Getting recognised as entitled: the INSS step before the card

Terms used

• CAISS — A CAISS is a Social Security care office where you can handle matters in person.
• cita previa — A cita previa is an appointment you book in advance with a public office before you can be seen.

Key rules

• Employees and self-employed: You skip the INSS step, but your family members need recognition as beneficiaries.
• Appointment: You normally need an appointment at a CAISS office before you can apply.
• Next step: The INSS resolution is what you take to your regional health service to get the card.

Do you need this step?

• Employee or self-employed: registering with Social Security gives you the right, so you have no separate entitlement step. Your family members need INSS recognition as beneficiaries, and you, as the insured person, apply to add them. The same goes if you receive a Spanish contributory benefit or pension.
• Between jobs: while you receive unemployment benefit you stay covered and skip this step. When it ends and you have no other cover, you need INSS recognition.
• Pensioner with an S1, or a posted worker: you need INSS recognition. Register the S1 and your family on it.
• EU, EEA or Swiss citizen: your EHIC covers temporary stays only. Once you live here you are covered through work, an S1 or INSS recognition.
• Non-lucrative or student resident: your permit rests on private insurance, so you have no public right and no card until you join the convenio especial after one year of residence.
• Pregnant: pregnancy, childbirth and postnatal care are covered for everyone, including before you have a card. Apply for recognition and the card early so your health centre follows the pregnancy.
• Dependant of an insured person: you need INSS recognition as a beneficiary; the insured person applies.
• Resident with no job, benefit or other cover: you need INSS recognition if your income is under €100,000 a year. Above that limit, join the convenio especial or use private insurance.

Where and how to apply

You apply to the INSS at a Social Security information office (CAISS). You normally need an appointment (cita previa). Book it online through the Social Security website or by phone.

You apply in person at your appointment; some provinces also take the application online with a digital certificate or Cl@ve.

Bring your ID, your padrón registration, proof of residence and status, and any S1, family or income papers that fit your case. Non-EU nationals must also show legal residence. The recognition has no fee.

What you get

The INSS issues a resolution or certificate recognising your right to public healthcare.

Take it to your regional health service to ask for your health card. The decision takes two to four weeks from your appointment. What covers you in the meantime is on the while-you-wait page.

How long it lasts

How long it lasts depends on your basis. If you were recognised as a resident with no other cover, it is checked periodically. It has a fixed term, and renewal depends on your residence and income. If your right comes from work, a pension or an S1, it lasts while that situation lasts.

Read the end date on your resolution and note it down.

Family members as beneficiaries

The INSS recognises family members as beneficiaries of an insured person, and each one then gets their own card.

• Spouse: beneficiary, proved by the marriage certificate or family book.
• Registered partner: beneficiary, proved by the registration certificate of the partnership.
• Unmarried, unregistered partner: not covered automatically. You prove a durable relationship, such as 12 months living together or a child together, and the INSS decides case by case.
• Child: beneficiary, proved by the birth certificate or family book, until age 26, or with no age limit if the child has a disability.
• Dependent parent: a parent reunified with you is excluded as a beneficiary and needs their own private health insurance.
• Other dependent relative: beneficiary once you prove with documents that they depend on you; the INSS decides case by case.

A spouse, partner and children reunified with you are covered as your beneficiaries this way and need no private policy. Foreign certificates follow the apostille and translation rules on the card page.

The convenio especial

The convenio especial is a paid public scheme for residents who have no other public cover. You qualify after one year of registered residence in Spain. It costs €60 a month under 65 and €157 a month from 65. Apply at a CAISS office with an appointment, bringing your ID or NIE, a padrón certificate showing the year of residence and a declaration that you have no other cover. Take the INSS certificate to your regional health service for the card. The card lapses if you stop paying.

If the INSS refuses

The INSS office that decided gives you the reason in writing on request. Send your appeal to that same office within 30 days, or reapply once you meet the conditions.

If you are still abroad

You cannot apply yet: register on the padrón first, then apply to the INSS. The cover to arrange before you leave is in What to arrange before you move so you are not uncovered.

Documents you need

• The application form to recognise your right to healthcare (solicitud de reconocimiento del derecho), from the INSS.

• Your ID: a DNI, or your NIE with your passport, or the EU registration certificate.

• Proof that you live in Spain: your padrón registration (empadronamiento) from the town hall.

• If you are a dependant of an insured person: proof of the relationship, such as the family book or a marriage or birth certificate.

• If you are an EU, EEA or UK pensioner or a worker posted abroad: your S1 form or equivalent.

• If you are a non-EU national: proof of legal residence, and in some cases a document showing no coverage by another system.