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EU, UK and S1 healthcare rightsArticle 1 of 7 · 8 min read

Does being an EU citizen change your healthcare route in Spain?

Being an EU, EEA or Swiss citizen gives you a choice of route only in some situations. This page helps you decide whether you stay under your home country's cover or enter Spanish cover, depending on whether you work, study, look for work, or are retired or inactive.

Terms used

S1 — The S1 is a form from your home country's institution that makes it pay for your healthcare in Spain.

A1 certificate — The A1 certificate shows a posted worker stays in the home country's social security system while working in Spain.

Convenio especial — The convenio especial is a paid scheme giving public healthcare to people not otherwise covered, with a monthly fee.

Certificado de registro — The certificado de registro is the certificate proving an EU, EEA or Swiss citizen is registered as living in Spain.

Padrón — The padrón is the register of residents at your town hall.

INSS — The INSS is Spain's national social security institute, which recognises the right to healthcare.

TGSS — The TGSS is Spain's Social Security treasury, where workers register and pay contributions.

Key rules

EHIC: An EHIC is for temporary stays only and does not cover you as a resident.

Work: If you work in Spain, you normally enter Spanish cover, unless you are a posted worker with an A1 certificate.

Not working: If you do not work and have no S1, you need comprehensive private insurance, and public care comes only through the convenio especial or insured-status conditions.

Unemployment benefit: Exporting unemployment benefit keeps you under the paying country's cover through an S1, normally for up to three months, extendable to six.

The short answer

Your EU, EEA or Swiss passport does not give you Spanish healthcare by itself. What decides your route is what you do in Spain: work, receive a pension, look for a job, study, or none of these.

An EHIC is only for temporary stays. Once you live in Spain, you are covered in one of two ways: by your home country's instruments (an S1, or posting with an A1 certificate), or by registering in the Spanish system. Which one depends on your activity.

When your EHIC stops working

Your EHIC or GHIC stops covering you once Spain becomes your habitual home, even if the card has not expired. In practice, that is the day you settle here, for example when you register as a resident. Habitual residence is judged case by case, so do not wait for the card to expire. Have your new cover ready before you settle.

Which route fits you

You work or are self-employed in Spain. You enter Spanish cover. Spain is responsible for you whatever your nationality or where you live. You register with Social Security (TGSS) and contribute, then ask your regional health service for a health card. Exceptions are posted workers, people who work in several countries, and some civil servants and seafarers.

You are a posted worker. If your employer sends you here temporarily and you hold an A1 certificate from your home social security institution, you stay in the home system.

You are a pensioner with an S1, or a family member of one. You stay under home cover. Your home country pays Spain for your care. Your home institution issues the S1 and decides eligibility.

You are looking for work and export unemployment benefit. You get an S1 from the country paying the benefit. Export normally lasts up to three months, extendable to six. If you do not export benefit, or you have worked in Spain, Spanish rules apply. Those who qualify for Spanish unemployment benefit are covered through the Spanish system.

You are a student. If you are insured at home, your EHIC covers medically necessary care during your studies. If you are a resident with no home cover, you usually need private insurance or the convenio especial.

You are not working and have no S1. You do not get public cover automatically. To have a right to reside, you need sufficient resources and comprehensive private health insurance. You also register as an EU citizen (certificado de registro) and in the padrón. For public care, you have two options:

The convenio especial: a paid scheme for people not otherwise covered. It costs a monthly fee and requires one year of residence in Spain.
Meeting the insured-status conditions under Spanish law. The INSS then issues a recognition of your right to healthcare.

How to decide

Check whether a home-state instrument applies to you (A1, S1, exported unemployment benefit). If it does, ask your home institution for the form before you travel.
If you will work here, plan to register with Social Security and get your health card.
If neither applies, arrange private insurance and ask Social Security about the convenio especial.

The comparison, decision, timeline, documents and FAQ below set out the details for each case.

Choosing between options

Should you stay under home-country cover or enter Spanish cover?

Stay under home-country cover: You are a posted worker with an A1 certificate, an S1 pensioner or family member, exporting unemployment benefit, or a student insured at home using the EHIC for necessary care during your studies.
Enter Spanish cover through work: You work as an employee or self-employed person in Spain and are affiliated to Social Security; you then get a health card from your regional health service.
Enter Spanish cover through private insurance and the convenio especial: You are not working, have no S1, and hold comprehensive private insurance and registration; the convenio especial is a paid scheme, or you can ask the INSS to recognise your right to healthcare.

If a home-country institution gives you an A1 or S1, stay under home cover. If you work in Spain, Spain covers you. Otherwise, arrange private insurance and look into Spanish paid or insured-status routes.

S1, EHIC, GHIC and Spanish card compared side by side

The table below shows who each document is for, who pays and when it stops. The Spanish health card is the destination: the other documents either lead to it or cover you only until you have it.

	S1	EHIC	GHIC	A1	Spanish health card
Who it is for	People who live in Spain but are insured by another state, such as pensioners, and their dependants	Visitors from the EU/EEA who are insured at home	Visitors from the UK who are insured at home	Posted workers and cross-border workers, who need proof of which country's social security applies to them	People who are registered in the Spanish system, for example through work, an S1 or other eligibility
What it does	Registers you for Spanish healthcare while another state is responsible for you	Covers temporary visits	Covers temporary visits	Proves your social security stays in your home country. It is not a health card	Gives you normal access to Spanish public healthcare
Who pays	The state that issued the S1, such as the one paying your pension	Your home state's health system	Your home state's health system	You and your employer keep paying social security contributions in the country named on the certificate	Spanish social security, or the state that issued your S1
When it stops	When the issuing state withdraws or cancels it, you leave Spain, or the holder dies. It also stops if you start working in Spain, because you are then insured in the Spanish system	An EHIC or GHIC stops being valid once you make Spain your habitual home, even if the card is still in date	Same as the EHIC	On the end date shown on the certificate	When you lose the right it was based on, such as your entitlement or insurance

What to watch for

EHIC and GHIC are not a cover plan for living in Spain. Residence is judged case by case, so do not wait for the card's expiry date. Arrange Spanish cover as soon as you settle.
S1 dependants follow the main holder. A dependant's S1 changes if they stop qualifying, for example after a divorce or when a child reaches the age limit.
S1 holders must report changes. Tell the INSS (Spain's social security institute) and the institution that pays you about any change of address or family status. Each sets its own notification deadlines, so ask them directly.
Starting work in Spain changes your cover. You are then insured under the Spanish system rather than on an S1.

Timeline and deadlines

Your EHIC or GHIC stops covering you and you need Spanish or S1-based cover: on the date you make Spain your habitual home

Documents you need

A1 certificate, issued by your home country's social security institution, if you are a posted worker staying in your home system.
S1 form, issued by your home country's health or pension institution, if you are an S1 pensioner or family member, or exporting unemployment benefit.
Comprehensive private health insurance policy, if you are not working and have no S1.
Certificado de registro (EU citizen registration certificate), if you are an inactive EU/EEA/Swiss citizen living in Spain.
Padrón registration (the certificate showing you are registered at your town hall), if you are an inactive EU/EEA/Swiss citizen living in Spain.

Frequently asked questions

Can I keep using my EHIC after I move to Spain?

No, your EHIC stops working once you make Spain your habitual home, even if the card is still in date. It only covers temporary visits. After that you need cover through an S1, work-related insurance or another Spanish eligibility route.

Which workers stay under their home country's system while working in Spain?

Posted workers with an A1 certificate stay in their home social security system. Most other employees and self-employed people working in Spain are covered by Spain once they are affiliated to Social Security. People who work in several countries usually fall under the country where they live, if they work a substantial part there.

How long can I keep home-country cover while looking for a job in Spain?

If you export unemployment benefit from another country, you stay covered by that country for up to three months, extendable to six, through an S1. Without exported benefit, Spanish rules apply to you.

What can I do for healthcare if I am not working and have no S1?

You generally need comprehensive private health insurance to meet the residence requirement, and you do not get public cover automatically. You can then ask about the convenio especial, a paid scheme for people not otherwise covered, which needs one year of residence in Spain.

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