Social Security Registration
The National Institute of Social Security or branded as 'Seguredad Social' (used known to everyone as the INSS) is the state body that administers Social Security Health Care and state retirement and disability Pensions. They have a network of offices throughout Spain. Their telephones and addresses can be found in the official web site: www.seg-social.es.
When a foreign national worker starts a first job in Spain he/she will sign a labour contract and all an application form to become affiliated to the Social Security. The employer will register the employee with the Seguridad Social. Each month when the employee received his/her pay slip (Nomina) the employers (about 35% ) and employees (about 5%) monthly contribution will be itemised. After a few weeks the employee will receive a letter with the social security affiliation number and Tarjeta Seguridad Social.
When a foreign national self employed business person undertakes the paperwork to start a business in Spain, he/she will sign a form to become affiliated to the Social Security. This would normally be undertaken with the help of a Gestor. This may be as Autonomo (Self Employed) or Administrador (Director) of a limited company. On the last day of each month Seguridad Social will deduct by direct debit from the bank account the monthly contribution. The minimum monthly contribution is 283.30€ (2020) for Autonomo and 367.80€ for Societario (Company Director), it can be increased for greater future pension benefits. After a few weeks the Autonimo will receive a letter with the social security affiliation number and Tarjeta Seguridad Social.
When a pensioner from the European Union decides to move permanently to Spain, they should apply for a EHIC (European Health Insurance Card) for themselves and their family from their own country to enable them to register for Spanish state medical care. After obtaining a green Residence Certificate they should go to one of the offices to apply for the registration as a foreign pensioner living in Spain. They should take their Residence Certificate, passport or National ID card along EHIC card. In approximately one month they will receive a letter with the social security affiliation number and Tarjeta Seguridad Social.
When a pensioner from UK moves residence to Spain, or when a resident reaches UK pensoionable age, they should apply for a UK S1 Form from NHS Overseas Healthcare Services, Telephone: +44 (0)191 218 1999 for UK funded health care in Spain. More info about Healthcare for UK nationals on gov.uk website. Take the S1 form to the local Social security office so that you can register as a foreign national pensioner for Spanish state medical care. They should take their passport, S1 form and TIE if already obtained. In approximately one month they will receive a letter with the social security afiliation number and Tarjeta Seguridad Social.
SAS and health Centre Registration
In all three cases above the person can now go to their local health centre (Ambulatorio) and register with the Servicio Andalucia Salud SAS and the local Health Centre and be allocated a Doctor and given a 'Numero de Historia' which is useful to quote when making appointments. The doctor is equivalent of the UK's GP in Spain is called Medico de Cabezera. This several step process is important as it will expediate the process should the resident want a doctors appointment quickly.
In Spain medicines prescribed by your Medico de Cabazera and obtained at the Farmacia are is free for all pensioners, for others they are subsidized by about 60%, the remaining 40 % having to be paid by the patient.
Travelling to EU
If a foreign national who is a resident in Spain and affiliated to the Seguridad Social wishes to travel abroad, they should apply for a purple Spanish European Health Card (EHIC) from the Social Security office. It takes a couple of weeks for the card to arrive in the post. The stamped receipt of the application form may surfice in some circumstances. This will cover emergency medical treatment whilst travelling in the EU. If payment is required for any of the treatment, depending on the country, keep the bills and ask for a refund when arriving back to Spain at the Seguridad Social office.