How UK Nationals Get State Healthcare in Spain

UK nationals living, working, or studying in Spain can access state healthcare through various means depending on their residency status and personal circumstances. If you are travelling on vacation, you have the right to access to state healthcare.

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

• registering a UK-issued S1 form with the social security office
• through entitlement to healthcare as a permanent resident if they’ve lived in Spain for 5 years
• paying directly into the public health insurance scheme (Convenio Especial): 1 year residence
• through work or study
• using a European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) for temporary stays

Pensioners and Retirees S1 Form

You may be entitled to state healthcare paid for by the UK if you’re a resident in Spain and receive a UK State Pension or an exportable benefit.

Who can use the S1 form? The S1 form is intended for:

• UK pensioners who reside in another EEA country or Switzerland.
• Posted workers in the EEA or Switzerland who still pay their social security contributions in the UK.
• Dependent family members of pensioners or posted workers who also reside in the EEA or Switzerland.

Therefore, UK nationals receiving a UK State Pension can access Spanish healthcare through the S1 form.

What are the benefits of this system:

• Temporary residents: Temporary residents do not have an automatic right to public healthcare.

• Coverage for dependents: Dependent family members who are not eligible for healthcare coverage based on residence in Spain can benefit from the S1 of the primary holder.

• Right to retain coverage in the United Kingdom: By being registered with the S1, pensioners and other beneficiaries are entitled to free healthcare in the UK when they visit, which is not always possible for residents in Spain without the S1.

STEP 1: How to get an S1 form

If you have a UK State Pension, you must request an application form by phone from the Overseas Healthcare Services). This is part of the NHS Business Services Authority (BSA).
You can apply for an S1 form up to 90 days before moving to live in an EU country. You can ask for the form to be sent to your UK address if you need it for your visa application.
For the S1 form to be issued, you need to have an address in the EU country you are moving to.

STEP 2: How to register at the INSS

To use for S1 form you must register your S1 at your local INSS office or via the INSS online portal. You’ll need digital copies of the following documents:
• your S1 form
• a completed healthcare application form – available to download on the INSS S1 registration webpage (in Spanish)
• your passport
• your green A4 or credit-card-sized residency certificate (‘residencia’) or new TIE card (Tarjeta de Identidad Extranjera)
• an email address
• a Spanish telephone number
• your NIE (número de identidad de extranjero)

You’ll also get:
• a UK-issued GHIC or EHIC for travel
• planned treatments in other EU countries

STEP 3: At the Health Office or Health Centre

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’ll be given a medical card which you can use when you visit a doctor, hospital or pharmacy.

MORE INFO:

NHS LIVING IN SPAIN: https://www.gov.uk/guidance/healthcare-in-spain-including-the-balearic-and-canary-islands#:~:text=You%20must%20register%20your%20S1,on%200044%20191%20218%201999.

NHS S1 FORM: https://www.gov.uk/guidance/register-your-s1-form-in-spain-online

INSS S1 FORM REGISTRATION: https://prestaciones.seg-social.es/servicio/registrar-formulario-s1-asistencia-sanitaria-espana.html

Permanent Residence After 5 Years

Once you’ve 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.

• You’ll need to show a ‘legislation letter’ (‘documento de no exportación’ 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.

Paying into State Healthcare Insurance

If you’ve 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’ve been registered on the ‘padrón’ (at your local town hall) for at least one year.
• You cannot joint the Convenio Especial if you:
  • If you’ve lived in Spain for less than one year and cannot get healthcare cover, you’ll need to buy private health insurance.
  • If the UK pays for your healthcare, for example through an S1.

If you’re paying into the Convenio Especial, you’ll pay

• the full cost for prescription medication.
• non-urgent transportation
• orthopaedic supplies, prostheses
• dietary supplies
• Some basic dental treatment is available under the state system, but most people use private dentists.

How much does it cost:

a) If the signatory is under 65 years of age: monthly fee of 60 euros.

b) If the signatory is 65 years of age or older: monthly fee of 157 euros.

MORE INFO: INSS CONVENIO ESPECIAL (in English): https://www.sanidad.gob.es/en/servCiudadanos/internacional/convenioEspecial.htm

Working and Studying in Spain

UK nationals working in Spain, either for a Spanish company or as self-employed, are entitled to healthcare through their social security contributions:

• Employed: Your employer handles your registration with the Spanish social security system, which entitles you to healthcare.
• Self-Employed: You must register with the social security system yourself to access healthcare services.

S1 form can provide essential healthcare coverage for posted workers:

This form allows them to remain under the UK’s social security system while accessing healthcare services in Spain. With the S1, their healthcare costs in Spain are covered by the UK, meaning they can receive treatment in Spain’s public health system as though they were a local resident.

This arrangement is particularly valuable for those on temporary assignments in Spain, as it allows them to access healthcare without needing to enroll in the Spanish social security system or purchase private health insurance. Additionally, being registered with the S1 allows them to maintain their rights to healthcare in the UK when visiting.

Students from the UK studying in Spain may have different options depending on the duration and nature of their stay:

• European Health Insurance Card (EHIC): UK students can use their EHIC to access necessary state-provided healthcare during a temporary stay in Spain. This includes treatments needed due to illness or an accident.
• Private Health Insurance: For longer stays, students may need to have private health insurance to cover their healthcare needs, depending on their university’s requirements and the specifics of their residency.

When you travel to Spain you should have either:

• EHIC: The EHIC was available to all UK citizens and EU nationals before Brexit. It allowed access to state-provided healthcare across EU countries, Iceland, Liechtenstein, Norway, and Switzerland.

• GHIC: The GHIC is a replacement for the EHIC for UK nationals. It provides similar access to state-provided healthcare in EU countries, but does not cover countries outside the EU.

A GHIC or EHIC is not a replacement for travel insurance. Make sure you have both before you travel.

The UK Global Health Insurance Card (GHIC) lets you get necessary state healthcare in the European Economic Area (EEA), and some other countries, on the same basis as a resident of that country. This may be free or it may require a payment equivalent to that which a local resident would pay.

You can apply for a new card up to 9 months before your current card expires. A UK GHIC is free and lasts for up to 5 years. Apply for your new card through the NHS website. Avoid unofficial websites – they may charge you a fee to apply.

If you do not have your GHIC or EHIC with you’ll need to apply for a Provisional Replacement Certificate (PRC) if you need treatment and do not have your GHIC or EHIC, or your card is lost or stolen abroad. Call the Overseas Healthcare Services.

What your GHIC or EHIC covers

• A GHIC or EHIC covers state healthcare, not private treatment.
• With a GHIC or EHIC you can get medically necessary treatment in Spain on the same basis as a Spanish citizen. This means that you’ll get healthcare services for free or at a reduced cost. This includes things like:
  • emergency treatment and visits to A&E
  • treatment or routine medical care for long-term or pre-existing medical conditions
  • routine maternity care, as long as you’re not going abroad to give birth
• A GHIC or EHIC is not a replacement for travel insurance – it does not cover everything, such as mountain rescue or being flown back to the UK (medical repatriation). Make sure you have both before you travel to Spain.
• You may need to pay in full for treatment if you do not have a GHIC, EHIC or Provisional Replacement Certificate (PRC).

How to use it

Show your GHIC or EHIC when you visit any state hospital or doctor. You cannot use either card for private healthcare.

What your card covers
You can use your card to get state healthcare that cannot reasonably wait until you come back to the UK (sometimes called “medically necessary healthcare”).

Examples for specific cases

Before you consult a doctor or go to a hospital, make sure that they are part of the public healthcare system, meaning they will accept your European Health Insurance Card.

Doctors
State-provided healthcare is free of charge.

Dentists
Dental treatment is generally not available under the state system.

Hospital treatment
You will need a referral from a doctor for any hospital treatment, except in an emergency.
Only public hospitals offer treatment free of charge.

Getting prescriptions
You can use a UK prescription to get medicines, including special food required for medical reasons, in Spain.
Prescription medicines are not free in Spain. With a GHIC or EHIC you get a reduced rate, but you’ll still pay:
• 50% of the prescription price
• 10% of the prescription price if you have a UK State Pension – you may need to show proof that you’re a pensioner to pay this rate

Travelling with a health condition
Bring any documents about your health condition or what medication you’re taking.
If you need to have treatment while you’re in Spain, you may need to pre-arrange it. For example, if you need oxygen treatment or dialysis.
You cannot take some products prescribed for health conditions with you into the EU.
Speak to your doctor in the UK for advice before you travel.

Oxygen therapy
You can get oxygen therapy with a GHIC or EHIC, but you need to arrange this before you travel.
You must send a written request to the Spanish health authority in the area you plan to visit at least one month before you travel.

Bringing medicine with you
You need a letter to prove your medicine is prescribed to you if it contains a ‘controlled drug’. You may need to show this at the border when you’re entering or leaving the UK and Spain.

Travelling to have planned treatment
You cannot use a GHIC or EHIC for non-urgent planned treatment – for example, if you’re going abroad to give birth.

Going to UK to Get Treatment

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

Planned treatment: S2 Healthcare Visitor

The ‘S2 arrangement’ allows people residing in the EEA or Switzerland to obtain planned healthcare treatment in another EEA country at the expense of their home state.
With an S2 form, your health insurance institution covers the costs of the treatment in another EU country directly.
If you choose this option, you can only access publicly provided healthcare, and you will always need to apply to your national health insurance institution for prior authorisation (known as an S2 form) before you go for treatment abroad. Your health insurer is obliged to give prior authorisation if the treatment you’re applying for is included in your health insurance cover, but can’t be provided to you in your own country within a time limit, which is medically justifiable.

MORE INFO:

NHS VISITING THE UK: https://www.gov.uk/guidance/healthcare-for-eu-and-efta-citizens-visiting-the-uk#uk-nationals-who-no-longer-live-in-the-uk

NHS S2 PLANNED TREATMENT: https://europa.eu/youreurope/citizens/health/planned-healthcare/right-to-treatment/index_en.htm

Standard forms for social security rights

Forms that certify your benefits situation when moving within the EU
These forms are useful for exercising your rights to benefits when living and/or working in an EU country other than your own — or having done so in the past.

The forms described on this page are valid if you legally live in an EU country, irrespective of your nationality.

MORE INFO: STANDARD FORMS: https://europa.eu/youreurope/citizens/work/social-security-and-benefits/social-security-forms/index_en.htm

Moving Back to UK

If you return to live in the UK you’ll be able to use the NHS like any other UK resident.
The first time you have treatment anywhere in the NHS you will need to bring proof that you are eligible for free healthcare. You should bring proof of residence in the UK.
You can also use documents that prove you no longer live abroad