Applying for a health card in Spain

First establish the basis for your entitlement

A Spanish social security number is neither recognised entitlement to healthcare nor a health card. What matters is whether you are employed or self-employed in Spain, receive a pension, can be registered as a family member, or are transferring your entitlement to Spain from another state.

Foreign nationals who are legally and ordinarily resident in Spain may be entitled to publicly funded healthcare if they are not required to demonstrate compulsory cover through another state, a special scheme or another liable body. For this route, legal residence is evidenced by the relevant residence document and ordinary residence by empadronamiento, registration with the local authority, according to information from the Seguridad Social.

1. Check your employment, pension and previous insurance status.
2. Ask your previous insurer whether it remains responsible for your healthcare costs.
3. Depending on the outcome, contact either the National Social Security Institute or the regional health service.

Employees and self-employed people

Anyone properly registered with Spanish social security as an employee or self-employed person is generally entitled to healthcare. Even so, check whether the derecho a asistencia sanitaria, the right to public healthcare, is recorded in the system. The Seguridad Social’s electronic office provides a facility to check and obtain proof of this.

Once you have proof of entitlement, register with the relevant regional health service. Depending on the autonomous community, this can be done at a centro de salud, a public health centre, at a card office or online. The regional authority then issues the Tarjeta Sanitaria Individual.

1. Check your registration with the Spanish social security system.
2. Access proof of your healthcare entitlement online or apply for it through the National Social Security Institute.
3. Then register with the regional health service and ask to be assigned to a health centre.

Pensioners and the S1 document

If you receive a Spanish pension, your entitlement may arise under the Spanish system. If you receive a pension only from another European Union state and are entitled to healthcare there, that state, which pays your pension, is generally responsible. Request the portable document S1 from its health insurer and register it in Spain with the National Social Security Institute.

There is an important exception for pensions from several states: if both Spain, as the state of residence, and another state pay a pension that gives rise to entitlement, the state of residence is generally responsible. Cases involving several states must nevertheless be assessed individually. Once the S1 has been registered, you will receive proof of entitlement in Spain and can use it to apply for the regional health card.

1. Ask the relevant pension or health insurer to establish which state is responsible for the costs.
2. If applicable, request the portable document S1 from that body.
3. Register the S1 with the National Social Security Institute in Spain.
4. Then apply for the regional health card.

Family members

Spouses, officially registered partners, and certain dependent descendants and equivalent persons may be registered as beneficiarios, or beneficiaries, subject to the statutory conditions. Descendants must generally be under 26 or have a recognised degree of disability of at least 65 per cent. There are also requirements concerning residence and the absence of any independent entitlement that takes precedence.

As a rule, an application for registration must be made to the National Social Security Institute. For children under three months old, the electronic service provides for immediate recognition. For other people, the relevant provincial directorate assesses the application. Each person registered is then issued their own regional health card.

1. Check whether the family member already has an independent entitlement.
2. Prepare evidence of the family relationship and registration, and, where applicable, financial dependency.
3. Apply to register the person as a beneficiary.
4. Then register the person with the regional health service.

People who are not working and other routes to access

People who are not working do not automatically receive a health card solely because they live in Spain or have a social security number. Foreign nationals who are legally and ordinarily resident in Spain may have their entitlement assessed if they do not have compulsory cover through another state or payer. This route may require a residence document and empadronamiento.

Since Real Decreto 180/2026 of 11 March 2026, people without legal residence have been covered by a separate procedure. Among other things, they must declare or prove that no other state or third party is required to cover the costs. The procedure is determined by the autonomous community. Once the required documents have been submitted, a provisional proof of entitlement must be issued, so there is no need to wait for the final decision.

If you are not entitled to publicly funded healthcare, a convenio especial de prestación de asistencia sanitaria may be an option. This is a special, fee-paying agreement for healthcare services. It is administered by the autonomous communities, so the requirements and place of application should be checked regionally.

1. Establish whether another state may be providing cover.
2. Apply for recognition through the route provided for your circumstances.
3. If you are not entitled, ask the regional health service about a convenio especial.

Regional card and required documents

The autonomous health authorities, and the Instituto Nacional de Gestión Sanitaria in Ceuta and Melilla, issue the Tarjeta Sanitaria Individual to people whose entitlement has been recognised. A card issued by the competent authority is valid throughout the Sistema Nacional de Salud. Regional registration is still important, however, as it determines your assignment to doctors and facilities where you live.

The place of application, appointment requirements, online procedures and documents vary by region. You may be asked for proof of entitlement, a passport or other official identity document, a foreigner identification number and proof of residence. Empadronamiento should not be presented as a uniform national requirement for every health card application. It is, however, expressly relevant when ordinary residence must be proved or the regional authority and health centre need to be determined.

1. Find the health service for your autonomous community.
2. Check its current list of required documents immediately before applying.
3. Apply for the card at the designated health centre, card office or online.
4. Keep your proof of entitlement and application receipt until you receive the card.

Using the European Health Insurance Card correctly

The European Health Insurance Card is for medically necessary public healthcare during a temporary stay. It does not replace registering an S1 or obtaining a regional health card when moving to Spain permanently. The S1, by contrast, confirms an entitlement to healthcare in the state of residence that has been transferred there and must be registered in that state.

The European Health Insurance Card is issued free of charge by the competent statutory health insurer. As a rule, it is valid only with public healthcare providers and does not cover planned treatment as a separate route to care. So if you are moving permanently, do not rely on this card alone.

1. Use the European Health Insurance Card only for the intended temporary stay.
2. If you have an entitlement transferred to your state of residence, register the S1 first.
3. If you receive conflicting information, ask for a written decision or list of required documents.