Before you start

Padrón certificate from the ayuntamiento
Social security number (NUSS), through employment or autónomo registration
TIE or NIE
An assigned centro de salud in your district

Step-by-step

1
Register on the padrón first
Municipal registration is the prerequisite for the regional health card. Without it the health centre cannot assign you, regardless of your social security status.
In personWho: YouWeek 1–2
2
Get your social security number
If employed, your employer registers you and the number follows. If self-employed you register as autónomo and pay contributions monthly, now on an income-based scale rather than a flat quota. The NUSS is what establishes healthcare entitlement.
In personWho: You
3
Apply for the Andalusian health card at your centro de salud
Take the padrón certificate, your social security document and your TIE to the health centre for your address. The tarjeta sanitaria is issued by the Servicio Andaluz de Salud and is what you present for every appointment and prescription.
In personWho: You
4
Meet your assigned médico de familia
You are allocated a family doctor by address, and they are the gateway to specialists. Self-referral is not how the system works, so build that relationship before you need it.
In personWho: You
5
Learn the heat protocols before your first summer
Seville names and categorises its heatwaves — the first city in the world to do so — and the categories trigger public health responses including cooling centres and targeted outreach. Learn what the categories mean, know the symptoms of heat exhaustion and heatstroke, and understand that the risk concentrates in the elderly, the very young and anyone working outdoors. This is not a precaution locals treat lightly.
OnlineWho: You
6
Understand the prescription co-payment
Spain charges an income-linked percentage co-payment on prescriptions, taken at the pharmacy. It is generally modest for working-age employees but it is not free the way the NHS is in Scotland or Wales.
In personWho: You

Documents you’ll need

Padrón certificate
Social security number document
TIE or NIE
Passport
Vaccination and medical records from your home country, ideally translated

Things most newcomers don’t know

Seville names its heatwaves, and that tells you how seriously to take them.

In 2022 Seville became the first city in the world to name and categorise heatwaves the way tropical storms are named, precisely because a named, categorised event provokes a response that 'hot weather' does not. The categories trigger cooling centres and outreach to vulnerable residents. Heat illness in a Sevillian July is a genuine cause of excess deaths, not an inconvenience — and newcomers from cooler climates are among the least acclimatised people in the city.

Source: Ayuntamiento de Sevilla / proMETEO Sevilla

Residency alone does not give you healthcare — social security does.

The chain is padrón, then social security registration, then the health card. People assume legal residence is sufficient and arrive at a health centre with a TIE expecting to be seen. Entitlement is contributory in the ordinary case, so employment or autónomo registration is what opens the door.

Source: Seguridad Social

The card is Andalusian, and moving region means changing it.

Health is devolved, so the card, the system and the app are regional. If you later move to Valencia or Madrid you re-register there. Your entitlement travels within Spain, but the practical business of appointments and prescriptions is regional and does not follow you automatically.

Source: Servicio Andaluz de Salud

Private cover alongside public is the Spanish norm, not a luxury signal.

A large minority of Spaniards hold private insurance in addition to their public entitlement, because it substantially shortens the wait for specialist consultations and scans. Premiums are low by British or American standards. Almost nobody uses it for emergencies or serious illness, where the public system is strong — it is bought to skip queues for routine things.

Source: community-reported

Common mistakes to avoid

Assuming a TIE alone gives you access to public healthcare.
Delaying the padrón and blocking the health card behind it.
Underestimating heat risk in your first Sevillian summer, particularly if you exercise outdoors.
Not registering with your assigned health centre and trying to self-refer to specialists.
Expecting free prescriptions as in the UK's devolved nations.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.