What health insurance do the self-employed need in Spain?

None by law once you are registered as autonomo, because your social security contributions give you public healthcare. What the Professional range adds is speed and income protection: private specialists, scans and surgery without the public waiting lists, and a refund of your premium and help at home when illness stops you working. It also adds healthcare after a work or road accident inside the Sanitas network, and a premium you can deduct from your taxable income, up to 500 euros a year per person.

Is private health insurance tax deductible for autonomos?

Yes. An autonomo taxed under direct assessment can deduct health insurance premiums for themselves, their spouse and their children under 25 who live with them as a business expense. The limit is 500 euros a year per person, or 1,500 euros for a person with a recognised disability. The deduction reduces the income your tax is calculated on. Sanitas issues a certificate of premiums paid each January, and your gestor enters it in the annual return.

Do I have to be registered as autonomo before I take out Sanitas Professional?

Yes. The Professional plans are for people registered as self-employed in Spain, and the registration comes first. If you are still applying for a visa from abroad, or have arrived but not yet registered, you take out a plan from the ordinary range and can move to Professional later; ask us when. The Professional premiums and the tax deduction do not apply in the Basque Country; ask us if you live there.

What is Total Protection?

The package of help that comes with both Professional plans for the moment illness stops you working. If you are signed off work or in hospital for more than 72 hours, Sanitas pays you a month's premium, up to three months or 200 euros a year. It also sends a home help for housework and childcare, a taxi to keep you working for the first two weeks, physiotherapy at home, and delivery of your medicines and post. It is included for everyone on the policy and costs nothing extra; the premium refund runs to the age of 75, and the services apply from the day the cover starts.

Does Sanitas Professional cover an accident at work?

Yes. Healthcare after an accident at work, a road accident or an occupational illness is covered inside the Sanitas network on both Professional plans, with no extra payment, no advance and no paperwork. Most health policies exclude these and send you to whichever insurer covers the accident, so it is one of the reasons the range exists.

How much do the Sanitas Professional plans cost?

Sanitas Professional, with no copayments, starts from 81.00 euros a month, and Sanitas Professional Plus, with copayments capped at 360 euros a year, from 51.40 euros. The price depends on your age and where you live, and the calculator on our plans page gives your own figure in a minute.

Can I put my family on a Sanitas Professional policy?

Yes. Your spouse and your children up to and including 26 can join the same policy, with one renewal and one tax certificate. The tax deduction covers your spouse and children under 25 who live with you. A child under three must be on a policy with at least one insured person over two, and a child of three to eighteen can hold their own policy if the policyholder is over eighteen.

Can I use Sanitas Professional for my visa or residency?

For residency paperwork once you are registered as autonomo, yes, because Sanitas Professional has no copayments. For a visa application made from abroad, no, because you cannot be registered as autonomo yet; use a plan from the no-copayment range and move to Professional later, as a new policy. Professional Plus has copayments and does not meet a residency or visa requirement.

What is the difference between Sanitas Professional and Professional Plus?

The cover is the same. Professional has no copayments: you pay the premium and nothing at the clinic. Professional Plus has a lower premium and a copayment from the seventh service in the year. It is 4 euros a service from the seventh to the tenth, 7 from the eleventh to the fifteenth and 10 after that, capped at 360 euros a year. High-frequency services such as a block of physiotherapy carry 12 euros. Both include Total Protection and the accident cover, and both are tax deductible. Dental 21 and accidental death funeral cover up to 5,250 euros are on Professional; Plus has the basic dental cover of 20 services.

What sick pay does an autonomo get from Social Security?

The public temporary incapacity benefit, paid by your mutua. It is 60 per cent of your contribution base from the fourth day to the twentieth and 75 per cent from the twenty-first, for up to a year with a possible six-month extension. You need to be up to date with your contributions and, for an ordinary illness, to have 180 days of contributions in the last five years. An accident at work or an occupational illness is paid at 75 per cent from the day after your sick leave starts. Total Protection sits on top of this, not instead of it.

Are there waiting periods on the Professional plans?

Yes, the ordinary Sanitas ones: three months for a minor operation, six for complex tests and psychology, eight for childbirth, ten for complex treatments such as chemotherapy, hospital admission and major surgery. An accident, or a life-threatening, unexpected illness arising after the start date, is treated at once. If you have held private health insurance with another insurer in Spain for at least a year, Sanitas waives them all except childbirth.

Yes, at two levels. Sanitas Professional includes Sanitas Dental 21: more than 40 dental services at no charge in the Milenium network, including check-ups, hygiene, X-rays and extractions, and up to 21 per cent off other treatment. Professional Plus includes the basic dental cover of 20 services with a €3 dental copayment per procedure. A wider dental plan can be added to either as an option.

What happens to my Sanitas Professional policy if I stop being autonomo?

The policy continues, and Sanitas does not require you to change plan. The tax deduction stops with the activity. If you choose to move to an ordinary Sanitas plan, that is a change of policy, with new waiting periods and a fresh health declaration.

Health Insurance Explained

The Benefits of Sanitas for the Self-Employed in Spain: Total Protection, Accident Cover and the Tax Deduction

Written by Sean Guy, authorised Sanitas agent (agent code 22395) and DGSFP-registered insurance mediator (C0320X5769518Z), Marbella · Reviewed September 2026

Two self-employed workshop owners in aprons standing in their studio in Spain

We offer two Sanitas plans built for the self-employed in Spain, Sanitas Professional with no copayments from €81.00 a month and Sanitas Professional Plus with capped copayments from €51.40. Both give the full Sanitas network, and both carry two things the ordinary plans do not. Total Protection refunds your premium and sends help to the house when illness or a hospital stay stops you working. Healthcare after an accident at work or on the road is covered inside the network. And because you are an autonomo taxed under direct assessment, the premium is a deductible business expense. The limit is €500 a year each for you, your spouse and every child under 25 who lives with you.

Who arranges it: HealthPlan Spain is an authorised Sanitas agent (agent code 22395) in Marbella that arranges Sanitas policies in English, at the same price as buying direct from Sanitas.

This guide explains what being self-employed changes about healthcare in Spain and what the public system already gives you. It then covers how the two Professional benefits work and how to claim them, how the tax deduction is applied, and how to choose between the two plans. The self-employed plans page puts the two plans side by side with your price.

Do autonomos need private health insurance in Spain?

Not by law: once you are registered as autonomo, your social security contributions give you public healthcare. The Professional range adds speed and income protection: private specialists, scans and surgery without public waiting lists, plus a premium refund and help at home when illness stops you working. The premium is tax deductible, up to €500 a year per person.

Tax deduction: up to €500 a year per person, or €1,500 for a person with a recognised disability, for you, your spouse and children under 25 who live with you (Agencia Tributaria).
Total Protection: after more than 72 hours signed off work or in hospital, Sanitas refunds up to three monthly premiums or €200 a year, and sends help to the house.
Public sick pay: 60 per cent of your contribution base from the fourth day to the twentieth and 75 per cent from the twenty-first, paid by your mutua (Seguridad Social).
Headline premiums: Sanitas Professional from €81.00 a month with no copayments, Sanitas Professional Plus from €51.40 with capped copayments.

What being self-employed changes about healthcare in Spain

Registering as autonomo puts you in the special social security regime for the self-employed, the RETA. Your monthly contribution buys you public healthcare on the same footing as an employee: a health centre, a GP, referrals to hospital specialists and free treatment in the public hospitals. Prescriptions are part-paid, with a working contributor paying a share of the price set by income. Your dependants are covered with you. Nothing obliges you to hold private insurance as well; the public versus private healthcare guide explains how the two systems sit together.

What changes is what an illness costs you. An employee who is off sick keeps a salary, at least in part, and the work waits. An autonomo who is off sick has no salary, and the work goes elsewhere. The public system treats you, but it treats you in its own time. A six-week wait for a scan or three months for a knee operation is six weeks or three months of lost income. That is the problem the Professional range is built around: seeing the specialist this week, and being paid something while you cannot work.

The public sick pay for the self-employed is real but thin. Temporary incapacity is paid by your mutua at 60 per cent of your contribution base from the fourth day to the twentieth and 75 per cent from the twenty-first. Your contributions must be up to date and, for an ordinary illness, you need 180 days of contributions in the last five years. The benefit is a percentage of your contribution base, not of your earnings, so if you contribute on a low base it is well below what you actually make. An accident at work or an occupational illness is paid at 75 per cent from the day after your sick leave starts.

What the Professional plans add

Total Protection: your premium refunded and help at home

Total Protection starts when a doctor signs you off work, or you are admitted to hospital, for more than 72 hours. Sanitas then pays you one month's premium, from the third day of the sick leave or the hospital stay. If the sick leave lasts more than two consecutive months, Sanitas pays a further month's premium, and then one for each complete month it goes on. The refund runs for up to three monthly premiums or €200 a year, whichever is reached first, and the benefit applies to the policyholder up to the age of 75. Between claims there is no waiting time after an accident, one month for a different illness and six months for the same one.

The practical help runs alongside the refund, with limits per claim:

A home help for housework such as cleaning, washing, ironing and cooking, and for looking after children under 16 or a dependant with a disability, up to 30 hours a month in two-hour visits.
A taxi to get you to the office, a meeting or a job for the first two weeks, two return journeys a week.
Childcare when you cannot move: the travel costs of a relative coming to look after the children, or of the children going to a relative. Someone to take them to school and back for up to ten days. If it is a child who is immobilised for ten days or more, tutoring at home for up to three hours a day for three months.
Physiotherapy at home for the sessions a doctor prescribes after the accident or illness, up to 20 hours a year.
Delivery of your medicines from the pharmacy and of your post from the office, twice a week for the first two weeks, and help setting up a workstation at home so you can keep working.

It is included for everyone on the policy, it costs nothing extra, and its services apply from the day the cover starts. Outside it are maternity leave, cosmetic treatment, injuries you cause yourself, back pain without scan or X-ray evidence, and headaches, depression and stress. So are an illness you already had when you took out the policy and injuries from professional sport. To use it, tell us as soon as the hospital stay or the sick leave starts: call HealthPlan Spain on (+34) 952 835 600 and we open the claim with Sanitas for you. Have the official sick note, the parte de baja from your health centre or mutua, or the admission report to hand, or send them to us and we start the claim for you. The Total Protection page has the full list.

Accidents at work and on the road

Most health insurance in Spain excludes an accident at work, a road accident and occupational illness. A work accident or occupational illness is handled by your mutua, and a road accident by a motor insurance claim. That means treatment through an insurer you have never dealt with, its own list of clinics, forms, and sometimes paying first and claiming back. On both Professional plans the healthcare after a work or road accident is covered inside the Sanitas network with the rest of your policy. That means the same hospitals, no advance, no extra payment and no paperwork beyond the usual authorisation. You still report a work accident to your mutua, because that is who pays the accident sick pay; Sanitas handles the treatment. An injury from a past accident is declared on the health questionnaire like any other condition. The work and road accident cover page describes the add-on that gives the same cover on the other plans.

On Sanitas Professional, if an accident kills you, the policy pays for the funeral service and for transfer anywhere in Spain to the cemetery or crematorium your family chooses, up to €5,250. The family activates it with one call to us on (+34) 952 835 600, and we arrange it with Sanitas.

The tax deduction: up to €500 a year per person

An autonomo taxed under direct assessment, the ordinary method for most self-employed people, can deduct health insurance premiums as a business expense. The deduction covers the part of the premium for you, your spouse and your children under 25 who live with you. The limit is €500 a year for each person, or €1,500 for a person with a recognised disability. The deduction reduces the profit on which your income tax is calculated, so what it saves you depends on your tax rate. It is written into the income tax law, and it applies to any health insurance you pay, not only to the Professional plans. A partner you are not married to does not count; a spouse counts whether or not they work.

Three things make it work. The policy is in your name and paid by you, from your business account so that your gestor can evidence it. Sanitas issues a certificate of premiums paid in January, which we send to every Professional customer. And your gestor books it as an expense in the quarterly returns and it carries into the annual one. On your own, the premium above €500 is not deductible; at a marginal rate of 30 per cent the €500 is worth €150 a year. A couple with two children under 25 living at home, all on one policy, can deduct up to €2,000 a year, worth €600 at the same rate. Your gestor can tell you in a minute whether you are taxed under direct assessment; a new arrival on a special tax regime should ask before counting on it. We are insurance people, not tax advisers, so the last word on your own return belongs to your gestor.

What the cover itself gives you

Behind the two special benefits and the tax deduction sits the full Sanitas policy. That means GPs and every medical and surgical specialty without a referral, blood tests, X-rays and scans, surgery, chemotherapy and radiotherapy, physiotherapy and psychology. Hospital admission has unlimited days, except a 50-day limit for psychiatric admission. It also means a second opinion from world specialists for a serious illness and emergency assistance abroad on trips of up to 90 days. Dental comes with both, at two levels. Sanitas Professional includes Dental 21, with more than 40 dental services at no charge and up to 21 per cent off other treatment. Professional Plus includes the basic dental cover of 20 services with a €3 dental copayment per procedure. The Sanitas Professional and Sanitas Professional Plus pages list every limit.

The app matters more to an autonomo than to most people, because it turns a half-day at the clinic into ten minutes between jobs. A 24-hour emergency video line with no appointment, specialist video appointments, and prescriptions and results in the app are included from the first day. So are digital physiotherapy exercises corrected on camera and the coaching programmes with a nutritionist, trainer or psychologist by chat or video. The video consultation guide and the Blua digital tools guide cover them.

The waiting periods are the ordinary Sanitas ones: three months for a minor operation, six for complex tests and psychology, eight for childbirth, ten for complex treatments, hospital admission and major surgery. None of them applies to an accident or to a life-threatening, unexpected illness arising after the start date. All except childbirth are waived if you are transferring from another insurer in Spain and have been insured with them for at least a year. The waiver is for customers coming from a different insurer; a change between Sanitas plans starts the Professional waiting periods again. The waiting periods guide has the detail. A condition you already have is declared on the health questionnaire and Sanitas decides how it is treated; the pre-existing conditions guide explains the outcomes.

Professional or Professional Plus

The medical cover is the same; dental differs, as above. The choice is between paying more each month and nothing at the clinic, or paying less each month and a small charge when you go. On Sanitas Professional Plus the first six services in the policy year are free, then €4 a service from the seventh to the tenth, €7 from the eleventh to the fifteenth and €10 after that. The cap is €360 a year per person, and a high-frequency block such as ten physiotherapy sessions carries €12. The copayments guide explains how services are counted.

Choose Professional if you see a doctor most months, if you are covering children, or if you need the policy for residency paperwork, because a consulate or foreigners' office accepts only a plan without copayments.
Choose Professional Plus if you mainly want the surgery, the scans and the specialist when something goes wrong, and are happy to pay a few euros a visit for a lower premium.
Either way Total Protection, the accident cover and the tax deduction are the same; accidental death funeral cover up to €5,250 and Dental 21 are on Sanitas Professional.

Both plans accept the ordinary Sanitas add-ons: a wider dental plan and reimbursement outside the network up to €300,000. The pharmacy add-on refunds half of eligible prescription costs up to €200 per person a year. The income protection add-on pays €60 a day while you are in hospital. To see your own price, compare the plans on our calculator.

If you take on staff, Sanitas Pymes Digital covers companies with 5 to 100 employees, and Sanitas business health insurance starts from 5 insured.

Your family on the same policy

Your spouse and your children up to and including 26 can join the policy, with one renewal and one certificate at the end of the year. A child under three must be on a policy with at least one insured person over two; a child of three to eighteen can hold their own policy if the policyholder is over eighteen. The tax deduction covers your spouse and children under 25 who live with you. Total Protection applies to everyone insured, so a child immobilised for ten days or more gets the home tutoring. The family health insurance guide and the children's health insurance guide cover what a household and a child get on a Sanitas policy.

Visas, residency and the order of events

The order matters. The Professional plans are for people already registered as autonomo, so the registration comes before the policy. If you are applying for a visa from abroad, you cannot be registered yet, and the consulate wants full cover with no copayments, no waiting periods and no cover limit, which means a plan from the ordinary range. Residents Visa is built for that, and the visa health insurance guide explains the requirements. Once you are in Spain and registered, you can move to Professional; ask us when. A change of Sanitas plan is a new policy: the Professional waiting periods start again and Sanitas can ask for a new health questionnaire, as the changing your plan guide explains. For a renewal made in Spain as a registered autonomo, Sanitas Professional qualifies because it has no copayments; Professional Plus does not. The no-copayment plans page lists every plan that qualifies. The Professional premiums and the tax deduction do not apply in the Basque Country; ask us if you live there.

For a digital nomad who works freelance and registers as autonomo in Spain, or anyone else who registers after arriving, the order is the same. The public healthcare comes with the registration, the Professional plan can follow it, and the premium goes on the tax return from that year.

When you stop being self-employed

If you close your activity, take a salaried job or retire, the tax deduction stops with the activity, but the policy continues. Sanitas does not require you to change plan when you stop being self-employed. Moving to an ordinary plan such as Sanitas Mas Salud is a change of policy, with new waiting periods and a fresh health declaration.

How to take it out and how to claim

Register as autonomo with the tax office and social security first; a gestor can do it in a day. The policy needs your registration. Already on a Sanitas plan? We move you to Professional from the first of a month as a new policy; tell us and we will set the date.
Get your price on the self-employed plans page or ring us on 952 835 600 for a quote on both plans.
Apply in your own name and pay the premium yourself, from a personal or a business account. Policies start on the first of a month, and Sanitas Total Protection applies from that day.
Once your policy is activated, Sanitas sends you a text message with the link to the app: your digital card, appointments, reports and the digital tools are there from day one.
When illness or a hospital stay stops you working for more than 72 hours, call us on (+34) 952 835 600. Or send us the sick note from your health centre or mutua, or the admission report, and we start Total Protection for you.
In January, file the Sanitas certificate of premiums paid with your gestor for the annual return.

Official sources

The facts on this page can be checked against these documents and official pages.

Frequently asked questions

What health insurance do the self-employed need in Spain?: None by law once you are registered as autonomo, because your social security contributions give you public healthcare. What the Professional range adds is speed and income protection: private specialists, scans and surgery without the public waiting lists, and a refund of your premium and help at home when illness stops you working. It also adds healthcare after a work or road accident inside the Sanitas network, and a premium you can deduct from your taxable income, up to 500 euros a year per person.
Is private health insurance tax deductible for autonomos?: Yes. An autonomo taxed under direct assessment can deduct health insurance premiums for themselves, their spouse and their children under 25 who live with them as a business expense. The limit is 500 euros a year per person, or 1,500 euros for a person with a recognised disability. The deduction reduces the income your tax is calculated on. Sanitas issues a certificate of premiums paid each January, and your gestor enters it in the annual return.
Do I have to be registered as autonomo before I take out Sanitas Professional?: Yes. The Professional plans are for people registered as self-employed in Spain, and the registration comes first. If you are still applying for a visa from abroad, or have arrived but not yet registered, you take out a plan from the ordinary range and can move to Professional later; ask us when. The Professional premiums and the tax deduction do not apply in the Basque Country; ask us if you live there.
What is Total Protection?: The package of help that comes with both Professional plans for the moment illness stops you working. If you are signed off work or in hospital for more than 72 hours, Sanitas pays you a month's premium, up to three months or 200 euros a year. It also sends a home help for housework and childcare, a taxi to keep you working for the first two weeks, physiotherapy at home, and delivery of your medicines and post. It is included for everyone on the policy and costs nothing extra; the premium refund runs to the age of 75, and the services apply from the day the cover starts.
Does Sanitas Professional cover an accident at work?: Yes. Healthcare after an accident at work, a road accident or an occupational illness is covered inside the Sanitas network on both Professional plans, with no extra payment, no advance and no paperwork. Most health policies exclude these and send you to whichever insurer covers the accident, so it is one of the reasons the range exists.
How much do the Sanitas Professional plans cost?: Sanitas Professional, with no copayments, starts from 81.00 euros a month, and Sanitas Professional Plus, with copayments capped at 360 euros a year, from 51.40 euros. The price depends on your age and where you live, and the calculator on our plans page gives your own figure in a minute.
Can I put my family on a Sanitas Professional policy?: Yes. Your spouse and your children up to and including 26 can join the same policy, with one renewal and one tax certificate. The tax deduction covers your spouse and children under 25 who live with you. A child under three must be on a policy with at least one insured person over two, and a child of three to eighteen can hold their own policy if the policyholder is over eighteen.
Can I use Sanitas Professional for my visa or residency?: For residency paperwork once you are registered as autonomo, yes, because Sanitas Professional has no copayments. For a visa application made from abroad, no, because you cannot be registered as autonomo yet; use a plan from the no-copayment range and move to Professional later, as a new policy. Professional Plus has copayments and does not meet a residency or visa requirement.
What is the difference between Sanitas Professional and Professional Plus?: The cover is the same. Professional has no copayments: you pay the premium and nothing at the clinic. Professional Plus has a lower premium and a copayment from the seventh service in the year. It is 4 euros a service from the seventh to the tenth, 7 from the eleventh to the fifteenth and 10 after that, capped at 360 euros a year. High-frequency services such as a block of physiotherapy carry 12 euros. Both include Total Protection and the accident cover, and both are tax deductible. Dental 21 and accidental death funeral cover up to 5,250 euros are on Professional; Plus has the basic dental cover of 20 services.
What sick pay does an autonomo get from Social Security?: The public temporary incapacity benefit, paid by your mutua. It is 60 per cent of your contribution base from the fourth day to the twentieth and 75 per cent from the twenty-first, for up to a year with a possible six-month extension. You need to be up to date with your contributions and, for an ordinary illness, to have 180 days of contributions in the last five years. An accident at work or an occupational illness is paid at 75 per cent from the day after your sick leave starts. Total Protection sits on top of this, not instead of it.
Are there waiting periods on the Professional plans?: Yes, the ordinary Sanitas ones: three months for a minor operation, six for complex tests and psychology, eight for childbirth, ten for complex treatments such as chemotherapy, hospital admission and major surgery. An accident, or a life-threatening, unexpected illness arising after the start date, is treated at once. If you have held private health insurance with another insurer in Spain for at least a year, Sanitas waives them all except childbirth.
Is dental included?: Yes, at two levels. Sanitas Professional includes Sanitas Dental 21: more than 40 dental services at no charge in the Milenium network, including check-ups, hygiene, X-rays and extractions, and up to 21 per cent off other treatment. Professional Plus includes the basic dental cover of 20 services with a €3 dental copayment per procedure. A wider dental plan can be added to either as an option.
What happens to my Sanitas Professional policy if I stop being autonomo?: The policy continues, and Sanitas does not require you to change plan. The tax deduction stops with the activity. If you choose to move to an ordinary Sanitas plan, that is a change of policy, with new waiting periods and a fresh health declaration.

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