Healthcare

Registering, the European Health Insurance Card, the S1 form.

In Spain

Checked on 23 October 2026

How do you get access to the public health system when you settle in Spain?

In Spain, the right to public care is linked to residence: employees and self-employed people registered with the Seguridad Social (social security), pensioners and foreigners in lawful residence with no other cover are entitled to it. The INSS (Instituto Nacional de la Seguridad Social) recognises this right, then the health service of your autonomous community gives you your tarjeta sanitaria individual (health card) and assigns you to a health centre. Your European Health Insurance Card is only for temporary stays.

Costs: Varies depending on your situation; paid special agreement (€60 or €157 per month) if you have no other entitlement
Timeframes: Varies depending on the INSS and the autonomous community; special agreement: decision within 30 days (silence = approval), then 3 months to sign

Steps

Before leaving: if you are a pensioner with a pension from your country of origin, or posted by your employer, ask for form S1 from the institution that covers you (Your Europe). For a temporary stay (a reconnaissance trip before settling, for example), also ask for your European Health Insurance Card (CEAM) from your health insurer.
During a temporary stay: the CEAM gives you access to medically necessary care. It is no longer valid when you transfer your residence to Spain (Seguridad Social, Ministry of Health): as soon as you settle, move on to the next steps.
Complete your residence papers: padrón (town hall register) and registration certificate (sheet ES-SEJOUR-TOUS-001).
Have your right recognised:
- employee or self-employed: your registration with the Seguridad Social gives you the right;
- pensioner or posted worker with S1: present your S1 to the competent Spanish institution (the INSS: the S1 is registered at the local INSS or on its portal, according to the British government);
- other lawful resident with no other cover: request recognition of the right to healthcare from the INSS ("Asistencia sanitaria. Solicitud de reconocimiento del derecho" service on the Seguridad Social portal). The condition is that you do not have to prove health cover by another means: an EU citizen with no activity must have it in order to reside (see below). According to the Ministry of Health, an EU or EEA citizen who has resided lawfully for 5 years in a row in Spain has the right of permanent residence, and therefore access to public care, without a special agreement.
Apply for your tarjeta sanitaria individual from the health service of your autonomous community, generally at your neighbourhood health centre. That is where you choose or are assigned your doctor.

Documents

Identity: TIE card if you have one, otherwise valid passport or identity card.
Proof of lawful residence: your certificado de registro de ciudadano de la Unión.
Empadronamiento certificate (padrón registration), especially if your registration is recent.
EU, EEA, Swiss and British citizens: a certificate from the institution of your country of origin stating that it does not cover your care in Spain (no "export" of the right).
Depending on the case: representative's power of attorney, proof of family relationship for dependants, form S1.

Costs and timelines

Recognition of the right: the Seguridad Social states neither fees nor processing time on its official page: ask the INSS when you submit.
With no other entitlement: access is possible through a paid convenio especial (special agreement). Conditions (Real Decreto 576/2013, art. 3, and Ministry of Health, "Convenio especial" page, consulted on 23/10/2026): having resided at least one year without interruption immediately before the application (the decree speaks of effective residence in Spain; the ministry also accepts periods of residence in the EU, the EEA, Switzerland or the United Kingdom), being registered on the padrón at the time of the application, and not having access to public health by another means. Amount set by the State (art. 6): €60 per month before age 65, €157 per month from age 65; communities may increase it if they add supplementary benefits. Payment is monthly, according to the arrangements set by the competent administration; the agreement lapses if two consecutive monthly payments, or three non-consecutive ones, are not paid (art. 7). For the application, the administration must notify its decision within 30 days, with no reply the application is deemed accepted, then you have 3 months to sign (art. 4). It is signed with the health service of the autonomous community of your home (or the INGESA in Ceuta and Melilla). The S1 excludes the agreement. According to the ministry, you must attach a sworn statement or a non-export certificate if you come from a country covered by the European coordination regulations, from the United Kingdom or from Andorra and Chile.
CEAM during a temporary stay: care on the same terms as Spanish insured persons; any patient contribution remains at your expense.

Common pitfalls

The vicious circle for inactive people. To obtain your residence certificate without working, you already need health insurance, public or private, that covers you in Spain like the national health system. The special agreement is also a public insurance route for inactive people, but it requires one year of continuous residence before the application; before that, there remains the S1 or private insurance (Your Europe, administracion.gob.es, Ministry of Health).
Keeping your CEAM after moving. The Seguridad Social states this for its own card: it is not valid when you transfer your residence to another country. The same logic applies in the other direction.
Forgetting the non-export certificate. Without it, your application to the INSS may remain blocked. Ask your home fund for it before leaving.
The Canary Islands and the other autonomous communities. Each has its own health service: it issues the card and organises the health centres. Practical procedures vary from one community to another.

What changes by country of origin

EU and EEA citizens: CEAM for a temporary stay only; once settled, registration through work, S1, or recognition of the right as a resident with the non-export certificate (special agreement or private insurance for an inactive person without S1, permanent right after 5 years of lawful residence).
Swiss citizens: same logic (European coordination); the non-export certificate is also requested.
British citizens (Scots included): third-country nationals since Brexit, but the Seguridad Social lists them among the countries for which a non-export certificate is needed. They access the system with their residence permit (TIE). The Spanish European card remains valid in the United Kingdom; the British UK EHIC or GHIC card covers the temporary stays of British visitors in Spain (social security coordination protocol); if you reside in Spain, it is your Spanish health card that treats you.

Official sources (10) ›

The European framework

These European rules also apply in Spain.

Checked on 23 October 2026

Health insurance required for visas and permits: what EU rules ask (short and long stays)

For a Schengen short-stay visa, you must show travel medical insurance covering urgent medical care, emergency hospital treatment and repatriation (including in case of death), valid in all Schengen countries, with at least €30,000 of cover (Visa Code, Article 15). For long stays, the EU directives ask for sickness insurance covering the risks normally covered for nationals of the destination, for example for students, family members, Blue Card holders and long-term residents. The exact proof, and whether you must buy private insurance or can join the public system, depend on the destination.

Who decides: Consulates (Schengen visas); the immigration authority of the destination (long stays)
Costs: Set by insurers; Schengen visa insurance must cover at least €30,000 (Visa Code, Article 15)

Before you act

No promise. The consulate or immigration authority decides whether your insurance is acceptable. This page is general information, not legal advice.
Scams. Buy insurance only from a real, identifiable insurer, and check the policy before paying. A fake or inadequate insurance certificate can lead to refusal of your application.
Ask a professional (the insurer, the consulate or a lawyer) if you have a chronic illness, are pregnant, or are over the age limits of standard policies.
Be honest in insurance forms about your health and your plans.

Steps

Short stay with a visa: buy travel medical insurance that meets Article 15 of the Visa Code (below) for the whole trip; for a multiple-entry visa, it must cover the first trip, and you sign a statement that you know you need insurance for later trips. Exceptions: the requirement may be considered met where adequate cover can be presumed from the applicant's professional situation (for example seafarers, Article 15(6)), and holders of diplomatic passports are exempt (Article 15(7)).
Visa-exempt short stay: insurance is not among the entry conditions listed in the Schengen Borders Code (Article 6), but medical care abroad can be expensive: travel insurance is your choice.
Long stay: read the destination's list for your route. Denmark and Ireland did not take part in the five directives below and are not bound by them (see the recitals of each text), so their rules are purely national. In the other EU countries, the directives ask for insurance "for all risks normally covered for nationals" for:
- students and researchers, valid for the whole planned stay (Directive (EU) 2016/801, Article 7(1)(c));
- family reunification, for the sponsor and the family, if the country requires it (Directive 2003/86/EC, Article 7(1)(b));
- Blue Card and seasonal workers, for periods not already covered through the job (Directive (EU) 2021/1883, Article 5(1)(e); Directive 2014/36/EU, Article 5(1)(b) for stays up to 90 days and Article 6(1)(b) for stays over 90 days);
- EU long-term residents, for themselves and for dependent family members (Directive 2003/109/EC, Article 5(1)(b)).
After arrival: ask whether your permit gives access to the public health system, and from when (see the destination's health fiche).

Documents

An insurance certificate in the name of each person, with dates, cover, amount and territory.
For a Schengen visa: proof that the cover is valid in all Schengen countries and is at least €30,000 (Article 15(3)); for a visa with limited territorial validity covering several Member States, the cover must be valid at least in the Member States concerned.

Costs and timelines

Price: set by insurers. The Visa Code asks you to take insurance, in principle, in your country of residence, or in another country if that is not possible (Article 15(4)).
Check: consulates verify that claims against the insurer can be recovered in an EU country (Article 15(5)).

Common pitfalls

Cover too low or not valid everywhere. For a Schengen visa: at least €30,000 and valid in all Schengen countries.
Wrong dates. The insurance must cover the whole stay or transit (Article 15(3)).
Travel insurance for a long stay. A short-trip policy may not meet the "all risks normally covered for nationals" standard required for long-stay permits, and what each country actually accepts varies: ask the immigration authority directly before you buy.
Gaps between the visa and the permit. Keep cover until you are registered in the public system or have the insurance the permit requires.

What changes by profile

Workers may be covered through their job; the Blue Card and seasonal directives ask for insurance only for periods not covered by, or resulting from, the work contract.
Retirees and people living on passive income follow national rules for national visas (for Portugal, see PT-VISA-TIERS-050).

Official links

Visa Code (consolidated), Article 15: https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:02009R0810-20240628
Commission, applying for a Schengen visa: https://home-affairs.ec.europa.eu/policies/schengen/visa-policy/applying-schengen-visa_en

Official sources (9) ›

These guides give the general rules. Your situation can change the answer: Moovy looks at it with you and tells you when you need a professional.

In Spain

Checked on 23 October 2026

How do you get access to the public health system when you settle in Spain?

Costs: Varies depending on your situation; paid special agreement (€60 or €157 per month) if you have no other entitlement
Timeframes: Varies depending on the INSS and the autonomous community; special agreement: decision within 30 days (silence = approval), then 3 months to sign

Steps

Before leaving: if you are a pensioner with a pension from your country of origin, or posted by your employer, ask for form S1 from the institution that covers you (Your Europe). For a temporary stay (a reconnaissance trip before settling, for example), also ask for your European Health Insurance Card (CEAM) from your health insurer.
During a temporary stay: the CEAM gives you access to medically necessary care. It is no longer valid when you transfer your residence to Spain (Seguridad Social, Ministry of Health): as soon as you settle, move on to the next steps.
Complete your residence papers: padrón (town hall register) and registration certificate (sheet ES-SEJOUR-TOUS-001).
Have your right recognised:
- employee or self-employed: your registration with the Seguridad Social gives you the right;
- pensioner or posted worker with S1: present your S1 to the competent Spanish institution (the INSS: the S1 is registered at the local INSS or on its portal, according to the British government);
- other lawful resident with no other cover: request recognition of the right to healthcare from the INSS ("Asistencia sanitaria. Solicitud de reconocimiento del derecho" service on the Seguridad Social portal). The condition is that you do not have to prove health cover by another means: an EU citizen with no activity must have it in order to reside (see below). According to the Ministry of Health, an EU or EEA citizen who has resided lawfully for 5 years in a row in Spain has the right of permanent residence, and therefore access to public care, without a special agreement.
Apply for your tarjeta sanitaria individual from the health service of your autonomous community, generally at your neighbourhood health centre. That is where you choose or are assigned your doctor.

Documents

Identity: TIE card if you have one, otherwise valid passport or identity card.
Proof of lawful residence: your certificado de registro de ciudadano de la Unión.
Empadronamiento certificate (padrón registration), especially if your registration is recent.
EU, EEA, Swiss and British citizens: a certificate from the institution of your country of origin stating that it does not cover your care in Spain (no "export" of the right).
Depending on the case: representative's power of attorney, proof of family relationship for dependants, form S1.

Costs and timelines

Recognition of the right: the Seguridad Social states neither fees nor processing time on its official page: ask the INSS when you submit.
With no other entitlement: access is possible through a paid convenio especial (special agreement). Conditions (Real Decreto 576/2013, art. 3, and Ministry of Health, "Convenio especial" page, consulted on 23/10/2026): having resided at least one year without interruption immediately before the application (the decree speaks of effective residence in Spain; the ministry also accepts periods of residence in the EU, the EEA, Switzerland or the United Kingdom), being registered on the padrón at the time of the application, and not having access to public health by another means. Amount set by the State (art. 6): €60 per month before age 65, €157 per month from age 65; communities may increase it if they add supplementary benefits. Payment is monthly, according to the arrangements set by the competent administration; the agreement lapses if two consecutive monthly payments, or three non-consecutive ones, are not paid (art. 7). For the application, the administration must notify its decision within 30 days, with no reply the application is deemed accepted, then you have 3 months to sign (art. 4). It is signed with the health service of the autonomous community of your home (or the INGESA in Ceuta and Melilla). The S1 excludes the agreement. According to the ministry, you must attach a sworn statement or a non-export certificate if you come from a country covered by the European coordination regulations, from the United Kingdom or from Andorra and Chile.
CEAM during a temporary stay: care on the same terms as Spanish insured persons; any patient contribution remains at your expense.

Common pitfalls

The vicious circle for inactive people. To obtain your residence certificate without working, you already need health insurance, public or private, that covers you in Spain like the national health system. The special agreement is also a public insurance route for inactive people, but it requires one year of continuous residence before the application; before that, there remains the S1 or private insurance (Your Europe, administracion.gob.es, Ministry of Health).
Keeping your CEAM after moving. The Seguridad Social states this for its own card: it is not valid when you transfer your residence to another country. The same logic applies in the other direction.
Forgetting the non-export certificate. Without it, your application to the INSS may remain blocked. Ask your home fund for it before leaving.
The Canary Islands and the other autonomous communities. Each has its own health service: it issues the card and organises the health centres. Practical procedures vary from one community to another.

What changes by country of origin

EU and EEA citizens: CEAM for a temporary stay only; once settled, registration through work, S1, or recognition of the right as a resident with the non-export certificate (special agreement or private insurance for an inactive person without S1, permanent right after 5 years of lawful residence).
Swiss citizens: same logic (European coordination); the non-export certificate is also requested.
British citizens (Scots included): third-country nationals since Brexit, but the Seguridad Social lists them among the countries for which a non-export certificate is needed. They access the system with their residence permit (TIE). The Spanish European card remains valid in the United Kingdom; the British UK EHIC or GHIC card covers the temporary stays of British visitors in Spain (social security coordination protocol); if you reside in Spain, it is your Spanish health card that treats you.

Official sources (10) ›

The European framework

These European rules also apply in Spain.

Checked on 23 October 2026

Health insurance required for visas and permits: what EU rules ask (short and long stays)

Who decides: Consulates (Schengen visas); the immigration authority of the destination (long stays)
Costs: Set by insurers; Schengen visa insurance must cover at least €30,000 (Visa Code, Article 15)

Before you act

No promise. The consulate or immigration authority decides whether your insurance is acceptable. This page is general information, not legal advice.
Scams. Buy insurance only from a real, identifiable insurer, and check the policy before paying. A fake or inadequate insurance certificate can lead to refusal of your application.
Ask a professional (the insurer, the consulate or a lawyer) if you have a chronic illness, are pregnant, or are over the age limits of standard policies.
Be honest in insurance forms about your health and your plans.

Steps

Short stay with a visa: buy travel medical insurance that meets Article 15 of the Visa Code (below) for the whole trip; for a multiple-entry visa, it must cover the first trip, and you sign a statement that you know you need insurance for later trips. Exceptions: the requirement may be considered met where adequate cover can be presumed from the applicant's professional situation (for example seafarers, Article 15(6)), and holders of diplomatic passports are exempt (Article 15(7)).
Visa-exempt short stay: insurance is not among the entry conditions listed in the Schengen Borders Code (Article 6), but medical care abroad can be expensive: travel insurance is your choice.
Long stay: read the destination's list for your route. Denmark and Ireland did not take part in the five directives below and are not bound by them (see the recitals of each text), so their rules are purely national. In the other EU countries, the directives ask for insurance "for all risks normally covered for nationals" for:
- students and researchers, valid for the whole planned stay (Directive (EU) 2016/801, Article 7(1)(c));
- family reunification, for the sponsor and the family, if the country requires it (Directive 2003/86/EC, Article 7(1)(b));
- Blue Card and seasonal workers, for periods not already covered through the job (Directive (EU) 2021/1883, Article 5(1)(e); Directive 2014/36/EU, Article 5(1)(b) for stays up to 90 days and Article 6(1)(b) for stays over 90 days);
- EU long-term residents, for themselves and for dependent family members (Directive 2003/109/EC, Article 5(1)(b)).
After arrival: ask whether your permit gives access to the public health system, and from when (see the destination's health fiche).

Documents

An insurance certificate in the name of each person, with dates, cover, amount and territory.
For a Schengen visa: proof that the cover is valid in all Schengen countries and is at least €30,000 (Article 15(3)); for a visa with limited territorial validity covering several Member States, the cover must be valid at least in the Member States concerned.

Costs and timelines

Price: set by insurers. The Visa Code asks you to take insurance, in principle, in your country of residence, or in another country if that is not possible (Article 15(4)).
Check: consulates verify that claims against the insurer can be recovered in an EU country (Article 15(5)).

Common pitfalls

Cover too low or not valid everywhere. For a Schengen visa: at least €30,000 and valid in all Schengen countries.
Wrong dates. The insurance must cover the whole stay or transit (Article 15(3)).
Travel insurance for a long stay. A short-trip policy may not meet the "all risks normally covered for nationals" standard required for long-stay permits, and what each country actually accepts varies: ask the immigration authority directly before you buy.
Gaps between the visa and the permit. Keep cover until you are registered in the public system or have the insurance the permit requires.

What changes by profile

Workers may be covered through their job; the Blue Card and seasonal directives ask for insurance only for periods not covered by, or resulting from, the work contract.
Retirees and people living on passive income follow national rules for national visas (for Portugal, see PT-VISA-TIERS-050).

Official links

Visa Code (consolidated), Article 15: https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:02009R0810-20240628
Commission, applying for a Schengen visa: https://home-affairs.ec.europa.eu/policies/schengen/visa-policy/applying-schengen-visa_en

Official sources (9) ›

These guides give the general rules. Your situation can change the answer: Moovy looks at it with you and tells you when you need a professional.

Healthcare

In Spain

How do you get access to the public health system when you settle in Spain?

Steps

Documents

Costs and timelines

Common pitfalls

What changes by country of origin

The European framework

Health insurance required for visas and permits: what EU rules ask (short and long stays)

Steps

Documents

Costs and timelines

Common pitfalls

What changes by profile

Other topics

Healthcare

In Spain

How do you get access to the public health system when you settle in Spain?

Steps

Documents

Costs and timelines

Common pitfalls

What changes by country of origin

The European framework

Health insurance required for visas and permits: what EU rules ask (short and long stays)

Steps

Documents

Costs and timelines

Common pitfalls

What changes by profile

Other topics