Spain Explained

Health care entitlement in Spain

Last updated on September 13th, 2019 at 09:11 am.

Ensuring you have access to health care in Spain is at the top of every Spanish property owner’s agenda. We are aware that there is a lot of confusion around entitlements and what Spanish health care you can access with which card.

There are three main public health cards in Spain that you might have access to if you live here:

EHIC = European Health Insurance Card

TSE  = Tarjeta Sanitaria Europea

SIP  =  Sistema de Información poblacional

You should be familiar at least with the first one. The EHIC is the health card which you would use as a non-resident in Spain if you needed emergency medical treatment here. The foreign office has been publicising its proper use over the past couple of months due to a concern that some people who are residents have been relying on their EHIC for medical care.  

The TSE is the Spanish version of the EHIC. It is the card you will need if you are a resident in Spain, not drawing a state pension from the UK and need emergency medical care whilst travelling in another European country, including the UK.

If you are a pensioner with a UK state pension then you will have an EHIC rather than a TSE. The EHIC continues to be issued by the NHS in the UK. Although pensioners have access to the full health service in Spain, this is subsidised by the NHS as they do not pay directly into the social security system here.

The SIP has been the subject of concern for many residents recently.   People have had theirs checked/ taken away or haven’t been able to get one in the first place. We’ve put together some tips for how to obtain a SIP if you are a resident in Spain:

If you are employed or self-employed – register the contract of employment or autonomous worker registration with Social Security. The Treasury will then issue a Certificate of Registration to Social Security and provide a document for the Health Centre. You can then obtain a SIP card with this, your NIE, passport and resident certificate at the appropriate Health Centre.

Pensioners – you need the document S1 (formerly E121) which you can obtain from the pension service in your own country. For pensioners from the UK it is ‘The Pension Service’ in Newcastle (00 44 1912037010). With this, your residency certificate, passport and  padron you can register with Social Security and they will issue a Certificate of Registration that you can take to the Health Centre.

Residents prior to 16th April 2012 – If you are an EU citizen who obtained your residency before the 16th April 2012 you are entitled to a SIP card. You need a certificate from the Social Security in the UK stating that you are not eligible to receive health care there. Once you have that, take it along with your passport and NIE to the Health Centre to obtain your SIP.

Whatever your resident status, it is important that you ensure you have the right card for the right health service to obtain the medical care you need.

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Marina. Page

9 September, 2020 12:17 pm

As a resident in both countries. Spain & UK
Which health card is best suited for us. Our UK pension goes into our banks in the UK. And then we take it out to transfer into Spanish bank.
Upon our return to & fro..( Spain & UK) we do not want to be refused NHS treatment in both countries . Also what are we to do if health insurance is refused. Due to previous health problems.
Thank you.

Oscar Paoli

10 September, 2020 2:06 pm

Thank your for contacting us.

We would recommend you to speak with our relocation adviser collaborator David Ruiz. He will go through everything with you, timing, documentation and costs. If you wish to contact him directly please send him an email at

With kind regards,

Ábaco Advisers