Sin Copago Explained
No Co-Pay Health Insurance for Spain's NLV — Why Sin Copago Matters
The no co-payment (sin copago) rule is the most frequently misunderstood health insurance requirement for Spain's Non-Lucrative Visa. Many applicants buy a policy that looks comprehensive — then get rejected because of a small copago buried in the terms. This guide explains exactly what sin copago means, how to spot a non-compliant policy, and how to get it right.
The Basics
What Is a Co-Payment (Copago) in Spanish Health Insurance?
In the Spanish private health insurance market, a copago is a fixed fee charged to the patient each time they use a medical service. The insurer pays the bulk of the cost; the patient contributes a smaller fixed amount at the point of care. This is an entirely normal feature of many private health plans in Spain — but it is categorically incompatible with the Non-Lucrative Visa.
Typical copago amounts in the Spanish private health market look like this:
- GP consultation: €5–€12 per visit
- Specialist consultation: €12–€25 per visit
- Emergency A&E attendance: €15–€30 per episode
- Diagnostic tests (blood tests, X-rays): €5–€15 per test
- Prescriptions: €2–€5 per item
These amounts seem small — and in everyday use they are. But for the purposes of the Non-Lucrative Visa, any co-payment, however modest, disqualifies the policy. The Spanish immigration system requires that your health insurance provides complete cover with zero patient contribution at the point of use.
Quick Definition
Copago: A fixed patient payment per medical visit or service. Common in Spanish private health insurance.
Sin copago: Without any co-payment. Zero cost to the patient at the point of use for all covered services. This is what the NLV requires.
Why it matters: Even a €2 copago disqualifies your policy. The consulate rejects applications where the insurance certificate shows any patient contribution.
The Requirement Explained
Why Does Spain Require Sin Copago for the NLV?
The sin copago requirement is not arbitrary bureaucracy. It reflects the underlying philosophy of the Non-Lucrative Visa — that applicants must be fully self-sufficient and not a financial burden on Spain in any respect, including healthcare.
The Spanish immigration authorities take a clear position: if your health insurance involves a patient contribution at the point of care, there is a theoretical risk that you might avoid or delay seeking medical treatment because of cost. This is exactly what the visa is designed to prevent. A sin copago policy ensures that financial considerations will never prevent you from accessing healthcare — and by extension, that you will never need to fall back on the Spanish public health system.
This is a stricter standard than most international expat health insurance policies. Many highly regarded international providers — Cigna, Bupa Global, Allianz Care, and others — offer plans with co-payment options as a cost-saving feature. These plans can be excellent for expats in many countries. But for Spain's NLV, they are disqualifying.
The consequence is that many applicants who research health insurance independently, compare policies online, and select what appears to be a comprehensive, reputable plan end up with a co-pay policy that gets their application rejected. This is avoidable — but only if you know to look for it in advance.
Red Flags
How to Spot a Co-Pay Policy Before It's Too Late
If you are reviewing a health insurance policy or certificate yourself, these are the key terms and phrases to look for. Any of these indicate a co-payment exists — and that the policy will not be accepted for the NLV.
Terms That Mean You Pay at the Point of Use
- Copago — the most direct term; means co-payment
- Copago por visita — co-payment per visit
- Franquicia — excess/deductible; a threshold you pay before cover kicks in
- Participación del asegurado — patient's contribution to the cost
- Ticket moderador — "moderating fee" — another term for co-payment
- Coaseguro — co-insurance; you pay a percentage of each claim
What a Compliant Certificate Should Say
- "Póliza sin copago" — policy without co-payment
- "Sin participación del asegurado" — no patient contribution
- Participación del asegurado: €0
- Copago por visita: €0 or N/A
- Explicit statement that all covered services are provided sin coste adicional para el asegurado (without additional cost to the insured)
If Your Certificate Is Silent on Copago
If your insurance certificate does not explicitly address co-payments either way, do not assume you are covered. Contact your insurer and request a supplementary letter in Spanish explicitly confirming the policy is sin copago (without co-payment). Consulates expect to see this confirmed — ambiguity is treated as disqualifying.
What You Get
What a Sin Copago Policy Covers
A properly structured sin copago health insurance policy provides comprehensive medical cover with no charges whatsoever at the point of use. Here is what a quality sin copago policy covers — and what you should expect to access freely in Spain.
GP Consultations
Unlimited GP visits included at zero cost per consultation. You see a doctor, you leave without paying — your insurer covers the full fee directly. This covers both routine check-ups and illness consultations.
Specialist Consultations
Referrals to specialists — cardiologists, dermatologists, orthopaedic surgeons, gynaecologists, and others — are covered at zero cost to you. With sin copago, the specialist fee is paid entirely by your insurer.
Diagnostic Tests
Blood tests, urine analysis, X-rays, ultrasounds, CT scans, MRI scans — all covered without additional patient cost. This is where copago policies become expensive; sin copago policies cover diagnostics in full.
A&E Attendance
Emergency department attendance is covered with no copago. Some policies do impose a copago specifically for A&E — this makes them non-compliant. Your sin copago policy must cover emergency attendance at zero cost.
Hospitalisation & Surgery
Inpatient care, surgical procedures, anaesthesia, and post-operative care are all fully covered. This is the high-value protection a sin copago policy provides — no surprise bills after a hospital stay.
Emergency Ambulance
Emergency ambulance transport is typically included within sin copago policies. Check your specific policy terms to confirm, as coverage details vary by insurer and plan level.
Note: Maternity cover, dental, and optical are often available as add-ons. Check your specific policy for inclusions. The six categories above represent the core NLV compliance requirements.
Budgeting
What Does Sin Copago Insurance Cost?
Sin copago policies are slightly more expensive than equivalent policies with co-payments, because the insurer absorbs 100% of the cost of each medical interaction rather than sharing it with you. That said, the price difference is typically modest — and the consequences of getting this wrong are far more costly.
Typical Monthly Premiums
- Age 30–39: approximately €80–€110/month
- Age 40–49: approximately €95–€130/month
- Age 50–59: approximately €110–€155/month
- Age 60–69: approximately €140–€180/month
- Age 70+: approximately €170–€220+/month
Indicative figures. Actual premiums depend on the insurer, plan level, pre-existing conditions, and location.
The Cost of Getting It Wrong
Buying a copago policy and having your NLV application rejected costs you:
- Your consulate visa fee (non-refundable)
- 3–6 months of delay to your Spain plans
- Cost of a second insurance policy (correct this time)
- Potential re-submission costs and additional document preparation
Getting the right policy the first time is always cheaper.
Common Questions
Sin Copago Insurance — FAQ
What is a copago in Spanish health insurance?
A copago (co-payment) is a fixed fee charged to the patient each time they use a medical service — for example, €5–€15 per GP visit or €15–€25 per specialist consultation. It is common in Spanish private health insurance as a cost-sharing mechanism between insurer and patient. However, the Non-Lucrative Visa specifically requires that your policy has zero co-payments — sin copago — meaning you pay nothing at the point of use.
Why must NLV insurance have no copago?
The Spanish immigration authorities require sin copago insurance to demonstrate that you have genuine, comprehensive health cover with no financial barriers to accessing medical care. A policy with co-payments could theoretically deter you from seeking treatment due to cost — which runs counter to the visa's requirement that you be fully self-sufficient and not reliant on the Spanish public health system. Sin copago means every covered medical visit and treatment is 100% covered with no out-of-pocket cost to you.
How do I check if my health insurance policy has copago?
Review your policy documents and certificate for any of these terms: 'copago', 'copago por visita', 'franquicia', 'participación del asegurado', or 'ticket moderador'. If any of these appear with a monetary value, your policy has a co-payment and will not be accepted. A compliant sin copago policy will either explicitly state "sin copago" or show zero (€0) for all patient contribution fields.
Can I get a refund if I bought the wrong insurance for the NLV?
Insurance refund policies vary by provider and country of purchase. Most EU insurers offer a cooling-off period of 14 days during which you can cancel and receive a full refund. If you discover your policy has copago within this window, cancel and switch to a compliant policy immediately. Our case managers review insurance documentation as part of our managed NLV service, catching issues like this before they reach the consulate.
Are policies with a small or partial copago allowed for the NLV?
No — there is no partial exception. The sin copago requirement is absolute. Even a €2 copago per visit disqualifies a policy from NLV use. There is no minimum threshold below which a small copago becomes acceptable. If your policy has any patient co-payment for any service, it will be rejected by the consulate. The only acceptable standard is zero patient contribution at the point of use.
What Spanish phrase should my certificate say to confirm sin copago?
The clearest language is "póliza sin copago" (policy without co-payment) or "sin participación del asegurado" (no patient contribution). Your certificate may also show "Copago: €0" or "Participación del asegurado: €0" in a schedule of patient charges. If your certificate does not address co-payments at all, ask your insurer to issue a supplementary letter in Spanish explicitly confirming the policy is sin copago.
How much does sin copago insurance cost for the NLV?
A sin copago private health insurance policy for Spain typically costs between €80 and €180 per person per month, depending on your age and the level of cover. Younger applicants in their 30s and 40s generally pay €80–€130/month; applicants in their 50s and 60s typically pay €110–€180/month. These are ongoing costs for the duration of your residency in Spain. Our insurance partner at spanish-healthinsurance.com can provide personalised quotes.
Which insurers offer sin copago policies for the NLV?
Several licensed Spanish insurers offer sin copago policies that are appropriate for NLV applicants — including Adeslas, Asisa, Sanitas, and DKV, among others. The key is to request the specific sin copago product from the insurer, as most providers offer both copago and sin copago versions of their policies. Our insurance partner at spanish-healthinsurance.com specialises in NLV-compliant policies and can guide you to the right option.
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→Official Requirements
Health Insurance Requirement — Full Detail
The official requirement in full detail, with consulate-specific notes and a document checklist.
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