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Management and Applications

Management, Granting of Entitlement and Control

  • Recognition and control of their status as insured or a beneficiary is, in general, the responsibility of the  National Social Security Institute (INSS) or, where appropriate, the Social Marine Institute (ISM), through their provincial departments, and will be done automatically in the circumstances provided for in article 3, section 2 of Law 16/2003, of 28 May.

    In the cases of medical assistance for people with disabilities,  foreigners who are not registered or authorised as residents in Spain, applicants for international protection, victims of human trafficking in a period of recovery and reflection, as well as in the case of individuals covered by a special agreement on medical assistance who do not have the status of insured or beneficiaries of the SNS  as laid down in |R.D. 576/2013, of 26 July, the  Autonomous Communities (ACs) are responsible for recognising the right to medical assistance.
  • Once insured or beneficiary status has been recognised, the entitlement to health care shall be implemented by the competent health authorities, who will give individuals access to medical assistance by issuing individual health insurance cards, through the Health Centres of the CAs.
  • The competent bodies that deal with foreign citizens can inform the INSS (or the ISM), without the consent of the interested party, of the necessary information in order to verify that the requirements set out in sections 3 and 4 of article 3 of Law 16/2003, of 28 May, have been met.
  • Likewise, the INSS (or the ISM) can process the information contained in the files of the Social Security managing bodies and common services or the competent civil service departments, which is necessary in order to verify insured or beneficiary status. Providing this information to the INSS (or the ISM) does not require the consent of the interested party.

    The INSS (or the ISM) will process the information referred to in the previous two paragraphs in order to provide the competent health authorities with the necessary information to verify that they meet the necessary requirements and conditions for entitlement to health care, without requiring the interested party´s consent. Any change or modification reported by the INSS (or the ISM) shall have the applicable effect on the individual health insurance card.

Documents which must accompany the application


(Original document accompanied by a copy for certification or a previously-certified photocopy, with the exception of identification documents where displaying the original will be sufficient)

IN ALL CASES (both holders and recipients):

  • Spanish Citizens: National Identity Document (DNI), for persons over 14 years of age.
  • Citizens of the European Union (EU),  countries in the Agreement on the European Economic Area (EEA),  or Switzerland.: Certificate of registration on the Central Register for Foreign Citizens, together with passport or identity document.
  • Citizens from the remaining countries: foreigner identity card (FIC) and valid passport. If they are beneficiaries of holders from the EU, Countries in the Agreement on the EEA or Switzerland, they should submit the residency card and NIE proving a family tie with a citizen of the EU/EEA/Switzerland. 


  • Certificate of electoral registration in the applicant's town of residence.
  • A signed statement stating that compulsory health care coverage has not been granted through another method.
  • Decision on the declaration of abandonment in the case of minors in state care.


  • In all cases:
    • Family Record Book, Civil Registry records or official certificate proving the family relationship. 
  • Descendants and people of a similar status:
    • Adopted children or children in the process of adoption: document proving the adoption or the start of adoption proceedings issued by the competent body of the Autonomous Community.
    • Foster Children: court order or certificate of foster care issued by competent body of the Autonomous Community.
    • Certificate of disability of a degree greater than or equal to 65%, if applicable.
    • Certificate from the Town Council proving cohabitation with the applicant (not required for children or minor foster children).
    • Brothers and sisters: Family record book or equivalent document proving they are the brother or sister of the insured person.
  • Common law partner of the holder:
    • Certificate of registration in the Registry of the Autonomous Community or town of residence, or proof of the formalisation of the common-law marriage by public deed.
  • Ex-spouse:
    • Separation or divorce ruling and document granting the right to receive the compensatory pension.
  • This documentation may be submitted at any Social Security Office or via the Service: Medical Assistance. Recognition of the right request, provided that you have a  digital certificate. 
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