Form S1: how a foreign state pension can pay for Spanish healthcare

Key rules

• Who pays: The state paying your pension covers the cost of your Spanish care, not you.
• Residence: You must live in Spain, and an S1 for a temporary stay will not work.
• Family: Each family member registers separately and normally gets their own health card.
• Working in Spain: If you start work in Spain, you are insured under the Spanish system instead of the S1.

Who can use an S1

An S1 from the state that pays your pension lets you and your family register with the INSS and get a Spanish health card. The pension-paying state covers the cost, not you.

Spain accepts an S1 issued by another EU or EEA state, Switzerland, or the UK (under the Withdrawal Agreement). It works for:

• pensioners who live in Spain and are paid a pension by that state
• people on certain long-term benefits, such as some invalidity benefits
• family members of those people
• some others, such as families of posted or frontier workers, and people exporting unemployment benefit

You must live in Spain, and the S1 must be valid. An S1 issued for a temporary stay will not do. For states other than the UK, the issuing state's own rules also apply, so ask the office that pays your pension if you are unsure.

What to do, in order

1. Ask your pension-paying office to issue an S1 for Spain.
2. Register on the local residents' list (the padrón) and get your registration certificate or NIE.
3. Register the S1 with the INSS and collect your certificate of entitlement.
4. Take that certificate to your health centre to get your health card.

The process below walks through each step, and the documents list shows what to bring. Requirements vary by provincial INSS office, so ask yours what it wants.

Your family

Your spouse or registered partner and dependent children can be covered. They may be on your S1 or have their own, issued by your home state. Who counts as family follows your home state's law.

Each family member registers with the INSS with the S1 and their own documents. Each normally gets their own health card. A family member who works in Spain or has their own entitlement is covered in their own right instead.

What the S1 covers

You get the same public healthcare as people insured in Spain, through the national health system. That includes GP, specialist and hospital care, and prescriptions. Private treatment is not covered.

You still pay the same copayments as Spanish residents. Pensioners pay a share of pharmacy prescription costs, based on income and capped each month. Some services are excluded or limited, such as most private dental and optical care.

When your cover changes

Tell the INSS and the office that pays your pension promptly if any of these happen:

• your home state withdraws the S1, for example if your pension stops
• you leave Spain or move to another state
• you start work in Spain, because then you are insured under the Spanish system instead
• a family member stops qualifying, for example after a divorce or when a child reaches an age limit

Also report changes of address or family status. Family members' S1s generally follow yours. If you die, the S1 cover ends.

Registering your S1 in Spain and getting your health card

From home-country S1 to Spanish health card

• Ask the office that pays your pension to issue an S1 for Spain: Before you move, as early as you can. It often takes weeks to a few months

• Send your request form, proof of pension, ID and your Spanish address, and ask for the S1 to go to you or straight to the INSS: When you apply for the S1

• Register on the local residents' list (padrón) and get your registration certificate or NIE: After you arrive in Spain, before booking the INSS

• Book an INSS appointment at a CAISS office through the Social Security online appointment system or by phone: Once you have the S1 and your padrón certificate or NIE

• Go to the appointment in person with your original documents: On the appointment day. Some offices also accept documents by email

• Collect your certificate of entitlement to healthcare, and a Social Security number if you need one: Often the same day or within a few days

• Take the certificate, passport or NIE, padrón certificate and sometimes a photo to your health centre or regional health service and ask for the tarjeta sanitaria: After INSS registration. The card usually follows within days to weeks

• If the S1 has not arrived or the INSS cannot find it, contact your home-country pension office and ask them to resend it to you or the INSS: If it has not arrived after the usual few weeks

Documents you need

• The original S1 (or certificate of entitlement), issued by the pension-paying state's institution.

• Your passport or national ID.

• Your NIE or EU registration certificate.

• A padrón certificate (local residents' list) showing your address, issued by your town hall.

• The application form provided by the INSS.

• For family members: their own IDs, plus proof of relationship such as a marriage certificate if the S1 does not include them.

• Some provincial offices also ask for a Social Security number request form or your bank details.

What to watch out for

• An S1 for a temporary stay will not work: Spain accepts an S1 only if you live in Spain, the home state is the one paying for your care, and the S1 is valid and not for temporary stays. Otherwise the INSS cannot register you. Check with the office that pays your pension that the S1 is issued for residence in Spain before you book your INSS appointment.

• Cover can end without warning if the S1 is withdrawn: Your cover ends if your home state cancels the S1, for example when your entitlement is lost or your pension stops. Family S1s generally follow the main holder's. Tell the INSS and the paying office promptly about any change, including a new address or family status.

• Starting work in Spain changes your cover: If you take up work in Spain, you are insured under the Spanish system, not on an S1. Tell the INSS before you start so your cover is switched correctly.

• A dependant can drop out of cover: A spouse after divorce, or a child who reaches the age limit or becomes independent, stops qualifying. Ask your home state's pension office what the dependant needs to do, and report the change to the INSS.

Frequently asked questions

Can my spouse be covered by my S1 in Spain?

Yes, your spouse can be covered by your S1, either on the same form or on a separate S1 issued for them by your home state.

What do I still pay for with an S1 in Spain?

You still pay the same copayments as Spanish residents, mainly a share of pharmacy prescription costs. For pensioners this share is income-based and capped each month. Most private dental and optical care is excluded, and private treatment is not covered.

What happens to my S1 cover if my circumstances change?

Your cover ends or changes if your home state cancels the S1, you leave Spain, you start work in Spain or you die. A dependant's cover changes after divorce or when a child passes the age limit.