Tarjeta sanitaria in Spain: access to public healthcare
The Tarjeta Sanitaria Individual (TSI) is your card for the public health system (SNS) and your médico de cabecera. The usual order is: empadronamiento as address evidence, recognition of the healthcare right (via Seguridad Social/INSS, the regional art. 3 ter route if you do not have legal residence, or a convenio especial if no public cover applies), then the TSI at your health centre. Ley 16/2003 sets a universal framework, but the padrón alone does not create the right.
What the TSI is
The Tarjeta Sanitaria Individual is your card for public healthcare (SNS) and your family doctor.
It is issued by the health service of your region (SERMAS, CatSalut, SAS, etc.).
It is NOT private insurance — it is access to the public system.
Governed by Ley 16/2003; RD-RDL 7/2018 restored universal access.
Who qualifies
- Workers with recognised Seguridad Social/INSS healthcare cover and their family beneficiaries.
- Pensioners and benefit recipients; students or residents with valid cover.
- Foreigners legally and habitually resident in Spain, and people without legal residence who meet the Ley 16/2003 art. 3 ter conditions, now through the procedure set by RD 180/2026.
- EU citizens — via the TSE/EHIC for temporary stays; as residents, under EU coordination and the applicable Spanish entitlement route.
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The right to care
- Ley 16/2003 recognises the right by residence and sets recognition/control rules for public-funded care; for people without legal residence, art. 3 ter applies — and since 13 March 2026 RD 180/2026 sets out a state-level procedure for it: you apply, you are given a provisional document that already lets you use public healthcare while the file is decided, and the administration has three months to resolve, with silence counting in your favour.
- Via the Seguridad Social: registration as a worker/dependant, an afiliación number.
- Without cover by another title — the regional reconocimiento del derecho where applicable, or a convenio especial if you meet its residence/padrón/payment requirements.
- The right to a médico de cabecera and basic care once registered.
- Urgent care is not blocked by not yet having the TSI; non-urgent/continuing care follows the recognition route.
Timing
- Empadronamiento first — without it the procedure stalls.
- Establishing the right and issuing the TSI take different times by region.
- In emergencies (urgencias) care is given regardless of having a TSI.
- A convenio especial is paid monthly — keep up the payments.
Documents
- A certificado de empadronamiento (padrón).
- NIE/passport.
- A Seguridad Social afiliación number (if covered) or the regional-route documents.
- An application at your centro de salud for the TSI and a médico de cabecera.
How to get it
- Do the empadronamiento at your ayuntamiento.
- Establish the right: Seguridad Social registration (worker/dependant) or the regional route / convenio especial.
- Go to your centro de salud for your registered address.
- Request the TSI and assignment of a médico de cabecera.
- Keep the card and number; use them for appointments and prescriptions.
Common mistakes
- Thinking the padrón alone gives the tarjeta sanitaria — it is usually evidence or a regional requirement, but recognition of the right is separate.
- Not doing the empadronamiento first.
- Confusing the TSI with private insurance.
- Not registering via the Seguridad Social when you are entitled to.
- Not knowing about the convenio especial for the uncovered.
If you are refused
- Universal access is set by Ley 16/2003 — if refused, demand recognition of the right.
- Check the route: Seguridad Social, the regional procedure or a convenio especial.
- For an unlawful refusal — a complaint/recurso through the proper channel.
- Keep the empadronamiento and filing justificantes.
Get help getting your tarjeta sanitaria
Tell us your situation (whether you work, your padrón, your region): NAVI tells you your route to public healthcare, whether you need the Seguridad Social or a convenio especial, which documents, and how to get the TSI with a médico de cabecera.
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Related guides
Key terms in this guide
Frequently asked questions
Do I need legal residence for the tarjeta sanitaria?
Not always. Ley 16/2003 has an art. 3 ter route for people not registered or authorised as residents if they meet the requirements and the region certifies access. The padrón may be needed, but it is not automatic by itself.
Where do I start?
With the empadronamiento. Without it, establishing the right and the TSI is hard.
What if I’m not covered by the Seguridad Social?
The regional reconocimiento del derecho or a convenio especial — a monthly fee for public access.
Is it the same as private insurance?
No. The TSI is access to the public system; private insurance is separate.
How do I choose a médico de cabecera?
At your centro de salud for your registered address when you get the TSI.
And emergency care?
Urgencias are provided regardless of having a TSI.
I am an EU citizen — what do I do?
For a temporary stay, use the TSE/EHIC. As a resident, follow EU coordination rules and the applicable Spanish entitlement route; the EHIC does not replace resident registration.
I was refused — what now?
Demand recognition of the right under Ley 16/2003; for an unlawful refusal, a complaint/recurso. NAVI helps.
Official sources
- Ley 16/2003 (cohesion of the SNS)
- Seguridad Social
- RD 576/2013 (convenio especial sanitario)
- European Commission — EHIC/TSE
Access and procedures vary by region — check yours with NAVI or your regional health service.
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This guide is general information about Spanish law, not a legal opinion on your case. Rules change and outcomes depend on your own facts and documents — check your situation before you act on it.
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