NHS S1 Form (UK): Who Qualifies, How to Apply and How to Register It in the EU (2026)

Written by Steffan Grund · Insurance specialist (Versicherungsfachmann BWV) · Updated October 27, 2026Facts checked: October 27, 2026

Key facts: the S1 form in 2026

Sources: NHSBSA (Overseas Healthcare Services pages and knowledge base), GOV.UK country healthcare guides, DWP State Pension age timetable. Details and dates in the list at the end of this page.

What is an S1 form?

An S1 is a certificate that proves the UK is responsible for your state healthcare while you live in another country covered by the scheme. The NHS Business Services Authority puts it plainly: an S1 gives you the same healthcare cover as a resident of the country you live in, with the UK responsible for the costs. You register the certificate with the local health or social security authority, receive a local health number or card, and then use public doctors, hospitals and pharmacies as a local would.

Three points are easy to miss. First, the S1 is not insurance: it gives no cash benefits and no private care, and every local co-payment still applies. Second, getting the paper is only half the job, because you have no cover until the S1 is registered in your new country. Third, it is not automatic for everyone who lived in the UK: you qualify through a UK State Pension, certain benefits, or particular work situations. Everyone else who moves to the EU has to use the host country’s own rules, which may mean contributions, residence-based registration or private insurance.

The S1 is part of the European social security coordination rules. The UK kept it after leaving the EU, under the Withdrawal Agreement for people already living in the EU on 31 December 2020 and under the UK–EU Trade and Cooperation Agreement for later moves. If you are comparing whole health systems rather than this single form, see our overview of healthcare systems by country.

Who qualifies for an S1 form?

You can get an S1 if you move to an eligible country and you are paid a UK State Pension, receive a qualifying exportable benefit, are a posted worker or are a frontier worker. NHSBSA lists exactly these four routes. For pensioners, the key word is paid: you must already be in receipt of your UK State Pension when you apply, so reaching State Pension age is not enough until you have claimed it.

Two exclusions catch people out. A workplace or private pension does not give you an S1, however large it is. And if you receive a UK State Pension together with a state pension from the country you move to, NHSBSA says you may not be eligible, because that country is then responsible for your healthcare; with pensions from several EU or EEA countries, the country where you paid contributions for the longest may be responsible.

The benefit route has narrowed. NHSBSA says the rules have changed and you can no longer apply for a new S1 based on Disability Living Allowance, Personal Independence Payment, Carer’s Allowance or Attendance Allowance. If you already hold an S1 based on one of these, it continues for as long as you receive the benefit, and a time-limited S1 can be renewed while the benefit continues.

Which countries accept the S1?

The S1 works in the 27 EU countries, Switzerland, Norway, Iceland and Liechtenstein, with start-date rules for the last four, and nowhere else. NHSBSA states that you are not entitled to UK-funded state healthcare if you move outside these countries. Ireland is a special case in the other direction: UK citizens do not need an S1 there at all.

If you are still choosing a country, the S1 is a real point in favour of the EU for anyone close to State Pension age. Our best countries to retire comparison and the retirement visas by country table show how this fits with visa income rules.

How do you apply for an S1 form?

If you are paid a UK State Pension and are moving to an EU country, apply online through the NHS Business Services Authority, or contact NHS Overseas Healthcare Services by phone, email or post. NHSBSA accepts online applications up to 90 days before you move. Posted and frontier workers apply through HMRC instead.

1. Claim your State Pension first. GOV.UK says you can claim within 4 months of your State Pension age; if you already live abroad, you claim through the International Pension Centre.
2. Have an address in the new country. NHSBSA needs one to issue the S1. A temporary address is accepted; send the permanent one when you have it.
3. Gather your details. Full names and dates of birth for you and any dependants, National Insurance number, residential address and the date you moved there, email address, the country and moving date, any planned return date, nationality, and whether you receive a state pension from an EU country, Norway, Iceland, Liechtenstein or Switzerland (and German contributions, if any).
4. Apply. Online, or by phone on 0191 218 1999 (+44 191 218 1999 from abroad), Monday to Friday, 8am to 6pm. Postal address: S1 applications, Overseas Healthcare Services, Bridge House, 152 Pilgrim Street, Newcastle upon Tyne NE1 6SN.
5. Receive the S1. If you gave an email address, NHSBSA emails a link to download it; otherwise it comes by post. For a visa application, you can ask for it to be sent to your UK address.
6. Register it in your new country (next section) and only then apply for a new UK GHIC.

Official sources differ on opening hours: GOV.UK’s country guides (2021–2022) also list Saturday, 9am to 3pm, while NHSBSA’s current contact page gives the S1 line as Monday to Friday only. The same old guides say to request a form by phone; the online service was added later. We follow NHSBSA.

How do you register an S1 in Spain, Portugal, France and other EU countries?

You register the S1 with the authority GOV.UK names for each country: the INSS in Spain, Segurança Social in Portugal, the CPAM in France, the local ASL in Italy, EOPYY in Greece, the GHS in Cyprus and the Entitlement Unit in Malta. Ireland needs no S1 for UK citizens. NHSBSA warns that you have no cover until this step is done, and that you often need it before you can register with a doctor or get a medical card.

GOV.UK “Healthcare for UK nationals living in …” guides for Spain (27 July 2022), Portugal (14 October 2021), France (25 July 2022), Italy (25 October 2022), Greece (21 October 2021), Cyprus and Malta (14 October 2021), Ireland (21 October 2021); NHSBSA knowledge base for Ireland. These guides have not been updated for some years; ask the local office what it currently needs.

Spain: INSS, then the health centre

In Spain the S1 goes to the INSS, either at your local office or through its online portal, and you can follow the application on the INSS website. The INSS posts you a Spanish social security number, which you take to your health centre. GOV.UK adds two Spanish rules: if the UK pays for your healthcare through an S1, you cannot join the public pay-in scheme (Convenio Especial) and you cannot register as a permanent resident for healthcare. Residents usually pay 10% to 60% of the cost of prescription medicines.

Portugal: Segurança Social, then the centro de saúde

In Portugal the S1 is registered at any social security office and then at your local health centre, where you receive your número de utente. Since June 2022, Portugal charges user fees only for hospital emergency visits without an SNS referral or admission, so older GOV.UK fee examples no longer apply. Our Retire in Portugal guide and the cost of living in Portugal cover the rest of the move.

France: CPAM, then the carte vitale

France is the slowest of the three big destinations on paper: GOV.UK mentions 1 to 3 months for a temporary social security number and 6 months or longer for the carte vitale. In the meantime, use your social security number, ask the doctor for a “feuille de soins” and send it to the CPAM for a refund. S1 holders still pay part of their costs like French residents, which is why many take a top-up “mutuelle”; our guide to expat health insurance in France explains the options.

Cyprus: GHS co-payments

Cyprus’s General Healthcare System is not free at the point of use. GOV.UK’s examples of co-payments are €1 per prescribed medicine or product, €6 to see a specialist with a GP referral and €25 without one, €10 for A&E, and up to €15 per GP visit once your free visits are used up. S1 holders can apply for a medical card, which lowers these co-payments.

If you hit delays registering your S1 and need urgent treatment, GOV.UK tells you to call NHS Overseas Healthcare Services on +44 191 218 1999. You are also responsible for telling the service about any change of address or circumstances.

Does the S1 cover your spouse, partner and children?

Usually, yes: you can add dependants to your S1 application, but each host country decides who counts as a dependant, and anyone who can get their own S1 must apply for it. NHSBSA says you can add anybody you consider a dependant, and that their registration is accepted only if they meet that country’s definition. GOV.UK repeats in each country guide that dependants and family members may be classified differently abroad than in the UK.

This matters for couples with an age gap. If the older partner draws the State Pension first, the younger partner may be covered as a dependant on that S1 until their own pension starts, but only if the host country accepts them as a dependant. Check this with the local office before you rely on it, and keep a plan B for the years before both pensions are paid.

What does the S1 not cover?

The S1 does not cover private healthcare, does not remove local co-payments, and does nothing for you outside the EU, Switzerland, Norway, Iceland and Liechtenstein. It gives you exactly what the local state system gives its own residents, which varies a lot from country to country.

GOV.UK gives concrete examples. In Spain, most people use private dentists. In Portugal, dental care is not usually covered by the national health service. In France, you pay part of every bill. In Cyprus, there are fixed co-payments. If those gaps matter to you, a private plan can sit alongside the S1; the general guide to expat health insurance explains how that works.

Can S1 holders use a GHIC or EHIC for trips?

Yes: once your S1 is registered in an EU country, you can apply for a new UK GHIC or UK EHIC for medically necessary state treatment on trips to other EU countries, Switzerland, Norway, Iceland and Liechtenstein. NHSBSA adds a step people miss: any UK GHIC or EHIC you held while living in the UK must not be used and should be returned, and you apply for a new one after registration.

The NHS and GOV.UK both say the GHIC is not a replacement for travel insurance, so keep a travel policy for trips, especially if you have a pre-existing condition. Avoid unofficial websites that charge a fee to apply; the card is free.

Can S1 holders use the NHS on visits to the UK?

Free NHS hospital treatment on visits to England is guaranteed only to people who were living in the EU on or before 31 December 2020 and hold a registered UK-issued S1. The Department of Health guidance on charging overseas visitors says that UK nationals who moved to the EU from 1 January 2021 should not expect to use NHS services for free when visiting, unless they have an EHIC, a Provisional Replacement Certificate or an S2 from their EU country of residence, or another exemption applies.

GOV.UK: How the NHS charges overseas visitors for NHS hospital care (31 December 2020), and the “Getting treatment in the UK” sections of the GOV.UK country healthcare guides. Rules shown are for England; Scotland, Wales and Northern Ireland have their own charging rules.

The reason is simple: the NHS is residence-based, so UK nationals who move abroad permanently lose their entitlement to free NHS care. If you moved after 2020, plan UK visits around travel insurance, or treat any non-emergency care as something to arrange in your country of residence. Do not count on a private expat plan here either: Care Expat World gives home-country cover only to citizens of EU or Schengen states, so a British citizen has no UK cover under that plan.

What changed for the S1 after Brexit?

The S1 survived Brexit for State Pensioners, but the protections differ depending on whether you lived in the EU by 31 December 2020. People who did are covered by the Withdrawal Agreement; people who moved later rely on the Protocol on Social Security Coordination in the UK–EU Trade and Cooperation Agreement, applied since 1 January 2021. NHSBSA’s current service, which accepts S1 applications up to 90 days before a move, shows that new movers still get one.

Frontier work shows how sharp the line can be. GOV.UK’s Spain guide says that people who live in Spain and work in Gibraltar keep healthcare in both places only if they are covered by the Withdrawal Agreement; others lost that reciprocal cover from 1 July 2022.

What happens to your S1 if you move back to the UK?

You cancel it: GOV.UK’s Living in Spain, Portugal and France guides each tell returning residents to contact the NHS Overseas Healthcare Team to cancel the S1. Once you live in the UK again, GOV.UK says you can use the NHS like any other UK resident.

• Tell NHS Overseas Healthcare Services the date you leave, so the UK stops paying the other country.
• Deregister locally. For Spain, GOV.UK lists leaving the padrón at the town hall and telling the foreigners’ office and your health centre.
• Return or stop using any UK GHIC or EHIC issued because of your S1, and apply again as a UK resident if you need one.
• Register with a GP in the UK once you are back.

Moving between two EU countries is different: you need the S1 registered in the new country, so tell NHSBSA your new address and country before you go.

What if you retire abroad before State Pension age?

Then you have no S1 through your pension until it is paid, so you need another way to be covered for those years. With State Pension age at 66 now and 67 for anyone born between 6 March 1961 and 5 April 1977, a Briton who moves at 60 can face six or seven years without an S1. Our S1 gap guide covers this period in detail.

DWP State Pension age timetable (Pensions Acts 2007 and 2014). DWP says the timetable for the rise from 67 to 68 could change after a review. Example from DWP: someone born on 31 July 1960 reaches State Pension age on 30 November 2026.

What fills the gap depends on the country. GOV.UK says that in Greece, people who are not working and have no S1 must take out private health insurance. Spain lets residents join the Convenio Especial after a year on the padrón, but you need cover before that, and its consulates ask visa applicants for comprehensive insurance. Portugal lets legal residents use the SNS, but the D7 visa still asks for insurance first. Read the country pages before you choose: Portugal D7 visa, Greece retirement visa, France retirement visa and retire in Greece.

For private cover, Care Expat World is open to people whose cover starts by 1 December of the year they turn 64 and has no end date once you are in. At 60–64 it costs €325–€800 a month in Zone 1, depending on tier and deductible; see international health insurance cost by age. One honest limit for British readers: its home-country cover applies only to EU and Schengen citizens, so it does not cover you in the UK.

Does the S1 affect tax or National Insurance?

No: the S1 is a healthcare certificate, not a tax document, and it does not decide where you pay income tax. Your tax residence and the relevant double taxation agreement do that. Three official pension and National Insurance points are worth knowing when you plan the move.

• Uprating: GOV.UK says your State Pension increases every year only if you live in the EEA, Gibraltar, Switzerland or a country with a social security agreement with the UK. Every EU country qualifies.
• Payment: the pension can be paid into a bank in the country where you live, every 4 or 13 weeks; GOV.UK mentions a conversion charge of 0.39% before payment.
• Voluntary National Insurance: GOV.UK states that from 6 April 2026 the rules have changed for people who live or work abroad. If you are within 6 months of State Pension age or older and live abroad, it tells you to contact the International Pension Centre before paying.

Gaps in your National Insurance record can delay or reduce the pension that unlocks your S1, so check your State Pension forecast before you leave.

Your S1 checklist

• Check your State Pension age and forecast on GOV.UK
• Confirm your destination accepts the S1 (EU, Switzerland, Norway, Iceland, Liechtenstein; not needed in Ireland)
• Claim your State Pension (within 4 months of State Pension age)
• Secure an address abroad (a temporary one is accepted)
• Apply for the S1 online or on 0191 218 1999, up to 90 days before the move
• Add dependants and check the host country’s definition of a dependant
• Ask for the S1 at your UK address if your visa application needs it
• Register the S1 locally (INSS, Segurança Social, CPAM, ASL, EOPYY, GHS, Entitlement Unit)
• Register with a local doctor and get your health card or number
• Return your old UK GHIC and apply for a new one after registration
• Arrange private cover for any years before the S1, applying before the year you turn 65
• Tell NHSBSA about any change of address, country or circumstances

Worked example: a 62-year-old Briton and a 59-year-old American

Graham, 62, from Leeds, was born in May 1964, so his State Pension age is 67 and he gets no S1 through his pension until 2031. He moves to Spain in 2026 on a workplace pension. The Spanish consulate wants health insurance for his visa, and the Convenio Especial is open to him only after a year on the padrón. He takes Care Expat World Basic with a €3,600 deductible at €325 a month at 60–64 (Comfort with the same deductible: €495), applying before 2029, the year he turns 65. From 2029 he pays the 65–69 rate, €465 for Basic with the same deductible. In 2031 he claims his State Pension, applies for an S1, registers it with the INSS and gets a Spanish health card; he can then decide whether to keep the private plan for private hospitals. He knows he is not covered in the UK by that plan and that, having moved after 2020, he cannot count on free NHS hospital care on visits.

Linda, 59, from Ohio, moves to Portugal with her British husband Peter, 67, who already draws his UK State Pension. Peter applies for an S1 and adds Linda as a dependant; whether Portugal accepts her as one is decided when they register at Segurança Social. Linda has no UK pension of her own and no Medicare cover abroad, so she would get no S1 alone. If she is not accepted as a dependant, she relies on SNS registration as a resident and private cover; Comfort with a €1,200 deductible costs €505 a month at 55–59. Our guide to health insurance for Americans living abroad covers her side.

Prices are monthly, Zone 1 (worldwide except the USA, China and Singapore), which includes every S1 country. Your home country is never part of the zone, and the terms give home-country cover only to EU or Schengen citizens, so Britons are not covered in the UK and Americans are not covered in the USA. We make no claim that any consulate or immigration office requires or accepts this plan for a visa or residence permit. Already 65 or older in the year cover would start? This plan is closed to you; we are preparing a comparison of plans without an entry-age limit. Full benefits are in the plan details and prices for all ages on the Care Expat World overview.

Where these facts come from

• NHS Business Services Authority, Overseas Healthcare Services: Applying for healthcare cover for living abroad; Healthcare abroad for posted workers and people with some exportable benefits; Contact Overseas Healthcare Services (read 27 October 2026)
• NHSBSA knowledge base: “Am I entitled to state-provided medical care if I move abroad?”, “Where does my S1 form cover me for healthcare?”, “How do I add or remove a dependant on an S1 form?” (read 27 October 2026)
• GOV.UK: Healthcare for UK nationals living in Spain (27 July 2022), Portugal (14 October 2021), France (25 July 2022), Italy (25 October 2022), Greece (21 October 2021), Cyprus (14 October 2021), Malta (14 October 2021), Ireland (21 October 2021)
• GOV.UK: Living in Spain (3 July 2026), Living in Portugal (10 July 2026), Living in France (2 October 2026)
• GOV.UK: The Withdrawal Agreement, what UK nationals need to know about citizens’ rights (6 November 2020); UK–EU Trade and Cooperation Agreement, Protocol on Social Security Coordination
• Department of Health and Social Care via GOV.UK: How the NHS charges overseas visitors for NHS hospital care (31 December 2020)
• DWP: State Pension age timetable; GOV.UK: State Pension if you retire abroad (6 November 2024); Claim benefits abroad (12 February 2025)
• HMRC: Apply for healthcare cover in the EU, Iceland, Liechtenstein, Norway or Switzerland (CA8454, 25 April 2025); Voluntary National Insurance contributions
• NHS: Get healthcare cover abroad with a UK GHIC or UK EHIC; GOV.UK: Foreign travel insurance (2 August 2024)
• Portuguese visa centre (VFS UK) D7 checklist: S1 accepted as proof of travel insurance; Portuguese government: user fees ended except in hospital emergency (Decree-Law 37/2022)

Several GOV.UK country guides were last updated in 2021–2022; where a newer official source differs (opening hours, online applications, Portuguese user fees), we follow the newer one and say so. Rules change; confirm your case with NHS Overseas Healthcare Services or the local authority before you move.