What is a health insurance card in Spain for foreigners?

The health card is the document that identifies you within the public healthcare system in Spain and allows you to go to health centers and public hospitals. It is also used at pharmacies to collect prescription medications, where the public healthcare system often covers a large part of the cost.

If you plan to live in Spain for more than a few weeks, it's usually a good idea to apply for residency to have stable access to public healthcare.

What exactly is a health card?

The individual health card is the document that proves your right to use the public healthcare system in Spain. It is issued by the health service of your autonomous community once you have been granted the right to healthcare.

It's not private insurance, nor a travel policy. It's the key that allows you to identify yourself at your health center, in the emergency room, at the hospital, and at the pharmacy so that you can be treated as a patient of the National Health System.

Who is entitled to a health card if you are a foreigner?

In Spain, the right to a health card is usually based on your residency status and coverage; this may be because you live here regularly, or because you have the right to assistance under European regulations or an agreement with your country.

1. Employees, self-employed individuals and people who pay social security contributions

If you are employed or self-employed and registered with Social Security, you will usually be recognized as insured. With this status, you can apply for your health insurance card and also register some of your dependents as beneficiaries.

Those who receive certain benefits (for example, certain pensions or subsidies) or those who have contributed and are no longer working but are still covered by the system may also be eligible.

2. Beneficiary family members

Spouse, common-law partner in some cases, ex-spouse with compensatory pension and children under 26 years of age who are financially dependent on you can usually be listed as beneficiaries in the insured's health care.

In practice, this means that even if only one person works and pays social security contributions, the whole family can have a public health card if they meet the kinship and cohabitation requirements set by the regulations.

3. Legal residents without work

If you have legal residence in Spain but do not work or pay social security contributions, access to a health card is not always automatic and depends on meeting the general requirements to receive assistance at public expense, such as residing habitually in Spain and not being required to prove other mandatory health coverage (for example, that which can be transferred from your country or that required by your residence permit).

To process it, you will normally have to provide documentation that proves your habitual residence and that there is no other coverage that should take responsibility (for example, that you cannot export the assistance from your country or that there is no third party obliged to pay).

If you are granted this right, you can apply for the card. If you do not meet the requirements, the usual solution is private insurance or signing a special healthcare agreement, paying a monthly fee to access public healthcare under the terms of the agreement.

4. People in an irregular situation, minors and pregnancy

Following the 2018 reform, foreign nationals without legal residency can receive public healthcare in Spain. To qualify for public funding, they must meet certain legal requirements, such as not being able to transfer their coverage from their country of origin and having no third party liable for payment.

Furthermore, minors under 18 and pregnant women are entitled to care during pregnancy, childbirth, and postpartum within the public healthcare system. In practice, procedures and flexibility vary depending on the autonomous community, so it's crucial to schedule an appointment with a social worker at your health center if you have a complex situation.

How do I get a health card step by step?

The process varies slightly depending on the community, but it usually follows these basic steps:

1. Register in your municipality
   Without being registered at the address where you live, it will be very difficult for you to be assigned a health center and family doctor.
2. Prove your right to healthcare
   If you work or pay social security contributions, the Social Security system will usually recognize you as insured automatically or after you apply. If not, you will need to submit a specific application to have your rights recognized or to be accepted as a beneficiary of another person.
3. Make an appointment at your local health center
   With your identity document (passport, NIE or DNI), the registration certificate and the certificate of entitlement to health care, you will be assigned a family doctor and, if applicable, a pediatrician for your children.
4. Issuance of the physical or virtual card
   The health center itself usually processes the health card. Some regions also offer a virtual health card through an app, valid at health centers and pharmacies.
5. Receive the card and verify your information.
   When your card arrives, check that your name, ID number, and health center are correct. If your region offers a virtual health card, activate it in the app in case you don't have your physical card with you.

How does public healthcare work once you already have a card?

Your health card assigns you a health center and a primary care physician, who will be your entry point to the healthcare system. For most medical issues, you'll need to make an appointment with them before seeing a specialist.

Appointments are usually made by phone, in person at the reception desk, or through your community's health service website or app. Primary care can refer you to traumatology, cardiology, gynecology, or other specialties, and can also order tests such as blood work, X-rays, or MRIs.

Mental health support is covered by the public system. Your primary care doctor can treat mild anxiety or depression at first, and can refer you into the the mental health network mental health care network if they feel it is appropriate.

In hospital and health center emergency rooms, you will be treated even if you don't have your card with you, but having it or being able to show it on your mobile phone makes the process much easier. In case of a serious emergency, always dial 112.

If you travel to another autonomous community, your individual health card remains valid: you can use it in public centers throughout the National Health System, although some digital functions may depend on the computer systems being well connected that day.

What does the health insurance card cover and what is usually excluded?

With your health card, you have access to the common services of the National Health System, although each region adds slight variations. Broadly speaking, this is what is usually included and excluded:

It's usually covered	It is not normally covered
Family medicine and pediatric consultations	Dental cleanings and fillings in healthy adults
Specialist consultations and diagnostic tests	Aesthetic orthodontics and dental implants
Hospital admissions, surgeries and emergencies	Cosmetic surgery without medical indication
Pregnancy, childbirth and newborn follow-up	Glasses and contact lenses for adults, except for very specific aids
Mental health care and vaccination programs	Purely cosmetic skin treatments or similar

For most adults, many dental treatments are performed in private clinics, but in primary care there are public oral health services such as advice and prevention, pharmacological treatment when needed and extractions, in addition to some specific programs.

Psychological and psychiatric care is available in the public system, but waiting lists can be long and sessions are infrequent. Therefore, it's important to be clear about exactly what mental health services your community offers and to combine them, if needed and affordable, with private or community resources.

Medications, co-payments, and expensive drugs

With your health insurance card, your doctor will usually prescribe medication electronically. At the pharmacy, the public healthcare system typically covers a significant portion of the cost, and you pay the remainder according to your co-payment. If the medication is not covered by public insurance, you may have to pay the full price.

The co-payment percentage depends primarily on your income and whether you are employed or a pensioner. As a general rule, employed individuals pay 40%, 50%, or 60% of the price of medications, depending on their income bracket.

Pensioners usually pay a lower percentage, typically 10% with maximum monthly limits, although a 60% rate may also apply to very high incomes. Some vulnerable groups are exempt.

Chronic treatments often have a reduced co-payment, and many very expensive drugs for cancer, rare diseases, or other complex pathologies are dispensed directly in the hospital, without payment at the community pharmacy.

If you are weighing up costly treatments for weight management or diabetes, such as Mounjaro or Ozempic, it is worth checking whether the public system covers them and what criteria apply.

Changes of autonomous community, loss of card and other situations

If you move from one autonomous community to another, you will need to register your address again and request a change of health center. Your old card may continue to be valid for a while, but normally the new health service will issue you a health card with its own design, maintaining your identification within the National Health System.

If you lose your card, the usual procedure is to request a duplicate at your health center or online. They will typically give you a temporary receipt, and in many regions, you can immediately activate a virtual health card on your mobile phone to continue going to the doctor and pharmacy without problems.

When your employment, residence, or income situation changes, it's advisable to inform both Social Security and your regional health service if they request it. This will help you avoid billing errors, unexpected coverage interruptions, or being charged a co-payment for medications you're not entitled to.

5 key ideas to avoid getting lost with your health insurance card

1. Without registration and without recognition of the right to healthcare, it will be difficult to get a card, even if you already live in Spain.
2. A health insurance card does not replace travel insurance: if you are only visiting as a tourist, it is advisable to have the European Health Insurance Card or private insurance (mandatory if you need a Schengen visa).
3. Your family doctor is the gateway to the public system for almost everything: specialists, mental health, sick leave, and prescription renewals.
4. Not everything is covered: for most adults, dental care, much of the optical work, and many cosmetic treatments will have to be paid for privately.
5. If you are undocumented, an asylum seeker, or have questions about special agreements, make an appointment with social services at your health center; they will explain your options for obtaining a health card.

The information in this article is general and may not apply to all cases. Always consult the official guidelines and the opinion of your doctor, pharmacist or specialized advisor before making decisions about your health or your health procedures.