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HEALTH

How to apply for a public health card in Spain

Here's everything you need to know about registering with Spain's public healthcare service, who is eligible and the steps to apply for a health card in the different regions.

Published: 25 February 2021 15:24 CET
Updated: 28 September 2023 15:08 CEST
How to apply for a public health card in Spain
Not everyone who lives in Spain can gain access to public healthcare in the country. (Photo by HANNAH MCKAY / POOL / AFP)

Spain has the seventh best public healthcare system in the world according to the World Health Organisation (2021 rankings).

With primary healthcare services available within a 15-minute radius from where most people live and an average of 8 to 9 percent of annual GDP expenditure on healthcare, the public’s opinion of Spanish healthcare is generally very high, although long waiting times and a lack of healthcare personnel have slightly tarnished this reputation in recent years. 

If you’re thinking of moving to Spain or want to have an alternative to private healthcare,  you may be considering if you can have access to Spain’s public healthcare, and if so, what the process involves.

Who is eligible for public healthcare in Spain?

In order to qualify for healthcare in Spain, you have to be paying into the social security system or be eligible through one of a few other ways. Here’s a list of those who can access la sanidad pública.

  • Pensioners resident in Spain, including those from a country that has a mutual agreement. This includes all countries in the European Economic Area (EEA). They must also have a permanent residence certificate.
  • Employees and autónomos (self-employed) workers registered with social security and paying into the system.
  • Residents who get certain social security benefits in Spain.
  • Those who previously registered for social security payments, but whose entitlement has now expired.
  • Those whose spouse pays into the social security system.
  • Children and other dependents of those paying into the social security system.
  • Those recently divorced or separated from a partner who is registered with social security and paying in. 

When you register for public healthcare in Spain you will receive a Tarjeta Sanitaria Individual or TSI card. As the name suggests, these are individual cards for each person. Children also get their own.

How do I apply for a public heath card?

Each of Spain’s autonomous communities has its own healthcare system and applying for your health card (often called TSI) varies slightly depending on where you live. Here’s what you need to know about applying for your card in some of the most popular regions for foreigners. 

Catalonia

In order to register for your TSI public health card in Catalonia, you usually need to go to your local CAP (Centre d’Atenció Primaria) primary healthcare centre and fill out an application form. You will also have to take several documents with you including your social security certificate, your green residency certificate, green residency certificate or TIE and your padrón certificate.

During the pandemic, Catalonia made it much easier to apply for your TSI card and now allows you to apply for it online. You will need digital copies of your green residency certificate, TIE or residence card, your padrón certificate and your social security certificate (given to you when you register with social security) to upload. If you don’t have these, you can authorise CATSALUT to look into your information and verify these documents online. You can apply for it here. 

Once this has all been processed, you will be assigned a doctor and can make an appointment from that moment onwards. Your TSI card will be sent to you in the post later and could take up to a month to arrive.

The new design of Catalonia’s Catsalut health card
 

Valencia region

In the Valencian community your health card is known as a SIP card. All the information about the SIP cards can be found here. 

You can get one by going to your local health centre and applying there. You will need to take the necessary documentation such as your social security certificate, your green residency certificate or TIE and your padrón certificate.

The SIP, the public health card in Spain’s Valencia region.
 

Madrid

In Madrid, you can apply for your TSI card either in person or online, if you have a digital certificate.

You will need to show your residency card, TIE or DNI, your padrón certificate and a Document Accrediting you to the Right of Health Assistance called the DAD. This is issued by the Social Security office and shows whether you’re recorded as a worker, self-employed, pensioner or beneficiary. You can apply for the DAD certificate here. 

Those with a digital certificate can apply through this link which will allow you to attach the documentation you need.

Whichever way you apply, you will receive your physical card in the post to your home address.

Madrid’s public health card
 

The Madrid region has also recently introduced a virtual health card, which you can get after you have applied for the physical one. This will allow you to make appointments and access your test results , You can download it here. 

Once downloaded, you can go to your local health centre in order to activate it via a QR code and a pin number. You can also activate it from home by calling the phone number on the app. Someone will then give you the activation code.

Andalusia 

In Andalusia, you can only apply for your health card in person at your local healthcare centre. You can only renew it online or request a new one if you’ve lost it. You must take with you originals and photocopies of your green residency document or TIE, the social security DAD certificate that Madrid also requires, and your padrón certificate. 

You can find out more about the process here. 

Andalucía’s public health card
 

Balearic Islands

In the Balearic Islands, the healthcare system is known as IB-SALUT. There are three ways to apply for your health card on the islands, these include by phone, in person at your local health clinic and online using your digital certificate or Cl@ve.

You will need your NIE or TIE and a recent colour photograph of yourself. IB-SALUT will then check your padrón and social security status for you and send you your card in the post. You can find all the information here. 

The Balearic Islands’ public health card
 

Canary Islands

In the Canary Islands you can only apply for your TSI card in person at your local health centre. Remember to take all the necessary identity documents with you such as NIE, TIE or residency certificate, social security documents and padrón and your health clinic will let you know if they need any other documentation.

The Canary Islands’ public health card
 

READ ALSO: TSE card: How to get a Spanish European Health Insurance card

Most regions will have a similar or slightly different to the regions mentioned above. Make sure to get into contact with your local health centre to ask about what you need to bring along when you register. 

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For members

BRITS IN SPAIN

Six factors British people need to consider before retiring to Spain

If you're a UK national and thinking of retiring to Spain, there are some important factors you need to think about before making the move, and before you make any decisions about your UK pension.

Published: 3 May 2024 09:59 CEST
Six factors British people need to consider before retiring to Spain

Retiring to Spain is a dream for many, but in order to make that dream a reality, you need to know that you can financially support yourself.

For most retirees, their main or only income will be a UK pension, so it’s important to understand how your pension will work once you make the move to Spain. 

There are some specific rules and restrictions you should know when your pension is paid outside of the UK. You also need to understand how your pension will be taxed in Spain.

Financial adviser, Maeve Hoffman, from Spectrum IFA Group, emphasised that people should not take these decisions lightly, telling The Local: “Figuring out what to do with your pension should be part of your wider financial plans for your life”.

“This may be your most important asset, besides your home, and the best answer for what to do with your pension is highly individual. There are no sweeping generalisations when it comes to advice on private pensions. Everyone’s situation is different,” she said.

This article is intended as an overview of how the system works for UK pensioners and is not intended as a substitute for individual financial advice. It’s aimed at people who have worked most or all of their career in the UK and then plan on retiring to Spain – the situation is slightly different for people who have worked in Spain and then retire here.

READ ALSO: Which UK benefits can Brits keep if they move to Spain?

Long-term or short-term

The first thing you need to decide is if you’re moving Spain for the long-term or short-term. 

If you’re looking to stay here permanently, there are certain advantages you can benefit from, but they could make things extra complicated if you end up returning to the UK in the future.

Make sure you ask yourself the tough questions so you can think about every eventuality. Is there a chance that you will have grandchildren in the future that you’ll want to be close to them? Have you ever spent a significant time in Spain, before, apart from just for short holidays? Do you have connections to Spain, such as friends, family or a home? If your health deteriorates, will you want to be cared for in Spain or the UK?

If are unsure about the answers to these questions, then take some time to really think about them. There are alternatives to permanently moving to Spain if you are unsure – for example, you can stay here for three months without the need for a visa.

Understand the different tax rules

British retirees should be aware that the UK and Spain have very different tax systems.

Once you become a tax resident in Spain you have to file a yearly declaration on your global income. Your UK pension will be taxed in Spain and you will no longer be liable to UK taxation, unless you have a government service pension.

You can check if your pension is classified as ‘government’ here.

The UK state pension, as well as any other private pensions, will be taxable in Spain.

Because of this, will want to think about whether your previous plans for your private pension were only advantageous to you as a UK resident. Once you become a Spanish tax resident, they could have unforeseen implications.

For example, there is no tax-free lump sum in Spain. If you want to take out a lump sum, taking it while you are still a UK resident will save you a lot in tax.

Taxes also depend on the region in which you decide to retire to. Some are a lot more advantageous than others, so it’s important you know the rules of where you plan on moving to. 

READ ALSO: Why you should move to this region in Spain if you want to pay less tax

Get reliable, expert financial advice before doing anything

If you have decided you want to be in Spain permanently, then you will need some expert tax and pension advice – but you need to be careful who you take advice from, this is a highly specialist area and it’s unlikely that high street financial advisers will have the knowledge that you need. 

Brexit has also made getting financial advice more complicated, with fewer experts available.

Hoffman told The Local: “Because of Brexit, you cannot use a UK-based financial adviser anymore – you have to use an EU-registered one. This has made things more complicated. When picking an adviser, seek out someone who has expertise on the local taxation rules. They should also be regulated with the financial regulator where you live and where they work”. 

It can be especially complicated to work out who you should and shouldn’t take advice from – for example, some UK-based advisers have continued to give advice to EU-based clients, even though are not following EU regulations anymore. 

Hoffman adds: “There are free, government-based services in the UK that can help you understand your private pension – Pension Wise and Money Helper. Before doing anything, you should consult the free services. Any financial adviser worth their salt would recommend this too. 

“These services have begun to have longer wait times, so be sure to book well in advance of when you plan to draw from your pension.”

Decide whether to transfer your pension

Another question that is important for Brits to think about is whether or not to transfer their pension into either a UK-based SIPP for non-residents, or a QROPS (Qualifying Recognised Overseas Pension Schemes).

The SIPP will keep your pension in the UK, while the QROPS moves it out of the UK. 

These options can be helpful for residents in Spain, but you need to familiarise yourself with their benefits and drawbacks.

“The QROPS is not for someone who is unsure of their future, as if you return to the UK within five years of the pension transfer, HMRC will seek their tax back as if it was a full encashment,” Hoffman said.

You should also beware of scams on this subject, as the post-Brexit period saw many scammers seeking to persuade Brits that it was now mandatory to transfer their UK pension – always be wary of any cold-calling or unsolicited financial advice.

Determine how you will draw from your pension

The next factor to consider is how you want to receive your pension – either as regular income or as a lump sum. The option that you chose will have tax implications in Spain.

Generally, the tax rate will depend on the amount of your pension, but can range from 19 to 47 percent in Spain.

Remember that there is no ‘tax-free lump sum’ in Spain, so it’s best that you don’t draw from your pension that way.

Healthcare and Social Security

You won’t automatically be covered for healthcare in Spain if you retire here, because you won’t be working and therefore won’t be paying social security.

Thankfully, there are various options. UK nationals who retire to Spain (and have never worked in Spain) and have already reached the state pension age can apply for the S1. This means that the UK continues to pay for their healthcare costs and they would not be charged social security. Non-working spouses of an S1 holder can also benefit from this.

READ ALSO – Healthcare in Spain: the steps to apply for the S1 form for UK state pensioners

You can also choose to pay for the convenio especial (which translates to ‘special agreement’). This allows foreigners in Spain to pay a monthly sum into the country’s public health system to have access to it, even if they don’t work. To access it, you will pay a monthly fee of €60 if you are under 65 and €157 if you are over 65. 

Of course, you also have the option of getting private health insurance too.

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