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All residents in Spain need to register to access healthcare.

Once registered for healthcare, basic state services are free, but there are some things that patients need to pay for. For example, you usually have to pay something towards prescriptions 鈥� either a reduced price or the full price.

UK nationals usually access the Spanish national health system in one of these ways:

• through entitlement to healthcare if they鈥檙e employed or self-employed and make social security contributions in Spain
• registering a UK-issued S1 form with the social security office (see 鈥楿K-funded healthcare: getting and using an S1 form in Spain鈥� below)
• through entitlement to healthcare as a permanent resident if they鈥檝e lived in Spain for 5 years
• paying directly into the public health insurance scheme (Convenio Especial)
• using a European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) for temporary stays when studying, or as a posted (detached) worker

Healthcare if you live and work in Spain

You must register as resident or apply for the appropriate visa if you want to stay in Spain for more than 3 months. See the guidance on Living in Spain for more information about visa and residency requirements in Spain.

You must show proof of healthcare cover:

• before you can register as a resident
• when you apply for a visa

This will usually be through social security contributions as an employee, private insurance or paying voluntary contributions (the 鈥楥onvenio Especial鈥�).

If you鈥檙e working or self-employed in Spain, you鈥檙e entitled to state healthcare on the same basis as a Spanish worker. Your dependants are also entitled (see 鈥業f you鈥檙e a dependant of someone living or working in Spain鈥� below).

Register at your local health centre with your social security number. You can get a social security number from your local in Spain.

Your dependants need to .

You may be entitled to a for travel, including visits to the UK.

If you are not working and not entitled to an S1 form

If you鈥檝e been a resident in Spain for 5 years or more, you can apply for permanent residency. This will give you access to state healthcare on the same basis as a Spanish citizen.

Once you鈥檙e a permanent resident, you need to register for healthcare at your .

You鈥檒l need to show a 鈥榣egislation letter鈥� (鈥榙ocumento de no exportaci贸n鈥� in Spanish) stating that you are not covered by the UK for healthcare. You can request this by calling NHS Overseas Healthcare Services.

The INSS will give you a document which you need to take to your local health centre.

If the UK pays for your healthcare, for example through an S1 form, you cannot register for healthcare as a permanent resident.

If you are not a permanent resident and you are not working

If you鈥檝e lived in Spain for over one year, you can apply to join the public health insurance scheme. This is called the Convenio Especial. You pay a monthly fee to join the scheme, which gives you access to the Spanish health system.

You can apply if you鈥檝e been registered on the 鈥榩adr贸n鈥� (at your local town hall) for at least one year.

Find out how to apply on your .

If you鈥檝e lived in Spain for less than one year and cannot get healthcare cover, you鈥檒l need to buy private health insurance.

If the UK pays for your healthcare, for example through an S1, you cannot join the Convenio Especial.

You may have the right to apply for a UK S1 if you start drawing a UK State Pension.

If you鈥檙e a dependant of someone living or working in Spain

Dependants and family members are classified differently in Spain than the UK.

.

If you classify as a dependant of someone entitled to state healthcare in Spain (because they鈥檙e either working in Spain, a permanent resident or receiving Spanish benefits) you鈥檒l need to apply at your local .

If you live in Spain but work and make social security payments in Gibraltar

If you are covered by the Withdrawal Agreement, you are entitled to access state healthcare in both Spain and Gibraltar for as long as you continue to live in Spain and work and make social security payments in Gibraltar. You can .

If you are not covered by the Withdrawal Agreement, from 1 July 2022 you are no longer covered for state healthcare in Spain under reciprocal healthcare arrangements. You must check if you are entitled to access state healthcare in Spain via another route, or take out private healthcare insurance.

Contact the or the if you are unsure of the status of your healthcare cover.

How to access healthcare services

Once you鈥檙e registered for healthcare, you鈥檒l get a health insurance card. Take it with you whenever you visit a doctor, hospital or pharmacy.

How much you鈥檒l pay

Once registered for healthcare, basic state services are free.

There are some things that you may need to pay a percentage of the cost for, such as orthopaedic services.

Spain uses a co-payment system where residents usually pay between 10% and 60% of the cost of prescription medication. How much you pay depends on your circumstances.

If you鈥檙e paying into the Convenio Especial, you鈥檒l pay the full cost for prescription medication. You鈥檒l also pay for:

• non-urgent transportation
• orthopaedic supplies
• prostheses
• dietary supplies

Some basic dental treatment is available under the state system, but most people use private dentists. Many private insurance companies have specific dental policies.

If your UK employer has sent you to Spain temporarily (鈥榩osted workers鈥�)

A posted worker, also known as a 鈥榙etached worker鈥�, is someone employed or self-employed in the UK, but temporarily sent to a European Economic Area (EEA) country.

UK posted workers can access healthcare in Spain using a GHIC, EHIC or S1 form.

HMRC has a . They can answer questions about posted worker status and explain which documents you will need to get healthcare while posted.

UK-funded healthcare: getting and using an S1 form in Spain

There鈥檚 different guidance if you鈥檙e a 鈥榩osted worker鈥� (see 鈥業f your UK employer has sent you to Spain temporarily (鈥榩osted workers鈥�)鈥� above).

You may be entitled to state healthcare paid for by the UK if you鈥檙e a resident in Spain and receive a UK State Pension or an exportable benefit. See on the NHS website for more information about eligibility.

You may also be entitled to an S1 form if you鈥檙e a frontier worker (someone who works in one state and lives in another). You must contact HMRC National Insurance enquiries to find out if you鈥檙e eligible.

When you get your S1 form, you must register it with the INSS.

This will mean you and your dependants will be entitled to state healthcare on the same basis as a Spanish citizen.

You鈥檒l also get:

• a UK-issued GHIC or EHIC for travel
• planned treatments in other EU countries

You can find out more about and the rules on on the NHS website.

If you鈥檙e entitled to an S1 form as a dependant of a State Pensioner, your health cover will be cancelled once you begin claiming your UK state pension.

You will be sent a new S1 form to your registered address from NHS Overseas Healthcare Services. You must register this form with the INSS to ensure continuation of healthcare cover.

You are responsible for informing NHS Overseas Healthcare Services if you change your address or your circumstances change.

How to get an S1 form

If you have a UK State Pension or another qualifying exportable benefit, you must request an application form by phone from the Overseas Healthcare Services (see contact details above). This is part of the NHS Business Services Authority (BSA).

How to use an S1 form in Spain

You must register your S1 at your local or via the .

Read the guide to registering your S1 form online.

You can also .

Once your registration has been processed, the INSS will send you a Spanish social security number by post. Take this to your local healthcare centre to register.

You鈥檒l be given a medical card which you can use when you visit a doctor, hospital or pharmacy.

Studying in Spain

You should apply for a Student GHIC to get medically necessary, state-provided healthcare for the duration of your study period in Spain, whether this is for part or all of your course. This means that you鈥檒l get necessary healthcare services on the same basis as a Spanish citizen either for free or at a reduced cost.

If you already hold a valid Student EHIC you can use this until the card expires.

on the NHS website.

Getting treatment in the UK

Because the NHS is a residency-based system, under NHS rules UK nationals who move abroad on a permanent basis may lose their entitlement to free NHS healthcare.

If you are a UK national and move to the EU, you should not expect to be able to use NHS services for free when visiting the UK unless you have an EHIC, PRC or S2 to show your healthcare costs are funded by the EU country in which you now live, or another exemption applies.

Some former UK residents do not have to pay for NHS treatment when visiting England. This includes:

• UK war pensioners
• UK government employees
• UK nationals living in the EU on or before 31 December 2020, once they have a registered, UK-issued S1

Read more about using the NHS when you no longer live in the UK (see 鈥楿K nationals who no longer live in the UK鈥� in Healthcare for visitors to the UK from the EU).

If you return to live in the UK you鈥檒l be able to use the NHS like any other UK resident.

Read more about using the NHS when you return to live in the UK.