The EHIC and GHIC in Spain: What They Cover, and What They Don’t

By Andrew Turner — exclusive agent since 2007 · DGS Registry C0467B54657010 · Last reviewed September 2026

Four different cards get called “the European health card”, and mixing them up is the single most expensive mistake we see. This guide explains which card does what in Spain, the day your UK card stops working here, and how residents apply for the Spanish one. If you need cover the cards don’t provide, see our health insurance page or get a quote.

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Quick Answer. The EHIC and GHIC in Spain

Visiting Spain from the UK?A free UK GHIC covers state care only

Living in Spain?Your UK GHIC does not cover you here at all

Resident travelling in the EU?Apply for the Spanish TSE — free, 2 years

Does any card replace insurance?No — no repatriation, no private hospitals

Answered by Turner Insurance Specialists — exclusive insurance agents in Spain since 2007, Generali since 2024, based in Javea (Alicante). Talk to a real adviser in English: 966 461 625.

The 60-second summary. The GHIC is the UK card that replaced the EHIC after Brexit; it pays for medically necessary state treatment while you are visiting Spain. The UK EHIC still exists, but only for a protected group — mainly people covered by a UK-issued S1. The TSE (tarjeta sanitaria europea) is the Spanish version, issued free by the Seguridad Social to people already in the Spanish system, and it works when they travel out of Spain. The E111 has not existed since 2006. None of them is insurance: none pays for a private clinic, a flight home, or a rescue.

EHIC, GHIC, TSE and E111 — which card is which

These four names describe genuinely different documents with different issuers and different jobs. This is the table worth screenshotting.

Card	Issued byWho gives it to you	Who it is forEligibility	What it doesIn practice
UK GHIC Global Health Insurance Card	NHS (free)	UK residents	State-funded treatment while visiting Spain
UK EHIC The pre-Brexit card	NHS (free)	Protected groups only — mainly S1 holders	Same as GHIC, plus Norway, Iceland, Liechtenstein and Switzerland
Spanish TSE Tarjeta sanitaria europea	Seguridad Social (free)	People in the Spanish public system	State treatment when a Spanish resident travels elsewhere in Europe
E111 The paper form	Nobody — withdrawn	Nobody	Abolished in 2006. If a website still offers one, it is not official

Notice the direction of travel in each row. The GHIC and the UK EHIC point into Spain, for people whose home country is the UK. The Spanish TSE points out of Spain, for people whose home country is now Spain. That is the distinction almost every argument at a hospital desk comes down to.

What a UK GHIC actually covers in Spain

Used correctly, the GHIC is genuinely valuable. It entitles you to medically necessary state healthcare on the same terms as a Spanish resident during a temporary stay. In Spain that mostly means free at the point of use, because Spanish state care is not charged to the patient. Concretely, it covers:

Accident and emergency at a public hospital (urgencias).
Treatment that cannot wait until you go home — the test is clinical, not a rigid time limit.
Pre-existing and chronic conditions, including routine care such as dialysis, oxygen therapy and chemotherapy. These must be arranged before you travel: you cannot walk into a Spanish hospital and expect a dialysis slot to appear.
Routine maternity care if you are already pregnant. It does not cover travelling to Spain specifically to give birth.
Prescriptions, though on the same co-payment basis a Spanish patient pays — you will be charged a percentage at the pharmacy.

Applying is free and takes minutes on the NHS website. If a site charges you a “processing fee” for a GHIC, you are on a copycat site — the card has never cost anything.

The mistake that catches visitors on the Costa Blanca

Here is the practical failure we see most often, and it has nothing to do with eligibility. The GHIC only works inside the public system. Much of the Costa Blanca, Costa del Sol and the islands is served by large, modern, well-signposted private hospitals, and several of them display the word Urgencias in exactly the way a public hospital does.

A visitor who feels unwell, or a taxi driver asked for “the nearest hospital”, will very often end up at the private one. It is closer, it is smarter, there is parking. The GHIC is worth nothing there. You are a private patient, you will be asked for a card on admission, and the bill is yours — a few hundred euros for a consultation and scan, far more if you are admitted.

If you are relying on a GHIC, learn the name of your nearest public hospital before you need it, and say that name specifically. And if an ambulance takes you somewhere private in an emergency, tell the desk immediately that you hold a GHIC and want to be treated under the public system — the transfer is much easier to arrange in the first hour than on discharge.

What the GHIC does not cover

The NHS is explicit about the gaps, and they are the expensive ones:

Private treatment of any kind — including a private room, a private clinic, or a private ambulance.
Repatriation. Flying you home ill, or on a stretcher with medical escort, is not covered by any state card. This is routinely a five-figure cost.
Mountain and sea rescue, which Spanish regions may charge for.
Cancelled trips, lost baggage, missed departures — the ordinary travel-insurance items.
Being a resident. Covered in the next section, because it is the big one.

This is why the card and a policy are complements, not alternatives. Our guide to travel insurance beyond the GHIC sets out what a policy adds, and what to look for if you are a Spanish resident travelling rather than a UK resident visiting.

The day your UK GHIC stops covering you in Spain

This is the most consequential thing on this page. A UK-issued GHIC is not valid for you in Spain once Spain is where you live. It covers UK residents visiting Spain. The moment your residence moves — when you take out residencia, when you are here beyond a temporary stay — the card stops being the right document for treatment in Spain, whatever the expiry date printed on it says.

People carry an in-date GHIC for years assuming it is their safety net, and discover otherwise at an admissions desk. If you live in Spain, your access to Spanish healthcare has to come from one of these routes instead:

Working and paying into Spanish social security, employed or as an autónomo. Cover for you and your dependants.
Form S1, if you draw a UK state pension or certain other exportable benefits. The UK pays Spain for your care and you are treated like a Spanish pensioner. Our guide to healthcare in Spain for pensioners covers the S1 route, prescription charges and what happens after 75.
The convenio especial, a pay-in scheme for residents outside the other routes — roughly €60 a month under 65 and €157 at 65 or over. It does not include subsidised prescriptions.
Private health insurance, which is also the route the Non-Lucrative and Digital Nomad visas require at application.

The exception worth knowing. If you live in Spain under a UK-issued S1, you can apply for a new UK EHIC — and it is one of the few new EHICs the NHS still issues. It does not cover you in Spain: Spain is your country of residence and the S1 handles that. It covers you when you travel from Spain to other European countries. S1 holders often do not realise they are entitled to it.

How to get a Spanish European Health Insurance Card (TSE)

If you are in the Spanish public system — working, S1, convenio especial — the card you want for travelling around Europe is the Spanish tarjeta sanitaria europea. It is free, and it is the Spanish equivalent of what a GHIC is to a UK resident.

Where: the Seguridad Social sede electrónica at sede.seg-social.gob.es, under Ciudadanos → Asistencia Sanitaria, or through the Import@ss portal.
Identification: digital certificate or Cl@ve. There is also a simplified route using your personal details if you have neither.
Family: you can request cards for beneficiarios — spouse and dependent children — in the same application. Each person needs their own card.
Delivery: by post to your registered address, usually within days. Check the address held by the Seguridad Social first, because a wrong one is the usual reason a card never arrives.
Validity: normally two years, longer for some groups such as pensioners. Renewal is free and uses the same channels.
Cost: nothing. As with the GHIC, any site charging you for one is not the official channel.

Apply before you need it. If you are travelling imminently and the card will not arrive in time, the Seguridad Social can issue a Certificado Provisional Sustitutorio, a temporary certificate that does the same job.

Tarjeta sanitaria vs tarjeta sanitaria europea

Two similarly named Spanish cards, constantly confused:

Your tarjeta sanitaria is your regional health card — the SIP in the Valencian Community, with different names in Andalucía, Murcia and the islands. It is issued by the region, tied to your local health centre, and it is what you present for treatment in Spain.
Your tarjeta sanitaria europea is national, issued by the Seguridad Social, and only relevant outside Spain.

You need the regional card first: the TSE is issued off the back of being registered in the system. If you have just moved region within Spain, re-register locally before you apply.

Whatever happened to the E111?

The E111 was a paper form, stamped at a post office, and it was withdrawn in 2006 when the EHIC replaced it. It has now been obsolete for twenty years, but the name persists — partly because people who travelled in the 1990s still use it, and partly because copycat websites use the old term to sell “applications” for cards that are free. There is nothing to renew and nothing to apply for. If you are a UK resident, you want a GHIC. If you live in Spain, you want the Spanish TSE.

Where private health insurance fits

None of these cards is insurance, and for most people living here the honest position is that the state card and a private policy do different jobs. The public system in Spain is genuinely good — strong emergency care, well-equipped hospitals. What private cover buys is speed for routine specialists, choice of hospital, and treatment in English, none of which a card provides.

It is also the only one of these routes that is available immediately and regardless of your work or pension history, which is why it is what the NLV and DNV visas ask for. Premiums run from roughly €40 a month for a healthy adult under 40 to around €150 for a 65-year-old on a no-co-payment plan; our 2026 cost breakdown by age has the detail, and the comparison page puts Generali Salud alongside Sanitas, Adeslas, DKV and Asisa.

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Frequently asked questions

No. A UK-issued GHIC covers UK residents during temporary visits. Once Spain is your country of residence it does not cover you here, regardless of the expiry date on the card. Your access must come from Spanish social security contributions, a UK S1, the convenio especial or private insurance.

Existing UK EHICs stay valid until the expiry date printed on them. New ones are only issued to protected groups — mainly people living in the EU with a UK-issued S1, E121, E106 or E109. Everyone else applies for a GHIC when their EHIC expires. The practical difference is that an EHIC also works in Norway, Iceland, Liechtenstein and Switzerland, which the GHIC does not.

No. It only works inside the Spanish public system. This matters on the Costa Blanca and Costa del Sol, where large private hospitals are often the nearest and are signed “Urgencias” just like public ones. Treatment there is billed to you privately. Find out the name of your nearest public hospital before you need it.

Free, through the Seguridad Social sede electrónica at sede.seg-social.gob.es under Ciudadanos then Asistencia Sanitaria, or via Import@ss. Identify yourself with a digital certificate or Cl@ve, or use the simplified route. Cards for a spouse and children are requested in the same application and arrive by post, usually within days.

Normally two years from issue, and longer for some groups such as pensioners. Renewal is free and uses the same channels as the original application. If you are travelling before the card arrives, ask for a Certificado Provisional Sustitutorio, which does the same job temporarily.

No. The E111 paper form was withdrawn in 2006 and replaced by the EHIC. There is nothing to apply for or renew. Sites offering E111 applications are copycats charging for something that no longer exists. UK residents need a GHIC; Spanish residents need the Spanish TSE.

No, and this is the largest gap. Neither the GHIC, the EHIC nor the Spanish TSE pays to fly you home ill, with or without a medical escort, and that is routinely a five-figure cost. Repatriation comes from travel insurance or from a private health policy that includes it.

They cover different things, so most of our clients hold both. A private policy gives fast specialist access, choice of hospital and English-speaking treatment in Spain. The Spanish TSE costs nothing and covers state treatment when you travel elsewhere in Europe. If you are in the Spanish public system, there is no reason not to hold the card as well.

Sources & references

NHS — Apply for a free UK GHIC — the only official UK application route.
GOV.UK — Healthcare in Spain, including the Balearic and Canary Islands — S1, GHIC and residency.
Seguridad Social — Sede Electrónica — official application for the Spanish TSE.
Healthcare in Spain for pensioners — the S1 route, prescription costs and the convenio especial.
Health insurance for Spanish residency — what the NLV and DNV visas require.
Travel insurance in Spain: beyond the GHIC — the gaps a policy fills.

This guide is general information, not personalised advice. Entitlement, cover and application procedures vary by circumstances and change over time; always check the official NHS and Seguridad Social pages linked above. For advice on your situation, contact Turner Insurance.