Healthcare for European expats: EHIC, S1, local registration and private cover (2026 guide)

Before any paperwork, identify which of four buckets you fall into. Most people will recognise their situation in one of the four:

• Stay under 12 months + insured at home → EHIC is usually sufficient for *necessary* care (sudden illness, injury, ongoing treatment of chronic conditions). Bring the EHIC and your home insurer's number to every appointment. Examples: a UK student doing one year of Erasmus in Lyon, a German consultant on a 9-month project in Madrid.

• Employee in the host country → register in the local public system ([Ameli](/en/blog/2026-04-26-cpam-ameli-registration-guide-expats-france) in France, Krankenkasse in Germany, Seguridad Social in Spain, INPS+SSN in Italy, ZUS+NFZ in Poland, etc.). Your employer files the initial enrolment within days of your start date; you complete the personal registration afterwards with your address and bank details. Until your insurance number is issued (4–12 weeks), keep your EHIC for emergencies.

• Pensioner / cross-border worker with S1 → the S1 portable document is requested *from your home insurer* before you move, and presented to the host-country health authority on arrival. The host system treats you as if you were locally insured; the home insurer reimburses the host state. A French retiree settling in Portugal, a Belgian frontalier working in Luxembourg — both use this route.

• Freelancer, remote worker, jobseeker, early retiree without S1 → this is the awkward middle. EU rules say you must be insured *somewhere*, but the host country may not enrol you immediately if you are not yet employed there. Two options: enrol voluntarily in the host system if it allows it (France's PUMa, Spain's Convenio Especial), or carry private international insurance until you qualify for public cover.

The European Health Insurance Card is free, valid 1–10 years depending on issuing country, and proves you are insured in one EU/EEA state. It entitles you to medically *necessary* state-provided care during a temporary stay — at the same cost a local resident would pay. It does not cover: private healthcare, planned treatment in another country (that requires the S2 form), repatriation, lost or stolen property, or care once you have moved your residence.

The practical limit most travellers hit: many EU countries still charge a co-payment at the point of care (around 30 % of consultation fees in France, fixed prescription contributions in Germany, regional variations in Spain) — the EHIC reimburses what the *home* system reimburses, which may be less than the host charge. Always carry a credit card to cover the gap and keep all receipts for later claim. UK nationals: the GHIC (UK Global Health Insurance Card) replaces the EHIC post-Brexit and covers the EU/EEA but not Switzerland or Norway.

The S1 (formerly E121) is the single most useful piece of paper for any expat who keeps a legal link to their home country: pensioners drawing a state pension, cross-border workers commuting daily, posted workers on a fixed assignment, certain civil servants. The home country's insurer issues the S1; the document is registered with the host country's health authority; from then on you are treated locally exactly like a national of the host country, with the *bill* being passed back to the home country.

The S1 must be requested *before* you move — most insurers will not back-date it. Once registered, you do not keep your home country's GP — you must pick a new GP in the host country. Keep proof of registration (a paper or PDF confirmation from the host authority) in case of disputes.

Bring the originals and at least one photocopy of each. Most national health offices accept digital copies on a phone for the first appointment, but the original is required at some point. Standard set:

• National ID or passport — for non-EU spouses, a valid residence permit.

• Proof of address in the host country — utility bill, rental contract, attestation d'hébergement. See our first home abroad guide on getting documented proof of address.

• Employment contract OR S1 portable document OR proof of voluntary residency for self-employed/inactive applicants.

• Birth certificate (international or sworn-translated copy) — needed in France, Italy, Portugal for the initial file.

• Bank account details (IBAN/BIC) for reimbursements. See our European bank account guide for setting this up.

• Vaccination record for any children — most schools also require this separately.

• Marriage certificate if registering a non-working spouse as a dependant.

File size matters in some countries. France's Ameli accepts up to 4 MB per document; Germany's Krankenkassen vary by insurer. If the office rejects your file for an unstated reason, ask for the reason in writing — this triggers a formal review process.

Each national system has an official directory. France: ameli.fr → annuaire santé. Germany: kbv.de → Arztsuche. Spain: ask your CAP centre. Italy: ASL website by region. Filter for doctors *accepting new patients* (médecin traitant accepts in FR, Hausarzt without Aufnahmestopp in DE). Expect a 4-12 week wait for a first appointment in most major cities.

For the first visit, bring: ID, your new health insurance card (or temporary attestation), any prior medical records you have, your previous prescriptions in *generic* names (drug brand names vary across the EU), and a list of any allergies. Ask the GP to register you officially in the system (declarer médecin traitant in France, einschreiben in Germany) — this is the step that activates higher reimbursement rates for future visits.

Many drugs sold under one brand name in one EU country are sold under a different brand name in another, even though the active molecule is identical. Always carry prescriptions in generic form (e.g. *paracetamol* instead of *Doliprane* in France or *ben-u-ron* in Germany). Pharmacists in any EU country can dispense an equivalent if the prescription is generic. For chronic medication, ask your GP for a 3-month prescription before each consultation to avoid running out between appointments.

Reimbursement varies wildly: France refunds 65 % of most prescription drugs at the counter via the carte vitale; Germany has fixed-amount contributions (zuzahlung) of 5–10 € per box; Spain refunds 60–90 % depending on income. Keep every receipt — even when you think the reimbursement is automatic — for the first 12 months of any new system.

Emergency number is 112 across the entire EU, EEA and Switzerland — this is the single number that always works for ambulance, fire and police. Mental-health-specific lines vary: SOS Amitié (FR) 09 72 39 40 50, Telefonseelsorge (DE) 0800 111 0 111, Teléfono de la Esperanza (ES) 717 003 717. Most national health systems offer low-cost or free counselling through municipal centres or universities; ask your GP for a referral letter (this is the gateway to reimbursed specialist sessions in most countries).

Telemedicine has expanded rapidly across the EU since 2020. France's Doctolib, Germany's TeleClinic, Spain's MIO Salud all offer video consultations with reimbursed GPs. For expats in a job that does not match local 9-to-5 hours (remote workers across time zones, healthcare workers, etc.), telemedicine is often the realistic way to access timely care.

Three mistakes recur often enough that they are worth flagging explicitly:

1. Letting EHIC become your default. EHIC was designed for temporary stays. Once your stay exceeds 3 months or you start work, you are expected to register locally. National authorities can — and do — demand retroactive contributions if they discover you have been using EHIC as a long-term substitute.

2. Not declaring a primary GP. Most systems halve the reimbursement rate for non-emergency visits to a GP you have not formally registered with. The declaration is usually a single form signed at your first appointment — there is no reason to skip it.

3. Forgetting the bank-details step. Even after registration is approved, reimbursements only flow once your IBAN is on file. Many expats discover this after 3–4 unreimbursed appointments.

Starter email to the local health office (adapt as needed):

*"Hello, I have just moved to [city] from [home country] as an [employee / freelancer / pensioner / cross-border worker]. Could you confirm which office I should register with, the documents you require, and the timeline for receiving my health number? I would also like to know whether I can use my EHIC / S1 / GHIC in the interim. Thank you, [name]."*