How to Register an S1 Form for Healthcare in Spain

Who can use an S1 in Spain

An S1 is a certificate of entitlement issued by the country that remains responsible for your healthcare while you live in another one. For Spain, the issuing country must be an EU member state, Iceland, Liechtenstein, Norway, Switzerland or the United Kingdom. Spain does not issue you an S1 because you have moved here; it comes from the country paying your pension or benefit.

The people who most often hold one are:

• State pensioners. Under EU rules, if you have no pension from your country of residence, you can be treated there if you would be entitled to treatment in the country paying your pension. You request an S1 from that pension institution and register it on arrival (Your Europe). UK guidance says the same for residents of Spain receiving a UK State Pension or certain other exportable benefits, though "not all UK benefits that can be claimed while abroad entitle you to UK-funded healthcare" (GOV.UK).
• Posted workers, sent to Spain by an employer at home for a limited period.
• Frontier workers, who work in one country and live in another.
• Dependants of an S1 holder.

A pension from the US, Canada, Australia or any other non-participating country does not generate an S1. If you are in that position, see healthcare for pensioners and early retirees for the alternatives.

If you work in Spain yourself, you do not need an S1 at all: you are covered through Spanish Social Security like any other worker.

Step 1: Request the S1 from your home country

UK state pensioners

The S1 is issued by NHS Overseas Healthcare Services, part of the NHS Business Services Authority (NHSBSA).

• Phone: +44 (0)191 218 1999, Monday to Friday 8am to 6pm, Saturday 9am to 3pm (GOV.UK).
• Online: NHSBSA says UK State Pension holders moving to an EU country can apply online up to 90 days before the move. A temporary address in Spain is acceptable at that stage, and if a visa application needs the S1 you can ask for it to be posted to your UK address (NHSBSA).

Have your National Insurance number, the date you moved (or will move) to Spain and your State Pension date to hand (Age in Spain). Frontier workers and posted workers check their position with HMRC National Insurance enquiries rather than NHSBSA.

NHSBSA is explicit on one point that catches people out: "You will not have healthcare cover automatically when you get an S1 from us." Until Spain registers it, the form is just paper.

EU, EEA and Swiss pensioners

Ask the health insurance institution in the paying country. German pensioners, for example, request it from their statutory insurer (Krankenkasse), which issues an original S1 for each person; there is no joint family form (Mallorca.com).

When the form arrives, check names, dates of birth and your Spanish address, and confirm whether family members are on your form or have their own.

Step 2: Get your Spanish paperwork in order

The INSS needs to see that you are legally resident in Spain before it registers the S1. In practice that means three things must come first: your NIE (foreigner identification number), your residence document and your padrón (registration on your town hall's municipal register).

The document list on form C-176 itself is the S1, DNI/NIE or passport, the EU registration certificate or TIE, and proof of kinship for beneficiaries (INSS form C-176). UK guidance adds the resolución favorable option and asks for an email address, a Spanish phone number and your NIE (GOV.UK). The padrón is listed by Age in Spain for online applications and by Mallorca.com for in-person ones, so take it either way.

If you refuse to let the INSS check your data electronically with other administrations (there is a consent box on C-176), you must supply the documents yourself within 10 working days.

Step 3: Register the S1 with the INSS

You have two routes. Both end in the same place.

Online (no digital certificate needed)

The INSS runs an online S1 registration service on its benefits portal (Seguridad Social). You do not need a digital certificate or Cl@ve: identity is checked on screen.

1. Complete and save form C-176 (it is in Spanish).
2. On the S1 service page, click Enviar solicitud.
3. Enter and confirm your email address, then type in the code the INSS emails you.
4. Enter your name, ID type (NIE or DNI), ID number and the expiry date of your residence document.
5. Upload a selfie holding your ID and both sides of your TIE (or passport scans if you have no TIE yet). There is a QR-code option if your computer cannot take photos.
6. Add anything relevant in the free-text box under Datos de la solicitud, plus your province, town and postcode.
7. Attach C-176, then add the S1, your residence document or resolución favorable, padrón and any proof of relationship under Añadir otros documentos.
8. Give consent for contact, complete the CAPTCHA, click Firmar solicitud, enter the second emailed code and draw your signature.

Age in Spain warns that the session expires 30 minutes after you enter the site, so have every scan ready before you start (Age in Spain). To check progress or add a missing document later, return to the service and choose Ya he presentado una solicitud (GOV.UK). GOV.UK's walkthrough dates from 2021, so expect the screens to differ slightly.

In person at an INSS office (CAISS)

INSS offices, known as CAISS (Centros de Atención e Información de la Seguridad Social), work by cita previa (prior appointment). You can book:

• By phone, 24 hours a day, on 91 541 25 30 or 901 10 65 70, with your NIE and postcode ready. You get a locator code for changing or cancelling.
• Online, through the Social Security electronic office, either with a digital certificate or Cl@ve, or through the anonymous access link without one. You select the reason for the appointment, province and office.

The general INSS information lines do not book appointments (Revista Seguridad Social, 27 February 2026).

Take the original S1, passport, NIE, residence document and padrón certificate, plus copies.

What happens next

The INSS contacts you if it needs more information and may ask you to book an office appointment. Once the S1 is registered, it posts you a Spanish social security number (GOV.UK). Neither GOV.UK nor the INSS publishes a standard processing time, so do not plan around one.

Step 4: Get your health card from the regional service

Registration with the INSS establishes your entitlement; the card comes from the health service of your autonomous community. GOV.UK's instruction is short: take your social security number to your local health centre to register, and you will then receive a medical card for doctor, hospital and pharmacy visits.

Each region has its own card name and process, for example the SIP card in the Comunitat Valenciana and the TSI in Catalonia and the Balearics. See how to get a Spanish health card for the regional table, and use our S1 registration checklist to gather documents.

Once registered, UK S1 holders also qualify for a UK-issued GHIC for trips to other EU countries (GOV.UK). Age in Spain says registered UK S1 holders can get free NHS treatment in England on visits from 1 January 2024 (Age in Spain), while GOV.UK's Spain page still refers only to those living in the EU on or before 31 December 2020, so check before travelling for treatment. See EHIC, GHIC and residence healthcare.

While you wait, and keeping the S1 valid

If registration is delayed and you need emergency or urgent treatment, GOV.UK says to contact Overseas Healthcare Services on +44 (0)191 218 1999. Age in Spain explains that the service can issue a Provisional Replacement Certificate (PRC) to present at a health centre or A&E. More on this in healthcare while waiting for public registration.

After registration:

• Tell Overseas Healthcare Services about any change of address or circumstances.
• Dependants of a UK state pensioner lose that cover once they start claiming their own UK State Pension. A new S1 is sent to them, and they must register it with the INSS to stay covered (GOV.UK).
• If you leave Spain, contact the NHS Overseas Healthcare team to cancel the S1.

S1 versus the alternatives

An S1 and the convenio especial are mutually exclusive: GOV.UK states you cannot join the convenio if the UK pays for your healthcare through an S1. Nor does the S1 give access to private hospitals. Some S1 holders keep a private policy as well for faster specialist access or English-speaking doctors. That is a choice, not a requirement once the S1 is registered. To compare prices properly, see how to get quotes in Spain.

One last check for visa applicants: an unregistered S1 is not the same as registered cover. If your visa or residence application asks for proof of health cover, follow the deciding authority's own checklist (see health insurance requirements for Spanish residency).