Medical care in the region is run by the Gibraltar Health Authority (GHA), 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).

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: you do not need to pay into the national insurance scheme to qualify for free treatment. If you are uncertain about your eligibility, check with the GHA.

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 be in Gibraltar for a short period.

Anyone who pays into the national insurance scheme, or who is a British citizen, will be covered. 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 living in Spain but work in Gibraltar, you will be entitled to coverage on both sides of the border once you have registered with the system. To do this, you will need:

• a certificate of your social insurance contributions or your latest PAYE slip
• your ETB work contract
• your passport
• a passport-sized photograph

You may also wish to obtain an EHIC card even if you are a UK citizen. This is because, though medical personnel and facilities in Gibraltar are excellent, it is a very small country and specialist care can be limited. Medical specialists sometimes have to be flown over from the UK, and if something serious befalls you, you might have to be transferred to a hospital over the border in Spain, which is not covered by Gibraltan state health insurance. The EHIC will not cover you for repatriation in the event of a serious illness.

If you are a resident or a British citizen, this will be automatically in place and you do not need to do anything. For other expats, check that your employer is paying into the health insurance system on your behalf. If you are self-employed, contact the GHA and sign up. 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 and paying your social insurance contributions in Gibraltar but reside in another EU member state, you will need to apply for an S1 form at the Social Insurance Contribution Office.

Visits to the doctor and emergency hospital treatment are covered by state health insurance, although you may have to pay for some of your prescriptions. There is a cap of around £8 on prescription costs.

You will be covered by the national scheme if:

• you are a British citizen in receipt of a pension
• you are an expat of another nationality who is making national insurance contributions

You will also be covered if you are a cross-border resident and have an E121 form.

You will be covered by state medical insurance if you are an EU citizen and have an EHIC card or a S1.

If you are a student from outside the EU, you will need to take out comprehensive private health insurance.

If you are resident in Gibraltar, your family will be covered under the national insurance scheme. If you are a cross-border worker, your dependents will need to fill in an S1 form 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 if the following conditions are met:

• treatment becomes necessary on medical grounds during their stay in the 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 you live

If you are an EU national who is not employed, but who is resident in Gibraltar, and if you are in receipt of private insurance or have an E111 form for medical cover, you may be asked to pay a voluntary contribution into the GPMS.

State insurance will not normally cover dental treatment, although all dental treatments are free for children.

Contributions are currently 10% of your gross salary, subject to a minimum of £6.05 and a maximum of £30.25 per week / a minimum of £26.22 and a maximum of £131.08 per month.

Some expats take out private insurance even if they are covered by the state health insurance system, as the latter does not cover all eventualities.

Most companies will offer plans for dental treatment, and may also offer repatriation cover.

If you are a cross-border worker, some private plans cover you for Spanish healthcare as well.

If you are an EU citizen, have a pre-existing condition and need, for example, regular blood tests, it is a good idea to take out some private cover rather than relying on your EHIC.

If you are planning on accessing private treatment, it is more effective to take out private cover rather than relying on out of pocket one-off payments, as treatment in Gibraltar can be expensive.

Private insurance will entail speed of access to treatments and better facilities. Packages vary but will usually cover:

• hospital charges, including accommodation, nursing care, meals, drugs and dressings
• specialist fees
• tests, including X-rays, CT scans and MRI scans
• radiotherapy/chemotherapy
• psychiatric treatment
• out-patient treatment
• consultations with specialists
• nursing at home
• private ambulances
• complementary medicine
• minor surgery
• hospice care

For those seeking international private medical insurance (iPMI) cover for multiple countries including Gibraltar, numerous variables can have an impact on the cost.

The most important variables are:

• age (the higher the more expensive)
• area of cover (i.e. in addition to Gibraltar, which other areas is coverage required in? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
• product choice (higher end insurance products are more expensive)

Other variables include:

• deductibles
• co-insurance
• payment frequency
• gender
• nationality
• country of residence

As so many variables have an effect on the cost of international private medical insurance in 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.

A number of international private companies operate in the region including:

• Aetna
• Apex
• AXA
• Bupa Global
• Castiel Winser
• Capurro Insurance
• Cigna Global

Soy ciudadano britanico - I am a British citizen

Tengo seguro de salud privado - I have private health insurance

Tengo una tarjeta EHIC - I have an EHIC card