Spain's public health system and the tarjeta sanitaria

• Employees and self-employed people registered with Social Security are insured, together with their beneficiaries: a spouse or registered partner and children under 26 (or with a disability of 65% or more) who live legally in Spain and do not have their own cover.
• Pensioners and people receiving Social Security benefits are covered automatically.
• Other residents without cover from work can apply to the INSS for recognition of their right, using the official application form, online with Cl@ve or a digital certificate, through the online procedures portal without a certificate, or by appointment at a Social Security office.
• EU citizens insured in another EU country, for example posted workers or pensioners with an S1 form, register that form in Spain. A European Health Insurance Card covers necessary care during temporary stays, not a move.
• People without any entitlement who have lived in Spain for at least a year can sign a special agreement (convenio especial) with their regional health service: €60 a month under 65 and €157 from age 65 (Ministry of Health). You must be registered in the padrón when you apply.

Each autonomous community issues its own card. In general you need to be registered in a municipality of that region and to have your entitlement recognised (automatically if you work). You then request the card online or at your local primary care centre (centro de salud, in Catalonia CAP). Barcelona International Welcome notes that even if you have private insurance, having the public card is worthwhile because only a public system doctor can certify paid sick leave. See Your health card in Barcelona for the Catalan procedure.

Many residence routes require health insurance before you have access to the public system. For example:

• Non-lucrative residence and student routes require health insurance.
• The international telework permit requires public cover through Social Security or private insurance with an insurer authorised in Spain, without waiting periods or co-payments; travel insurance is not accepted.
• EU citizens who register without working must show health insurance with full cover in Spain.

Policies vary widely; compare several insurers and read the exclusions before buying.

• Your family doctor (médico de familia) at the primary care centre is the first point of contact and refers you to specialists.
• Emergencies: call 112 or go to a hospital emergency department.
• Pharmacies dispense medicines prescribed by public doctors with a co-payment that depends on your situation.
• In Catalonia, the health advice line is 061 Salut Respon.