Gibraltar has a two-tier system of health insurance which is comprised of a national health insurance scheme, the Group Practice Medical Scheme (GPMS), and private cover. Overall, healthcare in Gibraltar is of a high standard. However, because the country only has one public hospital, and because you might find yourself having to seek treatment in neighbouring Spain or even be repatriated in the case of a serious illness, many expats choose to take out private health cover for additional peace of mind.We will take a look below at how to keep your health insurance costs in Gibraltar as low as possible if you do opt for private cover, and how to personalize your cover so that you’re not facing high premiums.
Personalising Your Health Insurance Cover
The GPMS covers a range of basic primary care treatment, maternity care, mental health care and emergency treatment. You may have to co-pay some prescription costs, but there is a cap on prescription charges.
St. Bernard’s Hospital has both out-patient and in-patient treatment for acute medical and surgical cases. The hospital also contains a maternity unit, a paediatric ward, surgical wards, medical wards, a critical care unit, operating theatres, radiology, pathology and rehabilitation. Two elderly care wards are managed by the Care Agency Elderly Residential Services. Facilities also exist for specialist medical services to be obtained outside Gibraltar if these are beyond the scope of local resources.
If you are British, you will automatically be covered by the national health insurance scheme in Gibraltar, since it is a British Overseas Territory. The cover will apply whether you are a resident or a visitor. If you have private health insurance for the UK, however, check with your provider as to whether you’ll also be covered in Gibraltar as well should you choose to access private sector medical treatment there.
The Rock also has a private hospital: the Hospital Quirónsalud Campo de Gibraltar, although some expats choose to go over the border to private clinics in Algeciras or Marbella.
Check the small print of any private policy to see whether it covers treatments that you may want to access, such as advanced dental care, and also whether it will cover you for treatment both in Gibraltar itself and over the border in Spain.
You should also check whether your potential policy covers pre-existing conditions: the definition of this varies between insurers. Usually the term applies to any conditions which present symptoms or for which you have been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for diagnosis.
You may also want to check out whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You will need to discuss this directly with your insurer.
Take a good look at any potential policy for any cover relating to healthcare which does not apply to you: some policies have provision for maternity care, for instance, and if you are not intending to become pregnant (or prefer to rely on the cover provided by the public maternity system on the Rock), then you may wish to reduce your policy costs by having such options removed.
You may also be able to reduce the cost of your premium through ‘cost sharing’: this means that you and your insurer will share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing, such as the below.
Co-pay: where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance: where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your co-insurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles: where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your GP. However, you would then have to pay the whole amount for 11 such visits (€1000/€85 = 11.8) before your insurance began to pay out to the doctor directly.
You may also need to take a look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met.
Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. You will thus pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000), or about 29 more visits (€500€17 = 29.4). At that point (40 total visits in a year), you would pay nothing more for the remainder of the plan year.
It’s worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
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Medical care in the British Overseas Region of Gibraltar is run by the Gibraltar Health Authority (GHA), established in 1987, in conjunction with the Social Welfare System. Both are based closely on the model of the UK’s NHS.Health insurance is organized by a contributory system called the Group Practice Medical Scheme (GPMS). We’ll look below at how to register with the GPMS and what you need to do if you are a British citizen, an overseas resident, a visitor or a cross-border worker living or working in neighbouring Spain.
Registering With The Health System In Gibraltar
If you are eligible for healthcare under the national scheme, then you and your family will be covered. Retirees are also covered if they are either British and in receipt of a pension, or if they are expats of another nationality who have been making national insurance contributions into the Gibraltarian scheme.
International students will be covered as long as they are from the EU; if they come from outside the EU, they’ll need to take out private health cover.
Economically inactive EU residents may be asked to pay a voluntary contribution into the GPMS. Visitors to the territory will be covered if they have a valid British passport but anyone else is advised to take out private health insurance or, if from the EU, make sure they bring their EHIC with them.
If you are a resident of Gibraltar, you are entitled to medical care that is free at the point of delivery, and if you are a British citizen, you are also eligible for it on production of a valid UK passport. Since the Rock is a British territory already, you do not need to pay into the national insurance scheme in order to qualify for free treatment. If you are uncertain about your eligibility, then you can consult the GHA and they will advise you.
If you are an expat from a country other than the UK, check your eligibility with your employer or the GHA. Americans, for example, are advised to take out travel or private insurance if they are only going to visit Gibraltar for a short period.
If you are a US expat and will be working and residing here, then the same rules will apply to you as to residents of the Rock as long as you are paying your national contributions. The GHA website says that if you are from elsewhere in the world, you will need the following documentation in order to obtain your Medical (Group Practice) Scheme card:
• a fully completed application form
• ETB contract (if applicable)
• PAYE Allowance & Social Insurance Contributions Class Certificate.
• one passport photo on a white background
• civilian Registration Card (Current ID card / Passport)
• proof of address
• changes of name or address – documentary evidence will be requested
If you are working in Gibraltar and paying your Social Insurance Contributions here, but you reside in another EU Member state, you will need to apply for an S1 (Former E106) at the Social Insurance Contribution Office. You can enquire at the Social Insurance Contribution Office as to how to register your S1 with the Spanish Authorities.
If you are an EU citizen and you have an EHIC card, you will also qualify for free emergency medical treatment, but this is only for emergencies and should not be used as a substitute for comprehensive health coverage.
If you are a ‘cross-border’ worker and live in Spain but work in Gibraltar, you will be entitled to coverage on both sides of the border. You will need to register and to do this you will need:
• a certificate of your social insurance contributions or your latest PAYE
• your ETB work contract
• your passport
• a passport-sized photograph
If you are a cross-border worker, your dependents will need to fill in an S1 form (formerly the E106) from the Contribution Unit in the Income Tax Department in Gibraltar. They will then be eligible for medical treatment in the country in which you work (e.g. Spain) if the following conditions are met:
• treatment becomes necessary on medical grounds during their stay in that country, taking into account the nature of the treatment and the expected length of the stay
• prior authorisation has been granted using form S2 (E112 form) issued by the health insurance authority in the country where they live.
Expats may also wish obtain an EHIC card even if they are citizens of the UK; Brexit might affect this. This is because, though medical personnel and facilities in Gibraltar are excellent, the country is a small one and specialist care can be limited. Some medical specialists may have to be flown over from the UK, and in the event of a serious condition or accident you might have to be transferred to a hospital over the border in Spain, which is not covered by Gibraltaran state health insurance.
Some people rely on the EHIC in case of emergency, but this will not cover you for repatriation in the event of a serious illness.
Registering With A Doctor In Gibraltar
With only 30,000 residents, Gibraltar is so small that you may not have a wide choice of where you go for treatment. The country has one public hospital, St Bernard’s, and a referral hospital as well as a number of GPs. St Bernard’s, a relatively new institution which has over 200 beds and is run by the Gibraltar Health Authority, deals with emergency cases, primary care and surgical treatment, maternity and mental health among other forms of treatment. Its Primary Care Centre has around 20 GPs on staff. The GHA also runs the Ocean Views Mental Health Facility and has recently set up a children’s primary and secondary care centre.
Dental treatment is not covered under the GPMS, with the exception of children, so you will have to sign up with a private dental practice.
If you are a cross-border worker, you should be entitled to medical treatment on both sides of the border so if you are, for example, living in Spain but working in Gibraltar, you may wish to register with a Spanish medical practice.
Visits to the doctor and emergency hospital treatment will be covered by the GPMS, although you may have to pay for some of your prescriptions. There is a cap on prescriptions of around £7-8.
For some specialist treatment, such as pediatric neurological treatment or plastic surgery, your consultant is likely to have to come from the UK: St Bernard’s runs a consultation service and will fly specialists in.
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Gibraltar has a modern healthcare system, based on a two-tier model of both public and private health insurance.If you are a British national or registered with the Group Practice Medical Scheme (GPMS), you will be covered by public health insurance throughout the course of your pregnancy and the standard of public care is high. However, you can also access private maternity care in either the Rock’s private hospital or a clinic.
How to decide on a birth plan
A birth plan is a list of what you would like to have happen in labour and beyond, written so that your doctor know what your wishes and expectations might be. Examples include:
• where do you want to give birth?
• who do you want to have with you (e.g. your partner)?
• what kind of birth do you want (e.g. vaginal birth or a Caesarian)
• do you need any birthing aids?
• do you want pain relief, and if so, what kind?
• what kind of birthing environment would you prefer?
Maternity care in Gibraltar
Regular checkups take place throughout the pregnancy. Mothers-to-be can choose either a public or private gynaecologist or obstetrician. Community midwives run antenatal and postnatal clinics at St Bernard’s Hospital.
The Millicent Mackintosh Maternity Ward at St Bernard’s (Gibraltar’s single public hospital) has 11 beds and 8 cots. It will provide care throughout pregnancy, childbirth and the postnatal period. The GHA has three community midwives who run antenatal and postnatal clinics and book appointments. The maternity ward also has a Special Care Baby Unit with two incubators for those babies requiring emergency and stabilisation special care.
If you need to be admitted with any complications of pregnancy or you go into early labour, you will be placed in either a two-bed antenatal bay or a side room, depending on your personal circumstances.
The unit has three labour wards for deliveries and postnatal bays to house mothers and babies. You will need to check with the hospital whether they will allow your partner to accompany you during the birth.
Gibraltar’s private hospital, the Hospital Quirónsalud Campo de Gibraltar, also runs a full range of maternity care and also offers reproductive and fertility treatments, such as IVF. It has facilities for treating high-risk pregnancies as well.
Baby STEPPs (Support Through Early Parenthood & Pregnancies) Gibraltar offer post-natal classes and other forms of support.
You must register your child within 21 days of the day of birth and will need a birth registration certificate.
If you are married, either parent can register the birth on their own. If you are not married, both parents have to register the birth together and will need the following documents:
∙ a completed registration form
∙ a valid form of photo ID (e.g. passport, ID card or driving license)
∙ if applicable, your marriage certificate
A dependent of a worker who is resident in Spain but working in Gibraltar (frontier worker) should be registered with the healthcare system in Spain, and the costs of the birth are covered in Spain.
You will be entitled to the following maternity benefits.
Maternity grant: paid up to 9 weeks before the birth and for 6 weeks after. This takes the form of a lump sum payment of around £600, but your eligibility for it will depend on the amount of national insurance contributions that either you or your partner have made. This is based on the period up to 52 weeks in the year before the birth, and up to 40 in the year preceding that.
Maternity allowance: this is a weekly benefit in the region of £87 paid while you are on maternity leave. It is paid on your social insurance contributions record alone, not on your partner’s. You can claim this from 11 weeks before the baby is due but not later than 6 months after the birth.
You don’t have to pay social insurance contributions for any week in which you are absent from work on maternity leave, which is set at 14 weeks in Gibraltar. However, you may take a longer leave: up to 29 weeks if you have been continuously employed for a year prior to the birth. You can also take up to four weeks of parental leave, but your employer is not legally obliged to pay you during this period.
Finally, note that although maternity cover and childcare in the territory is good, Gibraltar has some of the strictest abortion laws in Europe: you can technically face life imprisonment, though this does not usually happen in practice. Your alternative is to travel to Spain for your procedure. The legislature is due to have a referendum in 2020.
What nationality will my baby be?
Your child may be entitled to be registered as a Gibraltarian: check this with the Department of Social Security.
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Public sector healthcare in Gibraltar is run by the Gibraltar Health Authority (GHA), who also organize the national insurance scheme, the Group Practice Medical Scheme (GPMS). If you are a British national or are registered with the GPMS, your prescriptions will be subsidized under the national scheme.If you have a private sector GP, your prescriptions may be covered by your private health insurance, or you may have to pay out of pocket.
What is available?
You should be able to access a full range of medication in Gibraltar, either on prescription or over-the-counter, and expats report that you may have a wider choice on the Rock itself than over the border in Spain.
The Gibraltar Health Authority has recently implemented a new repeat prescription service at the Primary Care Centre, so that patients can get a repeat prescription of their regular medications without necessarily having to book a further appointment with a GP.
Take your prescription to the Repeat Prescription Desk at the Main Counter of the PCC and ask for your medication. Repeat prescriptions will be ready for collection 48-72 hours later. If your GP does need to see you before issuing a prescription, the desk clerk can book the next available appointment for you.
Recently the Gibraltarian authorities have announced that they are legalising medical marijuana. This will only be available from the pharmacy at St Beranrd’s hospital and is confined to the treatment of several health conditions including life-threatening pain, Multiple Sclerosis, severe epilepsy, muscle spasms and side effects resulting from chemotherapy.
Gibraltar has a variety of pharmacies, including one in Morrison’s supermarket, and you should have little difficulty in accessing the medication that you need. The GHA has a list of duty pharmacies on its website, open Monday-Friday 7pm-9pm and weekends/public holidays 11am-1pm and 6pm-8pm.
The Prescription and Pricing Advisory Unit (PPAU) is located in the Primary Care Centre. This manages the prescriptions issued and the reimbursement of pharmaceuticals dispensed by local pharmacies. It is also able to provide patients with medication for chronic conditions to cover shortfalls between GP appointments; assist with PCC-issued prescription omissions or errors; source medication for service users; and provide advice and assistance regarding any medication and prescription queries that you may have. It opens from 9am-12.30pm and 1.30pm-3.00pm.
How much do prescriptions cost?
The cost of your medication will depend on the nature of the drug, but there is a cap on prescriptions of around £7-8.
If you are buying medication over the counter, a packet of branded cold medicine, such as Tylenol, will cost you around £2.43. A 12-dose box of antibiotics will be in the region of £2.50.
The Crown pharmacy offers a free collection and delivery service for GHA and private prescriptions.
How to get the care you need
If you are registered with GPMS or are British national you will be entitled to treatment that is free at the point of delivery, including appointments with your doctor. If you need prescription medication you must register with a local GP. Pharmacies are widely available across the territory.
If you are visiting and need emergency medication, your best bet is to contact the pharmacy at St Bernard’s hospital. They may need to contact your doctor in the UK, or they may need to contact the appropriate doctor/unit in the GHA.
Perched at the entrance to the Mediterranean, with a pleasant climate and overlooking the sea, Gibraltar is a popular place to visit if you’re into swimming, sailing or other water sports. However, rugby, football and hockey are also popular sports on the Rock and a number of residents belong to sporting associations, such as the Gibraltar Football Association.The territory has three marinas, with opportunities for chartering a yacht or learning to sail. Diving is also popular, with over 50 wrecks around these dangerous straits, and so is swimming, with some people taking up the challenge to swim across the Straits to Morocco.
These are potentially high-risk activities. What sort of health insurance cover is offered should you hurt yourself as a visitor to the Rock or as a resident? We look at some of the options below.
What cover is available for residents of Gibraltar?
Health insurance is organized by a contributory system called the Group Practice Medical Scheme (GPMS), and if you are registered with it, or are a British national who has been paying national insurance contributions back home, then you will be covered in cases of emergency and injury. Gibraltar has one public hospital, St Bernard’s, and you will be treated here in the event of an accident or a sports injury.
What cover is available for visitors to Gibraltar?
If you are visiting the Rock, it is strongly recommended that you take out full private cover and do not rely solely on your EHIC card, if you have one. In this case, if you do sustain an injury, you will need to contact your health insurance provider and check that treatment will be covered under the terms of your policy. If so, then your provider may be able to pay for your healthcare treatment directly, but check this with the hospital as they may ask you to pay in cash and then claim the money back from your insurance company once you return to your home nation.
Note that there are time limits in place with most insurers for compensation claims; you will not be able to retroactively claim compensation for an injury suffered many years ago, for example.
If you booked your holiday through a registered travel agent, you should be covered by existing legislation and they will be able to advise you with regard to making a claim.
Make sure that you take notes relating to your treatment: the name of the hospital, the name of the doctor, the time and place of your injury, and the nature of your injury. Be sure also to keep any medical bills that you receive: you will need to forward this information to your insurance provider in order to maximize the chances of success of your claim.
Check that your existing health insurance policy covers you for repatriation: many policies do not.
Where to seek treatment in Gibraltar
Gibraltar has one public hospital and a number of private clinics. The public hospital, St Bernard’s, will cover you for emergencies. Private clinics, such as the Specialist Medical Centre, can offer a wide range of treatments from referral to a physiotherapist to surgical intervention, depending on the nature of your injury.
The SMM says that they can bill private insurers directly, depending on whether pre-approval for treatment has been sought, and will therefore need your policy details when you seek treatment.
How much will treatment cost?
The cost of your treatment will obviously depend on the nature of your injury. Osteo La Cala, a specialist clinic which includes treatment for sports injuries, says that an initial consultation will cost €65. This covers a 60-minute consultation which includes a case history, diagnosis, prognosis and treatment advice, with €55 for a follow-up, which will include an ongoing treatment plan. Overall, however, expats describe out-of-pocket private healthcare in the territory as expensive.
How much could I claim?
Again, this depends on the nature of your injury and the time and expertise required to treat it, but for a minor to severe leg injury, you would be looking at compensation in the region of up to €247,000. A minor to severe ankle injury would be around up to €12,000 – €61,000. A minor to severe back injury is in the region of €2,150 – €141,000, and a minor head injury €2,000 to £11,000.
As so many variables have an effect on the cost of international private medical insurance for Gibraltar it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle-tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.
Public sector healthcare in Gibraltar is run by the Gibraltar Health Authority (GHA), who also organize the national insurance scheme. Since this British Overseas Territory is so small, with only 30,000 inhabitants, it has only one public hospital, St Bernard’s. There are also a number of private providers including one public sector hospital, the Hospital Quirónsalud Campo de Gibraltar, for those who have private health cover. Some expats choose to go over the border to private clinics in Algeciras or Marbella in Spain.Overall, the quality of healthcare in Gibraltar, whether in the public or the private sector, is of a high standard and you should have no problems accessing suitable treatment for your needs. Since English is the first language of the territory, you should have no linguistic problems if you speak English.
Public healthcare in Gibraltar
The Gibraltar Health Authority (GHA) was established in 1987, in conjunction with the Social Welfare System. Both are based closely on the model of the UK’s NHS. Recently, the GHA has entered into a relationship with Spanish private healthcare provider Quirónsalud.
The GHA currently refers patients for specialised treatments to the group’s various medical centres, and it has also recently formed a contractual relationship with the Clínica Universidad de Navarra.
If you are seeking medical treatment on the Rock, therefore, your choice will not be confined to the public or the private sector actually in Gibraltar itself, but also in Spain and possibly in the UK, since the GHA also makes tertiary referrals to the NHS. A number of medical specialists are also flown in from the UK for regular appointments in Gibraltar’s public and private sector.
In 2018, HM Government of Gibraltar and the GHA issued a joint statement to the effect that there are currently no plans to privatise public healthcare in Gibraltar.
St Bernard’s deals with emergency cases, primary care and surgical treatment, maternity and mental health, among other forms of treatment. Its primary care centre has around 20 GPs on staff. The GHA also runs the Ocean Views Mental Health Facility and has recently set up a children’s primary and secondary care centre.
If you are a resident of Gibraltar, you will be entitled to medical care that is free at the point of delivery, and if you are a British citizen, you are also eligible for it on production of a valid UK passport. If you don’t fall into either of these categories, and if you are not from a EU state and do not have an EHIC card, you will need to take out private health insurance.
Gibraltar also has a Health Promotion Department, which uses social networking and promotional programmes to assist citizens of the Rock in making health choices. The Department also addresses underlying issues such as inequity, poverty, and lack of opportunity.
The GHA has an internal Infection Prevention, Control and Immunisation Department, comprised of two Infection Control Practitioners whose role is to oversee the prevention and control of infections throughout GHA premises. In addition, the GHA runs Abdominal Aortic Aneurysm (AAA) screening and Bowel Screening as well as other forms of screening. The GHA runs a drug rehabilitation centre in the upper Rock.
Cancer Research UK also has a branch in Gibraltar and runs regular events in the territory. Both the private and public sector healthcare deal with oncology.
You should have no problems with accessing your prescriptions, although you may have to make a small co-pay charge for some medication. This cost is capped.
Private healthcare in Gibraltar
Gibraltar’s private hospital, the Hospital Quirónsalud Campo de Gibraltar, covers both primary and secondary care, with private GPs and access to surgical treatment, plus opthamology, dermatology, plastic surgery, psychological counselling and other forms of treatment.
There are no public dental practices in Gibraltar and you will need private cover or to pay out-of-pocket for dental treatment. Your children will, however, be treated for free under the national scheme.
Healthcare in Gibraltar is run by the Gibraltar Health Authority, the GHA. Health insurance is organized by a contributory system called the Group Practice Medical Scheme (GPMS), and if you are registered for the scheme you will be covered for some dental treatment, but not for routine eye care unless it’s an emergency.Overall, the quality of healthcare in Gibraltar is of a high standard, whether you use the state system or opt for private health cover.
Since English is the first language of the territory, you should have no linguistic problems if you are English-speaking. However, if you are a cross-border worker and living or working in neighbouring Spain, you may prefer to access dental and eye care in Spain rather than in Gibraltar.
How to register with a dentist
There are a number of dental surgeries in Gibraltar, which you can locate via Google or the phone directory. Expats report that this can be a little confusing: since the territory’s dentists are all private, many tend to advertise their more advanced services such as implants or tooth whitening, but it’s recommended that you check that any potential choice also undertakes basic procedures such as check-ups and fillings. Most of them do, but it may not be immediately obvious.
Gibraltar has one public hospital, St Bernard’s, and a Primary Care Centre which also offers dental treatment with a team of seven dental nurses. A dentist is on call at the PCC out of hours and at weekends, and can be contacted for dental care for children and emergency treatment for adults. Adults with toothache will be asked to attend the emergency clinic the next day.
The full range of dental care at the PCC includes:
• restorative dentistry
• orthodontics (braces)
• paedodontics (children’s dentistry)
District Medical Service patients are entitled to these services, with the exception of Orthodontics. Your GP will be able to refer you for oral surgery or medication.
The PCC dental clinic is open from Monday to Friday 9.00-12.40 and 14.00-16.40.
To what extent does national insurance cover dentistry?
Dental treatment is not covered under the GPMS, with the exception of children, so you will have to sign up with a private dental practice.
The Primary Care Centre says that if you are in full-time education, on supplementary benefits, or have been granted exemption, you may be able to receive treatment free of charge. Adults registered at the Primary Care Centre, or in possession of an E111, may be treated in case of an emergency and will then be referred back to their usual dental surgery.
Accessing private dental treatment
Essentially, every dentist in Gibraltar is private, although you may be exempt if you fall under certain categories. Costs will obviously vary depending on the surgery and the nature of your treatment, but some ballpark figures are below:
• new patient consultation and examination: £120
• routine examination (for existing patients): £90 – £120
• new child patient consultation: £60 – £120
• fillings: £120 – £300
• crowns and bridgework: from £1,000
• root canal: £500 – 700
• dentures: £800
• implants: from £2500
How to register with an optometrist in Gibraltar
There are a number of optometrists in Gibraltar (the oldest has been there since 1830), and you should have little difficulty in accessing the eye care that you need. You can find your local branch via the phone book or by looking on the internet.
Eye care is not covered under the GPMS except in cases of emergency and some eye-related illnesses, in which case you will be treated at St Bernard’s. The ophthalmic department at the hospital covers conditions such as glaucoma, diabetes-related eye complaints, low vision assessment, hypertension-related eye conditions and more.
The Gibraltar Health Authority’s Ophthalmic Unit has recently started a cataract surgery initiative to reduce the waiting lists for surgery: this should be covered by the GPMS, but it’s best to check with your GP or with the GHA. The initiative is run by nursing staff, hospital optometrists, ophthalmologists and administrative staff, and is supported by some local optometrists outside the hospital system.
The initiative consists of pre-operative clinics, surgery and post-operative clinics, undertaken at the GHA’s Ophthalmic Unit after hours. Four surgical sessions are scheduled during normal working hours for patients who may need additional medical support from other GHA staff, or who are having their surgery in the hospital’s main theatre under general anaesthesia.
Accessing private eye treatment
Contact lenses will cost you from around £40 – 70, depending on the type and the length of supply. Glasses start at around £120 for the frames; lenses are usually extra.
There are a number of private eye clinics on the Rock offering laser surgery for sight correction. It is worth shopping around to compare costs if you are looking into this kind of treatment, and also checking how much similar procedures could cost you over the border in Spain.
The Gibraltar Health Authority (GHA) was set up under the Medical (Gibraltar Health Authority) Act of 1987 and its purpose is to provide health care in Gibraltar, which is home to more than 29,000 residents. Gibraltar enjoys similar health, and standards of health care provision, to most Western European countries. The Gibraltar Health Authority (GHA) delivers primary, secondary and mental health care in Gibraltar using a healthcare model closely linked to the National Health Service (NHS) in the United Kingdom, and for this purpose some tertiary referrals are delivered in the NHS as well as in Spanish hospitals due to proximity.Gibraltar has its own health authority which provides healthcare facilities. There is a community hospital, residential care for the elderly, a referral hospital and a mental health unit. These run the Group Practice Medical Scheme which covers the medical needs of contributors. All medical treatment that is required is arranged through this scheme.
Regarding the small population that Gibraltar has, it is not always practical for medical specialists to be employed full time, so if needed they are generally flown in from the United Kingdom. The health service employs dental professionals and opticians as well. General practitioners can also make home visits to patients if required.
Pensioners who move to Gibraltar from the United Kingdom often find that the health service is easy to access. The United Kingdom and Gibraltar have a special arrangement that allows all UK citizens access to free healthcare facilities in Gibraltar without the obligation to pay insurance contributions. On the other hand, it is necessary to pay for prescription medications. There are a number of private health care options for those who do not make contributions to the medical service or who are not entitled to free healthcare.
UK expats who move to Gibraltar to work are required to contact the Gibraltar Health Authority to see if they are covered by this agreement or if it would be necessary to pay into the country’s medical scheme. All visitors from the United Kingdom can obtain free emergency medical care if they show their UK passport to authorities as proof of identification. Visitors from other European countries should also be able to receive free emergency medical care if they possess the European Health Insurance card. The emergency telephone number for calling for an ambulance in Gibraltar is 190.
Most commonly used medications are available at the country’s pharmacies. Those who plan to move to Gibraltar and require specific medications on a regular basis should check ahead with the Gibraltar Health Authority to ensure that their particular drug is readily available. There are some vaccinations that are highly advised when visiting Gibraltar. Tetanus vaccinations should be up to date and occasionally a Hepatitis A vaccination is advised as well. If visiting forested areas a vaccination for encephalitis, a tick-borne condition, is recommended.
In general, the standard of healthcare in Gibraltar is excellent. Many of the medical professionals have studied and trained abroad, mostly in the United Kingdom. The hospitals are equipped with modern facilities and equipment, so most conditions can be treated without the need to seek help elsewhere. Both residents and expats will enjoy high standards when it comes to the provision of healthcare in Gibraltar.
The government-funded Gibraltar Health Authority (GHA) manages the country’s healthcare facilities and services, which include residential care for the elderly and a mental health unit. St Bernard’s Hospital is the only general public hospital in Gibraltar. The GHA also oversees the Group Practice Medical Scheme, which covers the medical needs of contributing members.
As a British Crown Colony, citizens from the United Kingdom are entitled to free healthcare in Gibraltar upon presentation of a passport, as are other nationals of the European Union if they have a European Health Insurance card. Prescription medicines must always be paid for. Apart from calling UK specialists when needed, the National Health Service also employs dentists and opticians, as well as GPs who can make house calls if required.
There are a number of private options for expats who aren’t entitled to free healthcare in the public facilities. In order to use private clinics and doctors, expats are advised to have private medical insurance.
Expat healthcare insurance
When it comes to some of the biggest expat healthcare insurance providers, there are three main companies in Gibraltar.
Aetna is targeted to expatriates and provides health benefits to more than 650,000 members worldwide. In addition, this company has helped develop world-class health systems for governments, corporations and providers around the world.
Bupa Global has been helping individuals and families to live longer, healthier, happier and lives for over 60 years. Bupa Global is trusted by expats in more than 190 different countries and has links with healthcare organizations throughout the world.
Cigna is an insurance company that has been operating in international health insurance for more than 30 years. Today, Cigna has over 71 million customers around the world. Looking after them is an international workforce of around 31,000 people, plus a network of more than 1 million hospitals, physicians, clinics and health and wellness specialists worldwide.
Emergency numbers in Gibraltar
All Emergencies – 112
Ambulance – 190
Fire – 190
Police – 199
The emergency number 112 can be used to reach medical, fire and police emergency services in Gibraltar. This pan-European emergency number can be called from any telephone (landline, pay phone or mobile cellular phone even without a SIM card). Calls are free. It can be used for any life-threatening situation, including:
– Serious medical problems (accident, severe injuries, chest pain, seizure, unconscious person
– Any type of fire (house, car)
– Life-threatening situations (crimes)
A rocky British enclave in the Mediterranean, Gibraltar has been at the centre of several political issues since 1713, when it was passed into the hands of the Britons. Though this small island of around 30,000 people governs itself, it remains a colony of Great Britain to this day.The Chief Minister is the Head of the Government as well as the Council of Ministers, but the Monarch of the United Kingdom continues to be the Head of State. All internal matters are dealt with by the Chief Minister, whereas foreign and defense-related issues are directly managed by the British government. The British authorities have been represented by a Governor and the colony is home to the UK’s Royal Navy Base.
The political situation since the 17th century has been uneasy to say the least. However, it was further aggravated in 2002, when a referendum turned down the suggestion that the sovereignty of this nation should be shared with Spain. Britain’s decision to leave the European Union isn’t likely to help matters in the near future.
The referendum made it very clear that the residents of Gibraltar definitely did not want UK to exit the bloc. Data show that more than 96% of the Rock’s residents voted to remain in the EU. This is primarily because Gibraltar’s flourishing economy, which is built around e-commerce, online gaming, and financial services, is based on the EU’s free movement and single market policies. In the present situation, more than 50% of the country’s workforce, which consists of more than 12,000 Spanish and EU nationals, commutes across the border on a daily basis. Many of the people who live and work in Gibraltar are therefore worried about their status once the UK leaves the EU. Will they be able to reside in this destination and seek employment in the same way, or will the regulations undergo major changes in the future? In truth, only time can answer these questions.
Gibraltar after the referendum
Life on the Rock has not really changed much since the vote but there is a definite sense of trepidation in the air, even as people are making an attempt to get on with their lives. Most Gibraltarians are preparing themselves to face increased border controls, weaker Pound Sterling values, and a possible attempt by Spain to regain at least partial sovereignty of the territory. Almost immediately after the Brexit vote was announced, Madrid made it clear that it sees the UK’s departure from the EU as its best chance in three centuries to once again claim sovereignty on a territory that it has regretted ceding to Great Britain since 1713. Spain’s Foreign Minister, Jose Manual Garcia-Margallo, went as far as stating that “the Spanish flag on the Rock is much closer than before”.
Brits living in this country are also worried about other factors such as higher healthcare bills and costlier flights when they decide to visit home. While some residents are confident that Spain will not take over because Gibraltar and the UK will not allow it, they are also concerned about the bigger issue of the border. For several years, Spain shut down its border on numerous occasions because of its on-and-off relationship with Gibraltar. This caused a huge problem for thousands of people who reside in Spain but travel to Gibraltar for work. Expats from across Europe are now apprehensive about their future, as there is no clarity on how the exit will affect free movement and employment visa requirements.
In the worst scenario of a “Hard” Brexit, Britain could lose the automatic access it has to Europe’s single market. In this case, firms that are based in the UK and Gibraltar would not be able to offer their services to other nations in the EU. The Rock’s efforts to attract businesses looking to Europe with the promise of easy access to regulators, corporate tax of 10%, and a Mediterranean lifestyle would therefore come to an abrupt end. On the other hand, if a company wanted to do business in the UK, it would need to set up a subsidiary in Britain or Gibraltar.
Concerns related to Brexit
There is no denying the fact that Brexit is going to have a major impact the world over, and especially on European nations. Some of the repercussions may not be felt immediately but may become evident over a period of time.
At present, there are more than 1.2 million British citizens settled in various nations of the Union. Their residency rights, work permit requirements and healthcare benefits are all likely to be affected by Britain’s decision to leave. Experts say it is unlikely that those who are already settled abroad will be sent back or asked to leave, especially if they have been legal residents for over five years. However, since Gibraltar is a British territory, these issues shouldn’t be a concern for its British expat residents.
In all probability, most of the agreements between the UK and EU nations will be reciprocal. This means that if Britain requires EU migrants to apply for a residence permits and work visas, British citizens moving to EU countries will be expected to go through the same procedure. Taxation and inheritance laws are likely to undergo a revision. Existing property rights and pensions are expected to stay the same.
Some of the issues that have a higher impact on the people of Gibraltar than on other EU nations include the following.
Spain’s relationship with Gibraltar
It is clear that Spain has already started using the UK’s departure from the Union to undermine this British territory. Of course, the idea of joint Spanish-UK sovereignty is far from new. Spain insists that Brexit has become a game changer for the Rock. In fact, Spain’s Acting Minister for Foreign Affairs and Cooperation has asked the EU partners to exclude Gibraltar from all negotiations related to Brexit. Letters have been sent to the Foreign Ministers of other nations asking for their support and understanding, so that Britain concedes to co-sovereignty of Gibraltar, which was a “bilateral matter between Madrid and London”. The Foreign Minister added that the citizens of this peninsula had two simple choices; they could be “British outside the EU” or “Hispano-Brit within the EU”.
Even before the decision was announced, a report by the Commons Foreign Affairs Committee called for some action to prevent Spain from taking advantage of the “leave” vote to take advantage of and target the disputed peninsula. It stated that “the UK must immediately act to protect Gibraltar from such actions in the event of a vote to leave the EU”. Gibraltar’s government submitted a statement to the committee, warning them about how Brexit could leave their country open to increased Spanish aggression. The statement read: “Experience has shown that Spain would take advantage of any such renegotiation in order to further undermine, isolate and exclude Gibraltar from the European mainstream”.
Restrictions on the borders
For the Spanish, Gibraltar has been like a disputed territory for more than three centuries, even though the two countries are neighbors and share a common border. In the past, Spain closed its borders to the Rock for more than a decade during the Franco dictatorship. The border was only fully reopened in 1985 when Spain was interested in joining the EU. If a similar problem occurred today, residents on both sides would be stranded.
Around three years ago, Spanish authorities intensified their border checks because of a bitter dispute over territorial waters between the two nations. This created huge traffic jams and people wasted hours at the crossing. Eventually, the situation only came under control after an intervention from the European commission.
Today, border inspections are only moderated by the EU rule over free movement of people. Without this policy in place the border between Gibraltar and Spain could once again become a wall. Spain may also ask the citizens of Gibraltar to obtain expensive visas every time they plan to visit. The introduction of heavy frontier tolls on all motorists driving in or out is another possible concern, as it would deter people from traveling freely and would consequently choke the Rock’s economy by slowing down its tourism industry.
Even during the European financial crisis, the economy of the Rock showed growth that was almost in double digits. Over the last decade, this country’s employment has increased by around 50%. Unfortunately, things are expected to go downhill without continued support from the union.
The modern and service-based economy of Gibraltar has mainly benefitted from the EU’s rules on free movement of people, capital and services. Much of its income is generated from customs duties, offshore financing, internet gaming, provision of ships, and tourism. The pillars of this peninsula’s economy include shipping trade, international finance and the online gaming industry. The success of these services depends a lot on access to single market and Brexit would therefore have an adverse impact on a number of industries as well as the overall economy. Some members of Gibraltar’s business community claim that “it felt like someone had died” when the decision to leave the bloc was announced.
To avoid going under, businesses have been forced to explore alternatives. Some of the entities may shift their focus back to the UK. They are repositioning themselves as entry points for European organizations that are keen to get into the UK market after Brexit. Gibraltar’s low startup costs and attractive tax regime should also work in its favor. New trade laws are likely to be implemented between both countries.
History has shown that the Rock is quite capable of adapting to different circumstances, no matter how adverse they may seem. This was all the more evident when former Spanish dictator Francisco Franco closed the border in 1969 and reopened it after a gap of more than a decade, in the 1980s. A majority of Gibraltarians are of the strong opinion that their country can quickly reposition itself, since is it a small jurisdiction.
The territory is not an integral part of the UK and their relationship with the 27-nation bloc is also different. This fortunately gives Gibraltar scope to retain some of its relations with the EU even after Brexit. While Theresa May has been talking about the Great Repeal Bill to terminate the EU’s authority over the Rock, officials have been working to preserve as many advantages as they can.
The Chief Minister of the nation, Fabian Picardo, is looking for options to keep the territory as a part of the EU in spite of the referendum. The Rock is seeking a Brexit deal that will preserve its access to the EU’s single market, along with the ability of thousands of workers to freely move across the border. Picardo claims that they are looking for a relationship with the EU that offers them an associate-like status and compares it to models such as Liechtenstein, Greenland and Andorra.
In Picardo’s words, Brexit “is an existential threat the Gibraltar’s current economic model”. He claims that if they were to lose access to the single European market for their services, they would have to make sure that those in Gibraltar seeking such services would somehow have access to the rest of the EU. Picardo further added that this does not mean Gibraltar will not be able to reposition its economy and continue to grow with a different, successful economic model.
While a lot has been said by all the three governments in the last few months, it is difficult to predict what the exact situation will be in Gibraltar once Brexit actually happens.
Are you living in Gibraltar? What are your thoughts on what will happen after Brexit? Share your comments below, or answer the questions here to be featured in an interview.
Gibraltar, a 300-year old British Overseas Territory, lies at the bottom of the Iberian Peninsula and is surrounded by the Mediterranean Sea. A short isthmus separates Gibraltar from mainland Spain and also serves as a land frontier to Spain, and the location of the Gibraltar airport, which has 2 ½ hour flights to and from London every day.Gibraltar is perhaps best known for its rock, which overlooks the strait of Gibraltar that marks the separation between Europe and North Africa. The Rock of Gibraltar, also known by its Latin name of Calpe, is a monolithic limestone promontory located near the southwestern tip of Europe on the Iberian Peninsula. It is the Crown property of the United Kingdom. A nature reserve covers most of the upper region of the Rock, which according to Greek mythology, was one of the Pillars of Hercules. Its strategic location has caused it to serve as a battle site over the centuries. Gibraltar measures less than 2.6 square miles and has a population of just over 32,000.
As a British Overseas Territory, Gibraltar retains the powers of self-government with its own parliament and currency. However, defense and foreign relations, including those with the European Union, are governed by the United Kingdom. Gibraltar’s relationship with the European Community is different from any other overseas territory of a member state. Gibraltar’s Parliament is responsible for passing legislation, which include European Community Directives.
Why relocate to Gibraltar?
Many European expats are drawn to Gibraltar because of the various different industries that one can work in. Gibraltar also offers a balance between the professional environment and a relaxed outdoor lifestyle. It is located just 2 ½ hours away from the UK and enjoys 300 days of sunshine a year. It is also an English-speaking community and therefore no language barriers exist for those relocating from the UK. Gibraltar is an exciting place to live in due to its subtropical Mediterranean climate, eclectic culture, lush natural scenery, stunning beaches, and a wide range of outdoor activities like windsurfing and biking. Even though it is small in size, Gibraltar is among the wealthiest countries in the world and offers a high quality of life to its residents.
Where to work
Gibraltar offers a range of career options especially in the financial, IT, legal, insurance, accountancy, and gaming fields. Apart from these, there are also the options of working in places like restaurants, bars and shops, which are centered in the city’s commercial hub. Most of the international companies located here operate in a professional environment similar to that in the UK. Since Gibraltar uses the same employment system as that of the UK, all contracts are in English. Non-Spanish speakers will find that being bilingual is not a necessity or a prerequisite for employment. This helps to open up a number of job opportunities for those only fluent in English.
The main employer, historically, has been the Ministry of Defence and the Gibraltar government. But there has been a major shift towards financial services in recent times. There are also an increasing number of frontier workers, making up the 4,000 who travel to and from the international border every day.
The online gaming industry is a major economic force in Gibraltar and employs nearly 12 percent of the workforce. Jobs ranging from customer service executives to game developers are available in this field.
Do I need a work permit?
Only citizens of Gibraltar and British citizens are allowed to live in Gibraltar without any type of residence permit. All other European Union and non-European Union citizens are required to apply for a residence permit if their stay is longer than six months. A non-Gibraltarian woman married to a Gibraltarian man requires a permit, while a man married to a Gibraltarian woman does not need a residence permit.
Since Gibraltar is part of the EU, it enables EU nationals to live and work within its territory. Upon entry into Gibraltar, a six-month residence permit is initially granted. This is followed by a five-year residence permit if the individual has secured employment or has started a business. Non-EU nationals must apply for residency through the Immigration Control Ordinance. The governmental guidelines maintain that residency can be granted to those who are able to buy a property suitable to accommodate them and their family, who are in good health, who have sufficient financial resources to support themselves, and do not need to rely on welfare. Non-EU citizens can also acquire residency through employment. A work permit is only granted if it is evident that no Gibraltarians were willing or able to fulfill the particular position.
The United Kingdom has initiated a prospective withdrawal from the European Union following Brexit, a referendum held on 23 June 2016. Residents of Gibraltar voted overwhelmingly (96 percent) to remain in the EU. There will be a two-year period during which negotiations will take place. During that time, the UK remains a part of the EU and is subject to the same rules that are applied to other EU member states.
EU and EEA nationals require the following documents in order to apply for a residence permit in Gibraltar:
• Passport or identification card
• Employment Training Board registration
• Proof of accommodation in Gibraltar
• Passport-sized photograph
In addition to these documents, self-employed individuals also require a business registration certificate, a certificate from the Department of Social Security and an Employment Training Board registration as self-employed. Retired or self-sufficient individuals require proof of income in the form of pension payments or bank statements from a local bank and private medical insurance. UK nationals must inquire at the Department for Work and Pensions about their eligibility for transferring their NHS cover to Gibraltar.
Civilian Registration Card
The Civilian Registration Card is granted by the Civil Status and Registration office with residence documentation for an initial period of one year. It can be renewed every five years. The card serves as an official EU photographic identification document.
EU nationals require the following documents for an ID card application:
• Filled out application form
• Passport-sized photograph
• Proof of address
• Proof of income
Depending on the applicant’s personal situation, the following may also be required:
• Employed persons require their employment contract and reference from the employer
• Self-sufficient individuals need to provide bank statements of six months before application or a valid Category 2 Individual Certificate
• Self-employed persons require their Business Name Registration Act Certificate, Certificate of Registration as a self-employed person and receipt of tax payment
• Pensioners require the Gibraltar Health Authority card and proof of pension
Spouses and dependents of EU nationals require the following:
• Filled in application form
• Passport-sized photograph
• Marriage certificate in English
• Birth certificate in English
Where to live
Expats moving to Gibraltar have the options of living in Gibraltar itself, or renting a place in Spain based on their future plans and financial situation. It is possible to rent an apartment in Gibraltar. However, rental costs have been steadily increasing over the years and are almost close to London prices. Since there is an open border, expats may also choose to live in Spain in any of the small towns near the frontier like Santa Margarita, La Linea or San Roque. The daily commute will be just a walk or a short drive.
There is a fairly wide range of rental properties in Gibraltar, ranging from sea-view apartments to houses in town. Naturally, the prices also vary widely. But due to the insufficiency of cheaper rental property, prices have risen causing many individuals to seek accommodation across the border in Spain. The location you choose will depend on how far you wish to commute to work and the amenities provided in each location. Spain is much cheaper than Gibraltar and offers more living space for the cost. It also gives you a chance to access the rest of Spain without a border crossing. The drawbacks of living in Spain are primarily the commute to work and lack of rail services in the local area (although there are buses). Spain also has Spanish as its primary language and expats will have to register themselves with the local authorities.
Many choose to rent property in Gibraltar, especially if they are on short-term work assignments. There is a high demand for housing because space is scarce and many new developments are luxury units. But it won’t be too hard to find a home that suits your lifestyle and requirement. Properties vary from large houses to compact studio apartments. Furnished and unfurnished properties are available. Most apartment blocks have shared facilities such as a laundry room and a swimming pool.
Expats who want to buy or rent property can contact any of the many real estate agents that operate in Gibraltar. The classifieds sections of local publications also carry listings of properties. Once you have found a property that suits your needs, you will be required to pay a deposit of one to two month’s rent and one month’s rent in advance. You may also need to provide references to the prospective landlord before signing the agreement. Most rental contracts are valid for a year. Your estate agent can organize the connection of utilities, and also arrange for a telephone line.
Income and working hours
Gibraltar’s working hours are similar to those in the UK, as are the working conditions and the legal treatment of employees. Income depends on which industry you work in. The online gaming industry in particular is known to pay fairly well. In the legal sector, wages may be lower than that in the UK. The average income in Gibraltar is usually 20 percent lower than that in the UK. Basic positions such as secretarial and administrative positions usually pay between £12k and £17k. Skilled roles such as those in the IT industry involve higher wages and are usually on par with wages in the UK. Keep in mind that if you work in Gibraltar but live in Spain, you are liable to pay income tax in Gibraltar. There are no VAT taxes in Gibraltar and the corporation tax and personal income tax are small.
Gibraltar’s culture bears marks of its diverse origins, and its Spanish and British influences are evident. Portuguese and German ethnicities have also influenced Gibraltar’s modern nature and these influences are especially evident in the cuisine of the city. Expats from the UK who are moving to Gibraltar will not face much of an issue in settling into the city, as many of the social practices will be quite familiar. It is common to spot the typically British red mailboxes, fish and chips pubs, and shopping stores in Gibraltar.
Residents and expats will have access to high standards of healthcare in Gibraltar. Many of the doctors and nursing staff have trained overseas and the hospitals are well-equipped with modern facilities. The Gibraltar Health Authority (GHA) governs the healthcare facilities and services. This also includes residential care for the elderly. There is also a mental health unit. The only general hospital in Gibraltar is St. Bernard’s Hospital. The GHA also manages the Group Practice Medical Scheme that provides coverage for the medical needs of contributing members.
Since Gibraltar is a British Crown Colony, healthcare is free for citizens of the UK. They only need to have their valid passports, which they can present at any healthcare institution. EU nationals must have a valid European Health Insurance Card. However, there are charges for prescription medicines. Medical specialists are not always employed full time in Gibraltar, but are flown in from the UK if there is a requirement.
Being a British Overseas Territory, Gibraltar’s official language is English, and is used by the government. It is also the language of instruction in schools. However, most locals are bilingual and also speak Spanish. Gibraltarians also converse in a language called Llanito, which is an Andalusian Spanish based language, unique to Gibraltar. Llanito consists of a mix of Andalusian Spanish and British English, but borrows words and expressions from a host of other languages.
Have you lived in Gibraltar? Share your thoughts in the comments, or fill in the questions here to be featured in an Expat Experience interview!