Plain English summary: A copayment (or copago in Spanish) is a small fee you pay each time you use your health insurance — for example, €5 every time you see a GP. A no copayment (sin copago) policy means you pay nothing per visit or treatment. Your monthly premium covers everything included in the policy. For the Spanish Non-Lucrative Visa, a no-copayment policy is not optional — it is a requirement.
What Is a Copayment?
In Spanish health insurance, a copayment (copago) is a small charge applied each time you access a covered service. It is separate from your monthly premium — you pay the premium to keep the policy active, and then you also pay a small fee each time you actually use it.
Typical copayments in Spanish health insurance look like this:
- GP consultation: €2–€8
- Specialist appointment: €5–€20
- Diagnostic tests (blood test, X-ray): €3–€15
- Accident and emergency attendance: €10–€30 on some policies
- Physiotherapy sessions: €5–€15 per session
Individually, these amounts are not huge. But if you are attending regular appointments — as someone managing a health condition might — they can add up quickly across a year. And for NLV purposes, they disqualify the policy entirely.
Copayment vs No Copayment — Side by Side
With Copayment (Con Copago)
No Copayment (Sin Copago)
Monthly premiumLower
GP visit charge€3–€8 each time
Specialist charge€5–€20 each time
Blood test charge€3–€10 each time
NLV compliant?✗ No
Suitable for visa?✗ No
Monthly premiumSlightly higher
GP visit charge€0 — nothing
Specialist charge€0 — nothing
Blood test charge€0 — nothing
NLV compliant?✓ Yes
Suitable for visa?✓ Yes
The Real Cost Difference — Is Sin Copago Worth It?
The natural question is: if no-copayment policies have a higher monthly premium, do they actually work out better value? The honest answer is: it depends on how much you use your insurance — and the NLV makes the question irrelevant anyway.
Example: cost comparison over a year
Hypothetical comparison for a 50-year-old. Illustrative figures only.
Monthly premium (copayment policy)€95/month
Monthly premium (no-copayment policy)€125/month
Annual premium difference+€360
12× GP visits × €6 copayment+€72
6× specialist visits × €15+€90
4× blood tests × €8+€32
Actual annual cost of "cheaper" copay policyPremium + €194 extra
Actual annual cost of sin copago policyPremium only — no extras
The point is that the "cheaper" copayment policy is often not as cheap in practice as it appears on the surface. Once you factor in the per-use charges, the gap narrows significantly — and the sin copago policy offers predictability. You always know your annual cost.
For NLV applicants: The comparison above is actually irrelevant to your decision — the NLV requires a no-copayment policy regardless. But it's reassuring to know that sin copago isn't just a visa requirement tick-box — it's often genuinely good value for anyone who uses their insurance regularly.
Why the NLV Requires No Copayment
The Spanish government's position is that NLV holders should have genuine, comprehensive access to healthcare without financial barriers. A copayment policy creates a per-use charge that could, in theory, deter someone from seeking care they need — which undermines the purpose of mandatory health insurance for visa holders.
A sin copago policy means that from the consulate's perspective, the visa holder has full, unrestricted access to healthcare. There is no disincentive to see a GP or specialist. This is what the requirement is designed to ensure.
Common mistake: Some expats buy a standard Spanish health insurance policy — often recommended by their Spanish bank or estate agent — without checking whether it has copayments. They submit it with their NLV application and only discover the problem when the consulate queries the certificate. Always check before you buy.
Our recommended sin copago policy
no-copayment health insurance — No Copayments, No Surprises
No-copayment health insurance is most commonly recommended to NLV applicants precisely because it is sin copago as standard. Every GP visit, specialist appointment, diagnostic test, and hospital treatment is covered without any per-use charge. Your monthly premium is your only regular cost.
- No copayments on any covered service — GP, specialist, diagnostics, A&E, hospital
- No waiting periods — cover starts from day one
- DGSFP-registered — accepted at Spanish consulates internationally
- Policy certificate explicitly confirms sin copago and sin período de carencia
- Extensive leading Spanish health insurers clinic and hospital network throughout Spain
- English-language support and documentation available
- Multiple product tiers: Residents (standard), Residents Plus (enhanced), Residents Platinum (worldwide cover)
- Annual renewal — suitable for ongoing visa renewals
Other Insurers Offering Sin Copago Policies
Other no-copayment policies are available and no-copayment products that can meet NLV requirements. The key, as always, is choosing the right product within each insurer's range — not every policy they sell is sin copago.
At 247 Expat Insurance, we compare sin copago options across the main insurers and confirm which policy is right for your specific situation, consulate, and budget. We advise in English and are available seven days a week.
Frequently Asked Questions
What does no copayment mean in Spanish health insurance?
No copayment (sin copago) means you are not charged a fee each time you visit a GP, specialist, or use a diagnostic service. The insurer covers the full cost of all included treatments. You pay your monthly premium and nothing more when you actually use the policy.
What is the difference between copayment and no copayment health insurance?
With a copayment policy, you pay a small charge each time you use the service — typically €2–€10 for a GP visit and €5–€20 for a specialist. With a no-copayment policy (sin copago), there is no per-use charge. The monthly premium is slightly higher, but you pay nothing when you access care.
Does the NLV require no copayment health insurance?
Yes. The Spanish Non-Lucrative Visa requires health insurance with no copayments (sin copago). A policy that charges you per visit or per treatment does not meet the requirement and can result in a rejected application.
Do qualifying policies offer no copayment cover?
Yes. Qualifying policies are sin copago policies designed specifically for foreign residents in Spain. You pay nothing per GP visit, specialist appointment, or diagnostic test. The policy is NLV-compliant and one of the most widely used options among British, American, and other international expats.
What is the Spanish term for no copayment?
The Spanish term is sin copago, meaning "without copayment". When reviewing Spanish-language policy documents or speaking to an insurer in Spanish, this is the phrase to look for. The NLV requirement is for a policy that is sin copago.
Is a no copayment policy more expensive than a copayment policy?
The monthly premium is usually somewhat higher, but the overall annual cost difference is often smaller than people expect once you factor in the per-use charges you avoid. And in any case, the NLV makes this comparison irrelevant — a copayment policy is not an option for the visa requirement.
