise prevent the continuation of study.
• Students are entitled to this benefit in the following cases:

  - Death of the head of the household. Both the father and mother can be considered the head of the household, provided that they contribute to the family income.
  - Family bankruptcy. Insufficient regular income to cover the cost of study will not grant entitlement to this benefit.

Amounts

• 86.55 euros for students NOT from large families.
• 103.85 euros for students from general category large families.
• 112.51 euros for students from special category large families.
• 129.82 for students from large families in the category of honour.

Amount

• Students will be entitled to the benefit from the beginning of the month after the circumstances arise.

Payment

• Payments will be made for the number of years remaining on the course of study (excluding repeated years).
• No further payments will be made once the beneficiary has reached the age of 28.

Compatibility

• Compatible with any academic scholarship.

Extensions

• Once entitlement to this benefit has been confirmed, annual checks will be made to monitor any changes in the family's economic situation. The student's academic performance will also be monitored.
• In the event of death of the head of the household, annual family income may not exceed 6,010.12 euros per member of the household. Calculations will take into account all family members living with the student in question and their respective income.

Compatibility

Student insurance benefits are not compatible with any other benefits of the same type to which beneficiaries are also entitled under a Social Security scheme.

In such cases, benefits will be received from the corresponding Social Security scheme and the student insurance will cover any excess.

Submission of applications

Where?

• Requests for benefits can be submitted at any Social Security information office (CAISS) in the province where the student is registered or where the student or the student’s family is resident.
• CAISS affiliated to the corresponding Provincial Office of the National Institute of Social Security (INSS).

Deadlines for submission of requests

• All benefits applicable to study-related accidents: 1 year.
• Healthcare benefits must be requested prior to receiving medical care to ensure entitlement, with the following exception: in the case of emergency treatment duly certified by the attending doctor, requests may be submitted within a period of up to 5 years.
• Financial aid and burial expenses not applicable to study-related accidents: 5 years.
• Economic hardship benefits: 5 years, with a maximum retroactive validity of 3 months.

Documents to be submitted with the request

In all cases:

• National ID card or Libro de Familia (booklet containing family information).
• Foreign students: passport, identity card, residency card or permit.
• For non-university students, a certificate from the school or centre specifying the course of study and specialisation, and confirmation of payment of the student insurance fee.
• For university students, a copy of the enrolment form specifying the course of study and choice of subjects and confirming payment of the student insurance fee.
• Certificate of payment of the student insurance fees for the previous academic year, except in the case of study-related accidents, economic hardship benefits and obstetric treatment (this requirement does not apply to students who, during the previous academic year, were enrolled on a course of studies not covered by student insurance).

Specific documents for each benefit type:

a) Financial aid:

• Compensation for disabilities caused by study-related accidents:

  - Study-related accident report.
  - Medical certificate specifying the evolution of the injuries sustained, the permanent after-effects, and the reduction of the student’s capacity to continue with the course of study.

• Compensation for burial expenses arising from study-related or non-study-related accidents and illness:

  - Accident report (only for study-related accidents).
  - In the event of death due to illness, a medical report indicating that the beneficiary died as a result of the stated illness during the two years following diagnosis and confirming that the student was unable to continue with the course of study from the time of diagnosis to the date of death.
  - Death certificate, in the case of study-related accidents and illness.

• Compensation for economic hardship:

  - Libro de Familia (booklet containing family details) and certificate of large family status, if applicable.
  - Death certificate, in the case of death of the head of the household.
  - Document clearly stating the cause of the family bankruptcy and the date of occurrence, if applicable.
  - In the case of extension of economic hardship benefits, the student’s academic transcript for the previous academic year, to ensure that the student has continued to attend and met the requirements of the course of study, and a statement of household income, to ensure that the limit of 6,010.12 euros per family member is not exceeded.

b) Healthcare benefits:

• In the case of study-related accidents:

  - Accident report, completed in point 4 of the request.
  - Medical certificate confirming unfitness for study.

• In the cases of surgery, obstetrics, neuropsychiatry, pulmonary and osseous tuberculosis:

  - Official medical certificate indicating the name and specialism of the doctor who will provide the medical care, the doctor’s professional licence number, the address of the clinic or healthcare centre, the date of admission and hospital name, if applicable, and the diagnosis, prescribed treatment and estimated time of recovery.
  - The above certificate may be substituted by an emergency treatment report, if applicable.
  - In the case of neuropsychiatry, the psychiatrist must provide a diagnosis using the international DSM-III-R or CIE/10 classifications, giving a brief description of the patient’s current condition, the pharmacological treatment and the psychological therapy indicated and stating whether he/she will be responsible for providing the psychological treatment or whether the student will be referred to a psychologist.

• In the cases of physiotherapy, radiotherapy, cobalt therapy and renal replacement therapy, in addition to the above requirements the student must submit the medical report on which the request is based, which should indicate the number and type of treatment sessions required and the total cost of the treatment.

Benefits must be requested prior to receiving medical care to ensure entitlement, with the exception of benefits for study-related accidents. In the case of emergency treatment duly certified by the attending doctor, requests may be submitted within a period of up to 5 years.

Applicable regulations

• Law of 17 July 1953, establishing the terms of compulsory student insurance for Spanish students (Official State Gazette 18/7).
• Order of 11 August 1953, ratifying the statutes on student insurance (Official State Gazette 28/8).
• Order of 6 June 1956, introducing student insurance benefits for pulmonary tuberculosis (Official State Gazette 18/6).
• Decree of 14 September 1956, extending student insurance coverage to students at intermediate level technical schools (Official State Gazette 13/10).
• Order of 25 March 1958, establishing student insurance benefits for general surgery (Official State Gazette 26/3).
• Order of 12 April 1958, establishing student insurance benefits for neuropsychiatry (Official State Gazette 29/4).
• Order of 2 January 1959, confirming the compatibility of scholarships and economic hardship benefits (Official State Gazette 17/2).
• Order of 22 December 1959, amending articles 7, 85 and 95 of the statutes on student insurance (Official State Gazette 29/12).
• Order of 1 March 1962, establishing the inclusion of post-hospital care in neuropsychiatry treatment under the terms of student insurance (Official State Gazette 16/3).
• Order of 1 March 1962, introducing student insurance benefits for osseous tuberculosis (Official State Gazette 16/3).
• Order of 27 June 1963, abolishing the waiting period applicable to student insurance benefits (Official State Gazette 6/7).
• Order of 27 June 1963, increasing the maximum value of economic hardship benefits to 14,400 pesetas (Official State Gazette 9/7).
• Order of 14 September 1964, establishing the extension of student insurance coverage to students of official upper secondary education in the general and labour-specialisation categories and to students enrolled on official healthcare assistant training courses, and setting the fees for this coverage (Official State Gazette 12/10).
• Order of 21 April 1965, establishing a general extension of student insurance healthcare benefits (introducing coverage for obstetrics, physiotherapy, radiotherapy, cobalt therapy and renal replacement therapy and incorporating coverage of diagnostic costs prior to surgery into existing provisions for general surgery) (Official State Gazette 13/5).
• Royal decree 2078/1971, of 13 August, extending student insurance coverage to students enrolled on official vocational training courses (Official State Gazette 18/9).
• Royal Degree 1633/1985, of 28 August, on the incompatibilities of the student insurance policy and establishing the applicable fee (Official State Gazette 14/9).
• Royal Decree 270/1990, of 16 February, incorporating insurance coverage for students taking university studies leading to a doctoral qualification (Official State Gazette 2/3).
• Resolution of 28 March 1990, by the General Directorate of Social Security Law, on entitlement to student insurance for students enrolled on special vocational training courses (Official State Gazette 6/4).
• Organic Law 1/1990, of 3 October, on the general regulation of the education system (Official State Gazette 4/10).
• Royal Legislative Decree 1/1994, of 20 June, approving the codified text of the general law on social security (Official State Gazette 29/6).
• Law 42/1994, of 30 December, concerning fiscal, administrative and social measures introduced into the revised text of the General Social Security Law (fourth final provision) (Official State Gazette 31/12 - Corr. Err. 16/2).
• Royal Decree 3/1995, of 13 January, on educational matters concerning higher education syllabuses and qualifications in ecclesiastical science. Order of 7 February 1997, concerning regulation of the identity card for foreign residents (Official State Gazette 15/2).
• Organic Law 4/2000, of 11 January, on the rights and freedoms of foreigners in Spain and social integration of foreign residents (Official State Gazette 12/1).
• Organic Law 8/2000, of 22 December, reforming Organic Law 4/2000, of 11 January, on the rights and freedoms of foreigners in Spain and social integration of foreign residents (Official State Gazette 23/12).