Information on prior authorisation

A citizen seeking healthcare in another Member State of the EU will have to pay for the healthcare in advance and will be entitled to reimbursement by his/her regional authority, the National Institute for Healthcare Management or mutual society for civil servants, as appropriate, upon returning to Spain, provided that the healthcare provided is included in the National Health System's Common Portfolio of Services.

In some cases, a citizen seeking healthcare in another Member State will have to request the competent authority of the regional authority where he/she resides, the National Institute for Healthcare Management or the mutual society of civil servants, as appropriate, for prior authorisation so the costs may be subsequently reimbursed.

Prior authorisation is necessary where:

1. Hospital accomodation for at least one night is required.
2. Regardless of the provisions set out in point 1, any of the following procedures, techniques and technologies included in the healthcare services portfolio of the National Health System, which have been selected due to requiring the use of highly specialized and costly medical equipment or medical infrastructure:
   a) Angiography, catheterization or interventional cardiology laboratories, magnetic resonance imaging, computed axial tomography, single-photon emission computed tomography and positron emission tomography, as well as any combination of the above.
   b) Radiotherapy, including radiosurgery.
   c) Medical robotic systems.
   d) Assisted human reproduction, as well as the cryopreservation of gametes and pre-embryos, preimplantation diagnosis and therapeutic techniques applied to the pre-embryo.
   e) Advanced therapy medicinal products.
   f) Human genetic studies.
   g) Performance of diagnostic and therapeutic procedures for conditions for which reference services have been designated, in accordance with Royal Decree 1302/2006 of 10 November, which establishes the foundations of the procedure for the designation and accreditation of reference centres, services and units of the National Health System.

Health benefits subject to prior authorisation

Prior authorisation has to be requested by completing the specific form available for downloading on the websites of the competent health authorities, regional authorities and mutual societies.

A reasoned resolution will be issued within 45 days either granting or rejecting authorisation and notice thereof will be given to the interested party. The appropriate appeals and complaints may be lodged against such resolution.

Reasons for refusal to grant prior authorisation

Health authorities may refuse to grant authorisation if the treatment or the service provider can pose a risk to the patient. Authorisation may also be refused if appropriate healthcare can be provided in Spain within a reasonable time limit that can be justified on medical grounds.