Public healthcare when you work or are self-employed (autónomo)

Terms used

• TIE — The TIE is the residence card issued to non-EU foreigners.
• Alta — The alta is your registration in Seguridad Social as an employee or autónomo.
• Autónomo — An autónomo is a self-employed worker who pays monthly Social Security contributions.
• Tarjeta sanitaria — The tarjeta sanitaria is the card that lets you use public healthcare in your region.
• INSS — The INSS is the national Social Security institute that recognises your entitlement to health care and benefits.
• CAISS — A CAISS is an INSS office where you can handle Social Security matters in person.
• Centro de salud — The centro de salud is your local public health centre, where you register with a doctor.
• Padrón — The padrón is the town hall register of residents; its certificate proves your address.

Key rules

• Entitlement: Your alta gives you the right to public healthcare, so no separate health application is needed.
• Card: You still have to register at your centro de salud or regional health office to get the tarjeta sanitaria.
• Late registration: If your employer registered you late, your cover can be recognised from the alta date.
• Unpaid quotas: Unpaid autónomo quotas can lead to a baja de oficio, after which you can lose entitlement.

Your alta gives you the right to public healthcare

Once you are registered in Seguridad Social, you are entitled to public healthcare. This applies to employees and to autónomos. You do not need to make a separate health application.

Entitlement is not the same as having the card. You still need to get the tarjeta sanitaria through the INSS and your regional health service. The steps are below.

When your cover starts

Your cover starts from the date of your alta. Your employer must register you before you start work.

If the employer registers you late, your cover can still be recognised from the alta date. Keep your payslips and contract in case you need to show when you started.

How to get your health card

Do it in this order:

1. Confirm your alta. Check that Seguridad Social has registered you. The alta gives you a Social Security number if you do not already have one. Note it down.
2. Check that the INSS has recorded your entitlement. In most cases this happens automatically from the alta. Many regions check it themselves. If the system does not show it, request the INSS document recognising your entitlement. You can do this at a CAISS office or online.
3. Register at your centro de salud. Go to the one for your address, or to your regional health service office. Bring your ID or TIE, your padrón certificate and your Social Security number. Bring the INSS document too if they ask for it.
4. Receive your tarjeta sanitaria. Some regions give it to you on the spot. Others send it by post.

Procedures and online options differ between regions. Ask your regional health service what it offers.

If you are an autónomo and fall behind on quotas

Your health entitlement generally continues while you stay registered, even if you owe quotas. Cash benefits, such as sick pay, are different. For these you need your payments up to date.

Do not ignore the debt. Seguridad Social can claim it with surcharges. If it decides your activity has ended, it can cancel your registration (a baja de oficio). After a baja, you can lose your entitlement unless another route to public healthcare applies to you. If you owe quotas, ask the TGSS or INSS what to do before it reaches that point.

The timeline, documents, checklist and questions below go through these steps in more detail.

Timeline and deadlines

• Employer registers you in Seguridad Social: before work begins

• Your health cover starts: from the date of your alta

• Cover is recognised from the alta date if the employer registered you late: if the alta is made late

Documents you need

• Your ID or TIE (residence card), to register at the centro de salud or regional health service office.

• A padrón certificate (proof of your address, issued by your town hall), to register at the centro de salud for your address.

• Your Social Security number, which the alta gives you if you do not already have one.

• The INSS document recognising your health entitlement, issued by the INSS (at a CAISS office or online), if the regional health service asks for it.

Checklist

• Confirm your alta with Seguridad Social and note your Social Security number.

• Check that the INSS has recorded your entitlement, or request it at a CAISS office or online.

• Register at the centro de salud for your address or at the regional health service office, bringing your ID or TIE, padrón certificate and Social Security number.

• Bring the INSS document recognising your entitlement if the office asks for it.

• Collect your tarjeta sanitaria, or wait for it to arrive by post.

• Ask the TGSS or INSS what to do if you are an autónomo with unpaid quotas.

What to watch out for

• Unpaid autónomo quotas can end your registration: Your health entitlement generally continues while you are in alta, even with arrears. But persistent non-payment can lead the TGSS (Social Security's collection office) to claim the debt with surcharges, and to remove you from the system automatically (baja de oficio) if it decides your activity has ended. After a baja you can lose entitlement. Pay or agree a plan for any arrears with the TGSS. If you are removed, ask the INSS whether another route, such as the universal route, applies to you.

• Cash benefits need quotas up to date: Health care does not depend on up-to-date payments the way cash benefits do. As an autónomo you must be up to date to claim cash benefits. Keep your quotas paid before you make any claim for cash benefits.

Frequently asked questions

Do I need a separate health application after my alta?

No, you do not need a separate health application after your alta in Seguridad Social, because the alta itself gives you asegurado status. The INSS normally records your entitlement automatically. Then you ask the regional health service for the tarjeta sanitaria.

What if the system does not show my health entitlement?

If the system does not show your entitlement, you can request the INSS document that recognises it. You can ask for it at a CAISS office (an INSS service office) or online. Bring that document when you register at the centro de salud.

Is my health cover back-dated if my employer registered me late?

Yes, your cover can be recognised from the alta date even if your employer registered you late, because the alta counts as existing in law. Employers must register you before work begins. Ask the INSS or your regional health service to record the earlier date.

Do I lose public healthcare if I fall behind on autónomo quotas?

Generally no, your health entitlement continues while you are in alta, even with unpaid quotas. Cash benefits are different, since you must be up to date for those. Persistent non-payment can lead to a baja de oficio (automatic removal), after which you can lose entitlement unless another route, such as the universal route, applies.