UK nationals in Spain: healthcare under the Withdrawal Agreement

Key rules

• Cut-off date: S1 cover under the Withdrawal Agreement is for people lawfully resident in Spain before 1 January 2021.
• GHIC: The GHIC is for temporary visits only and does not cover people who live in Spain.
• Arrived after 2020: You need work registration, the convenio especial or private insurance, unless you fall into a limited S1 case.
• S1 decision: The NHS Business Services Authority decides whether you get an S1.

Your route depends on when you became resident

Your date of arrival in Spain decides most things. If you were lawfully resident in Spain before 1 January 2021, you may keep UK-funded cover through an S1. If you arrived after 31 December 2020, you cannot get an S1 on that basis and your routes are narrower.

If you lived in Spain before 2021

An S1 means the UK pays for your Spanish public healthcare. You register it with the Spanish health service and then use the public system like a Spanish resident.

You may be eligible if you were covered before the end of 2020 and were lawfully resident in Spain by then. That includes:

• UK state pensioners and other S1 holders living in Spain.
• Frontier workers and certain posted workers.
• Family members who were covered, or who joined the holder on the basis of the Withdrawal Agreement.
• People with certain qualifying UK benefits, with conditions.

The S1 is issued by the NHS Business Services Authority through its Overseas Healthcare Services. Eligibility depends on your individual circumstances and on their decision, so ask them before you assume you qualify. The FAQ below covers spouses and children.

If you moved after 31 December 2020

You are not covered by the Withdrawal Agreement. A new UK pensioner can still get an S1 in limited cases, for example if the Withdrawal Agreement still protects you as a resident, or under the UK-EU trade agreement, which applies to some pensioners. Otherwise, your routes are:

• Work. If you are employed or self-employed and registered in the Spanish social security system, you get public healthcare through that registration.
• Convenio especial. This is a paid scheme for residents without other cover. It runs through the regional health service and the social security institute (INSS). Terms and regional rules vary, so confirm them with both.
• Private health insurance. Non-lucrative visas and most other residence visas require it.

The decision block below helps you choose between these.

The GHIC is for visits only

The UK GHIC covers medically necessary state-provided care during a temporary stay in Spain. You are treated by public providers on the same terms as Spanish insured people, including any copayments. It does not cover private care, planned treatment or repatriation. It is not for people who live in Spain, so do not rely on it once you are resident.

Choosing between options

Which healthcare route fits you as a UK national in Spain?

Which route to Spanish healthcare fits your situation as a UK national?

• UK-funded S1 cover: You were already living in Spain before 2021 and are covered by the Withdrawal Agreement, for example as a UK state pensioner.

• Work and social security registration: You moved after 2020 and work in Spain as an employee or self-employed person, registered in the Spanish social security system.

• Convenio especial: You moved after 2020, have no other public cover, and are willing to pay a monthly fee as a resident. It is run through the regional health service and the social security office (INSS).

• Private health insurance: You moved after 2020 on a visa that requires private cover, such as a non-lucrative visa and most other residence visas.

If you were resident in Spain before 2021, use the S1 route. If you arrived later, you cannot get an S1, so choose work registration, the convenio especial or private insurance, depending on whether you work, need a visa, or have no other cover.

EU and UK healthcare rights: S1, GHIC and Brexit quick answers

Can my spouse and children be covered under my S1 in Spain?

Yes, your spouse and dependent children can be covered by your S1, either on the same form or on separate S1s issued for each of them. Who counts as family follows the rules of the country that issued the S1, and usually includes a spouse or registered partner. Each family member registers with the INSS, Spain's social security office, with the S1 and their own documents, and normally gets their own health card.

What if my spouse works in Spain or has their own cover?

A family member who works in Spain or has their own entitlement is covered in their own right, not through your S1. They get cover once they are affiliated with Social Security and have a Social Security number.

Can I renew my GHIC from Spain?

Only if you still normally live in the UK. Renewal is free on the official NHS website and online applications can generally be made from abroad. If you have moved to Spain permanently, you are not eligible and should not renew it. Unofficial websites charge fees, so avoid them.

Do I need a residence certificate before I can get a Spanish health card?

Not strictly by law if you work and are affiliated with Social Security, but offices often ask for it. Regional health services usually want proof of where you live (padrón) and a document from the INSS showing your right to healthcare. EU citizens are often asked for the registration certificate with NIE too, so ask your local office what it requires.