A1, S1 and healthcare in Spain for the DNV
Two documents, endlessly confused with each other. One is about which country's rules apply to you. The other is about healthcare. Neither is an automatic insurance waiver.
Check that these documents apply to you at all
A1 and S1 are documents from the EU Social Security coordination rules, and they are not available to every DNV applicant. Whether those rules apply to you depends on the countries involved, on your own status, and on the rules themselves. Confirm that they apply to you before relying on an A1 or an S1 as part of your application.
If they do not apply to you, the equivalent question for agreements between Spain and countries outside the EU is on agreements between countries, and the general way to read whatever document you hold is on what your certificate proves.
What an A1 actually says
An A1 is a certificate of applicable legislation. It answers one question: which country's Social Security rules apply to you while you work in another one. It is issued by the competent institution in the country whose rules continue to apply, usually at your employer's request, and it matters — it is often exactly what keeps you and your employer out of two systems at once.
What it does not do is say anything about healthcare in Spain. An A1 on its own does not establish that you are entitled to healthcare here, and we will not tell you otherwise. Whether healthcare follows depends on the rules that apply to you and on a separate document.
An A1 on its own does not remove the insurance requirement
An A1 answers a contributions question. The DNV health-cover requirement asks a healthcare question. Holding an A1 tells you which country's rules apply to your contributions; it does not tell you, or anybody assessing your application, that you can obtain healthcare in Spain. Anyone who says an A1 is by itself an insurance waiver is answering a different question from the one your file asks.
What an S1 actually says
An S1 is a healthcare entitlement document. Where the scheme you belong to issues one, it says that you — and, where they are named on it, members of your family — can obtain healthcare in the country you have moved to, funded by the system you remain in. In Spain it is registered with the health authorities where you live, which is a step of its own.
An A1 by itself does not establish healthcare entitlement in Spain. That is why "do I need an S1 as well as an A1?" is a much better question than "is my A1 enough?". The two documents are issued by different processes and answer different questions, and holding one does not automatically produce the other. Whether an S1 is available to you at all depends on your circumstances and on the scheme you are in, so the institution that would issue it is the place to ask.
Do you need both?
It depends on what your application has to show. If the question of which country's rules apply to you is unresolved, that is what an A1 is for. If the question of healthcare in Spain is unresolved, that needs an entitlement document. If both are unresolved, you need both. What there is no version of is an A1 on its own closing the healthcare question.
The four points to check on any of these documents — who issued it, which rules it invokes, what it says about healthcare, and its dates — are set out once, for every kind of document: how to read the certificate you hold. They are not repeated here.
UK applicants
UK–Spain arrangements have their own rules about when a document of this kind is issued for remote work and when healthcare cover comes with it, and those rules have changed more than once in recent years. Form names and availability are exactly the details that go out of date fastest, so the reliable answer for a UK applicant comes from the UK bodies that issue these documents rather than from any general page.
Ask them two things directly: which document applies to your situation, and whether it covers healthcare in Spain for you and for anybody coming with you. Meanwhile the four-point reading above applies to whatever you already hold. How we source and check this.
Different offices ask for it differently
Some consulates publish their own wording about these documents. A consulate's instructions govern an application made there; applications made from inside Spain run through the UGE, the Spanish unit that handles them, and its documentation is its own. So the first thing to establish is which of the two you are applying through, because that decides whose checklist you have to satisfy.
Checklists differ between offices and they change, so read the current one for the office you are actually applying through. If it asks for something you have not seen mentioned anywhere else, it wins: it is the one being applied to your application.
If your documents don't add up to healthcare
"Not enough" splits into three different answers, and they lead to three different places. Work out which one describes each person on the application. An A1 in the file changes none of them by itself.
An entitlement document says healthcare in Spain
Where an S1, or another issued entitlement document under the rules that apply to you, says you can obtain healthcare in Spain and the office you are applying through accepts it, that document is what answers the healthcare question.
What you submit: the issued entitlement document, not the A1 in its place.
The rules that apply to you don't reach healthcare in Spain
Where you have established that healthcare in Spain is not included, that person needs a private policy. An A1 does not change this; it was never the document that answered the question.
What you submit: qualifying private cover for that person, meeting the standard the authorities set. If you want that priced, ask for a quote — but only once this is genuinely where you are, and not before.
You hold an A1 and nothing else yet
If you cannot tell what is covered, or the entitlement document has not been issued, nothing is settled in either direction. Holding an A1 and waiting on an S1 is this, not the card above it.
What you do: ask the institution that issues your documents what evidences healthcare under the rules that apply to you, or send us the case to look at.
What to ask the institution that issues your documents
Ask in writing, and ask narrowly. A broad question gets a broad answer that helps nobody.
- Under the rules that apply to me, am I entitled to healthcare in Spain?
- If so, which document evidences that, and how do I apply for it?
- Are my spouse, partner or children included, and must they be named on it?
- What dates will it carry, and can it be extended if I stay longer?
- How long does it currently take to issue?
Two things follow from their answers. Family members are not automatically included on your document, so anyone relying on it needs to appear on it by name, and anyone who does not is worked out separately: the family pages set out how. And if the timing does not work for your application, that is worth knowing now, while you can still plan around it.
Before you buy — or skip — insurance on the strength of an A1
What decides it is what has actually been issued and what it actually says. If an A1 is the only document you hold, the healthcare question is still open, and an open question is not a decision in either direction.
Common questions
Does an A1 mean I don't need insurance?
Not by itself. It says which country's rules apply to you. Whether you can obtain healthcare in Spain is a separate question with its own document.
Does an S1 replace private insurance?
Where an S1 says you are entitled to healthcare in Spain and the office you are applying through accepts it, it answers the healthcare question for the people named on it. Check its current checklist.
How do I register an S1 in Spain?
With the health authorities where you live in Spain. The institution that issued it and the Spanish side both publish current instructions, and they are the ones to follow.