How to get the health card and access the SNS as a foreigner

In short: to have a doctor in the public system you need the health card; the route depends on your situation but almost always starts with registering on the town roll (empadronamiento). There are three routes: as an insured person/beneficiary (work or family), via RD 180/2026 (without legal residence), or by paying the special agreement.

In person or by representative? Enrolment is usually done in person at your health centre (with your ID and the town-registration certificate). The exact procedure varies by region: some allow part of it online — check yours.

Routes to SNS coverage:

1. Insured or beneficiary (Royal Decree 1192/2012): if you work and are registered with Social Security, are a pensioner, or are a dependent family member of one → automatic coverage.
2. Without legal residence but registered: you access it through RD 180/2026, meeting the requirements (usually a period of town registration).
3. Special agreement (Royal Decree 576/2013): for economically inactive foreigners without other coverage, paying a monthly fee of €60 (under 65) or €157 (65+). Requires town registration.

How to do it in practice: be registered (empadronado) in your municipality and go to your health centre or regional health service with your ID (TIE/NIE or passport) and the town-registration certificate; they enrol you, assign a doctor and issue the card. Validity usually matches your TIE.

Important: the exact requirements, timing and documents vary by region (comunidad autónoma). Check yours: directory of regional health services.

Steps:

1. Register (empadronate) in your municipality.
2. Identify your route: insured/beneficiary (work or family), RD 180/2026 (without legal residence) or the special agreement.
3. Go to your health centre or regional health service with your ID (TIE/NIE or passport) and the town-registration certificate.
4. They enrol you, assign a doctor and issue the health card.

Official source: Healthcare — Ministry of Health.

Informational only; check the official source and your regional health service for your specific case.