S1 form: UK-funded healthcare abroad, for posted workers and pensioners

An S1 is the form that registers someone for state healthcare in the European country where they live, with the UK paying. There are two main routes to one. A worker posted abroad by a UK employer gets it through HMRC, as part of the same application that produces the A1 certificate. A UK State Pensioner or someone on certain exportable benefits gets it from NHS Overseas Healthcare Services. Either way it has to be registered locally before it does anything. This page quotes the GOV.UK and NHS guidance and sets the S1 beside the A1, GHIC and EHIC, which are easy to confuse.

S1, A1, GHIC, EHIC: what each one does

The A1 and S1 are a pair for posted workers: the A1 settles which country’s social security you pay into, and the S1 can follow from it for healthcare. The GHIC and EHIC are for temporary stays; the S1 is for where you live.

Posted workers: the S1 through HMRC

GOV.UK defines the group: “A posted worker, also known as a ‘detached worker’, is someone employed or self-employed in the UK, but temporarily sent to a European Economic Area (EEA) country.” And for healthcare, in the Spain guide: “UK posted workers can access healthcare in Spain using a GHIC, EHIC or S1 form.”

The S1 for a posted worker is not a separate application. It comes out of the certificate of coverage application:

The certificate itself is for postings of up to two years: HMRC’s wording covers someone “employed in the UK by an employer who normally carries out their activities in the UK, and you’re going to work temporarily in either an EU country for up to 2 years — your employer must have either sent or agreed for you to work there temporarily”. The detail is on A1 certificate. For the posted-worker questions, GOV.UK points to HMRC: “HMRC has a helpline for National Insurance enquiries from non-UK residents. They can answer questions about posted worker status and explain which documents you will need to get healthcare while posted.”

Frontier workers

“You may also be entitled to an S1 form if you’re a frontier worker (someone who works in one state and lives in another). You must contact HMRC National Insurance enquiries to find out if you’re eligible.”

Pensioners and benefit recipients: the S1 through the NHS

“You may be entitled to state healthcare paid for by the UK if you’re a resident in Spain and receive a UK State Pension or an exportable benefit.” The route is by phone: “If you have a UK State Pension or another qualifying exportable benefit, you must request an application form by phone from the Overseas Healthcare Services”.

• Not every benefit counts: “Not all UK benefits that can be claimed while abroad entitle you to UK-funded healthcare.”
• Dependants: “If you’re entitled to an S1 form as a dependant of a State Pensioner, your health cover will be cancelled once you begin claiming your UK state pension.”

Using the S1

An S1 has to be registered where you live. In Spain: “When you get your S1 form, you must register it with the INSS.” Once it is, “This will mean you and your dependants will be entitled to state healthcare on the same basis as a Spanish citizen.” You also get “a UK-issued GHIC or EHIC for travel”.

And only one: “You cannot have an S1 for more than one country. You can only apply for an S1 for the country you're permanently a resident in.”

Registering an S1: Spain and France side by side

The registration step is where the process differs most between countries, and where delays happen. The GOV.UK guides for Spain and France set out different bodies and different stages:

Two practical points come out of the French guide. Treatment is available before the card arrives: “If you need healthcare before you receive your card, use your social security number.” And there is a fallback for delays: “If you are experiencing delays registering your S1 with local authorities and require emergency or urgent treatment, contact the Overseas Healthcare Services”.

Being employed locally is a different route altogether. The French guide says: “If you’re employed in France, your employer must initiate your registration for PUMa via the employers’ online portal before you start work.” It also advises: “You should buy private health insurance while waiting for the registration process to be completed.” For an employer, the difference between posting someone (A1, possibly S1) and hiring them locally (local registration by the local employer) is the difference between the UK system and the local one.

We have quoted the Spain and France guides because they set out the routes in detail. GOV.UK publishes a guide for each country, and the local registration body and process differ; check the guide for the country concerned rather than assuming it matches Spain or France.

The EHIC for people who already hold an A1 or S1

A new UK EHIC is for people with continuing rights, and NHSBSA lists two groups whose rights come from these documents: people “living in the EU, Switzerland, Norway, Iceland, or Liechtenstein, since before 1 January 2021 with an A1 issued by the UK”, and those living there “and have been since before 1 January 2021 with a registered S1 form issued by the UK”.

For employers posting staff

• Apply for the A1 before the posting starts; the S1 question is dealt with in the same application.
• Tell the employee to register any S1 locally on arrival.
• Check the GOV.UK healthcare guide for the specific country.
• Decide whether private medical cover is also provided — a state entitlement is not the same as a policy.

Days allowed in the Schengen area are on the Schengen 90/180 rule. This page quotes GOV.UK, HMRC and NHSBSA guidance as read on 2026-09-30; it is not medical, tax or immigration advice.

Common questions