How to register an S1 form in Spain (healthcare for pensioners)

What it is

An S1 form shows that another country pays for your healthcare while you live in Spain. Pensioners use it most: if your state pension comes from another EU country, the EEA, Switzerland or the UK, and you don't also get a Spanish pension, that country usually covers your healthcare here. Once your S1 is registered, you use Spain's public health service on the same terms as a Spanish pensioner.

The S1 is issued by the country that pays your pension, not by Spain. In Spain you register it with the INSS (Instituto Nacional de la Seguridad Social).

Do you need this guide?

State pension from another EU or EEA country, Switzerland or the UK? Yes.
UK State Pension, moving after 2020? Yes: UK pensioners can still get an S1.
You also get a Spanish pension, or you work in Spain? No: Spain covers you directly. See the health card guide.
Not a pensioner? Some other people get an S1 too (for example family members of a pensioner, or posted workers). The steps in Spain are the same.

Before you start

You'll need:

Your S1 form, from the country that pays your pension:
- UK: phone NHS Overseas Healthcare Services (+44 191 218 1999) and ask for an S1.
- EU, EEA or Switzerland: ask the health insurance or pension body in that country.
Your passport or EU identity card, and your NIE.
Your Spanish residence document: EU registration certificate or TIE.
A Spanish address: you register the S1 where you live.
For family members on your S1: proof of the relationship (for example a marriage or birth certificate).
The INSS application form for healthcare (on the Seguridad Social website).

Steps

Get your S1 from the country that pays your pension. Ask before you move if you can.
Register it with the INSS, in one of two ways:
- Online, on the Seguridad Social electronic office (sede electrónica), uploading your S1 and documents; or
- In person at an INSS office (CAISS), with an appointment (cita previa).
Wait for the decision. If it's favourable, the INSS sends you a certificate with your Spanish Social Security number.
Take it to your health centre (centro de salud) for your address, with your ID and padrón certificate. You're registered there, given a family doctor and your health card (tarjeta sanitaria).

Cost

Registering the S1 is free.

Common pitfalls

Asking Spain for the S1. It comes from the country that pays your pension.
Visa applications. If you need a visa to live in Spain, the consulate asks for proof of health cover. Check whether it accepts your S1 or wants private insurance.
Dependants who start their own pension. If you're on someone else's S1 and then claim your own state pension, that S1 ends: get your own and register it again.
Leaving Spain. Tell the INSS and the country that issued your S1 when you move away.

When to ask a helper

Ask someone who registered an S1 in your province recently: they'll know whether the INSS office there prefers online applications or appointments, and how long the certificate takes.