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Healthcare in Spain… Among the Best in Europe


The healthcare system in Spain is widely envied across Europe – and for several good reasons. Hospitals, clinics and surgeries are solidly professional and inclusive, offering modern facilities, relatively short waiting times and exceptional service, consultations, referrals and treatments (often – at least in popular tourist’s areas – including in languages other than Spanish).


Which country is competent for your healthcare cover in Spain?

This depends on your personal circumstances, including situations such as whether you are working or have worked in Spain, are in receipt of a UK state pension or whether you are a family member of someone who has cover.

In which situations will SPAIN cover you?

If you work and pay social security contributions in Spain, you will be covered by Spain. In this case, you should register at your local health centre with your social security number.

If you are in receipt of a Spanish state pension or benefit, the INSS (social security office) will issue you with a document confirming this. You must present the document at your local health centre.

If you are not entitled to healthcare through any options listed above in Spain or any from the UK listed below, and you have a permanent residence certificate (green card obtained from the National Police), you may be eligible for healthcare on the basis of residency (read the Spanish law Real Decreto-ley 16/2012, de 20 de abril for reference. Please apply for the ‘documento acreditativo del derecho a asistencia sanitaria’ from the INSS. If you are required to present a documento de no exportación (Legislation Letter), you will need to apply for one from the Overseas Healthcare Service (+44 191 218 1999).

In which situations will the UK cover you?

You will be covered by the UK for healthcare if you are a UK state pensioner, a UK posted worker (also self-employed) or in receipt of a long-term sickness benefit then you should be covered by the UK. You could also be covered if you are a dependent family member of someone in the above situation. Please make sure that you change your healthcare entitlement as soon as you are in receipt of healthcare cover in your own right, as listed in paragraph below.

UK state pensioners or can register for healthcare in Spain by applying for an S1 (E121) form from the Overseas Healthcare Service (+44) 191 218 1999. The form can take up to 28 days to arrive at your Spanish address, so it is highly recommended to apply for it before moving to Spain. If any of your family members need to receive healthcare as your dependent because they may not be entitled to healthcare cover in Spain in their own right, then you can apply for a separate S1 form as your dependent.

Once you have received the S1 form, you will need to register it at the nearest Spanish social security office (Instituto Nacional de la Seguridad Social – INSS).

The S1 gives you the same medical cover in Spain as a Spanish national under the Spanish state-run health scheme. This cover may not be the same as you would expect to receive on the NHS in the UK so you may have to pay for some treatments or services and some social services may not be available.

UK posted workers are those who remain insured in the UK National Insurance scheme. Before moving to Spain your UK employer will need to fill out the application form CA3821 and the worker will need to complete the CA3822. You can find the forms here

They will need to be returned to the International Caseworker’s Insurability Team (ICW) at the address given on the application forms. If you have any enquiries about the forms, please contact Her Majesty’s Revenue & Customs (HMRC) on (+44) 191 203 7010.

You will then receive an A1 along with an S1 form if your posting will last more than two years. For any period less than two years you should continue to use a UK European Health Insurance Card in conjunction with the A1. If you are issued with an S1 you will need to take it to the nearest social security office in Spain (Instituto Nacional de la Seguridad Social) to register for healthcare. You will also need to take your Certificado de empadronamiento or ‘padrón‘, which you get from your local Town Hall. As soon as you’ve registered at the INSS, you will receive a Documento acreditativo that you will need to take together with your ‘padrón‘ every time you go to the local GP or public hospital. You will not be assigned a GP like you would in the UK because your S1 form for healthcare cover is temporary.

A dependent on a family member working and living in the UK can also request an S1 form from Her Majesty’s Revenue & Customs (HMRC) by calling (+44) 191 203 7010. As above it will need to be registered at the Spanish social security office (INSS).

Registering with the Spanish authorities

In order to register your S1 form with the Spanish social security office (INSS), you will also need to obtain the following documents:

Certificate of Residence in Spain (Certificado de Residencia with your Numero de Identificacion Extranjero) – available from your nearest National Police station. You can be assigned a NIE without having taken out residency therefore please make sure your NIE is printed on a green form – not a white one.
Certificate as a Local Resident (Certificado de Empadronamiento or ‘padrón’) from the Town Hall;

You will also need to show your valid passport when registering your forms. Your local INSS office will be able to tell you if there are any other documents they require.

If you are a dependent, please make sure you legalize your marriage/birth certificate with a Hague Apostille from the Legalisation Office in the UK as you will be asked for proof of this by the Spanish authorities and at the Spanish social security office. You can now do this online


If you have permanent residency in Spain you could be entitled to healthcare on the same basis as a Spanish national. You must not have entitlement to healthcare through any other means (e.g. linked to a UK state pension or benefit). The INSS are likely to request that you are not covered by the UK for healthcare. The document you need is called Legislation Letter and can be requested from the Overseas Healthcare Service on +44 191 218 1999, or by email at

You can access the application form here However, you will need to apply in person at your local INSS office (take the above documentation along with your residency, padrón and passports and photocopies of each one). Please consult the INSS directly for the full list of requirements to support your application.


In Spain residents are required to pay a percentage of the cost of their prescription medication.

If you are of working age, you will need to pay between 40-60% on prescriptions, depending on your annual income.
If you are a pensioner, you will only have to pay 10% of prescriptions. These are also capped depending on your annual income.
If you suffer from a chronic or serious illness, you will only pay 10% on prescriptions, capped at 4,26€ per medication.


If you are returning to the UK to live, please make sure you de-register with the Spanish authorities and if you are covered by the UK for healthcare in Spain, please inform the relevant UK department as well. If you don’t, the UK might still be paying for you in Spain if you are a UK state pensioner for example!

As a reminder, please be aware that within the UK, free NHS treatment is provided on the basis of someone being ‘ordinarily resident’. It is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK.

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Kelly Summerell

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