Short answer
An S1 is issued only when a participating European or UK system remains responsible for your healthcare. The participating systems are the EU countries, Iceland, Liechtenstein, Norway, Switzerland and the United Kingdom. A US, Canadian or Australian pension does not by itself create S1 entitlement. In Spain, the INSS recognises an issued S1 before the regional health service completes local registration.
Obtain the S1
Ask the responsible institution in the competent country to issue the document for each eligible person.
- S1 issued for the correct person
- Personal details checked
- Copies retained before submission
Prepare for INSS recognition
Check the current INSS service for the available submission route and exact supporting documents.
- Identity document
- S1 form
- Spanish address and residence evidence requested by the service
- Appointment or online-access requirement checked
Keep proof of recognition
Retain the decision or receipt. The physical S1 and the health card are not the same document.
- Submission receipt retained
- Recognition decision retained
- Each dependant checked separately
Register with the regional service
Take the recognised entitlement to the regional health service or assigned health centre and follow its local procedure.
- Padrón evidence prepared
- Regional application completed
- Health centre assigned
- Temporary access arrangements asked about if the card is pending