Moving to another EU country is exciting, but the administrative side can be daunting. One of the most confusing aspects for mobile workers is health insurance. You might hear colleagues whispering about the S1 Form (formerly E106 or E121) and how it saves them thousands of euros.
But what is it? Is it for you? And how is it different from the EHIC (European Health Insurance Card)?
If you are a Posted Worker, a Cross-Border Worker, or a Pensioner moving within the EU/EEA, the S1 Form is your most valuable document. This guide breaks down exactly how to use it to access state healthcare in your new home without paying double contributions.
🇪🇺 What is the S1 Form?
Think of the S1 Form as a “Healthcare Sponsorship Letter.”
It is an official EU portable document that certifies you are exempt from paying social security/health insurance contributions in the country where you live, because you are already paying them (or are insured) in the country where you work (or receive your pension).
The Mechanism:
- Home Country: Issues the S1. They agree to pay the bill.
- Host Country: Registers the S1. They agree to treat you like a local citizen.
It effectively “ports” your health coverage across the border.
🎯 Who is the S1 Form For?
The S1 is not for standard expats who move to Germany to start a new job with a German contract. If you work in Germany on a German contract, you pay German insurance. You don’t need an S1.
The S1 is specifically for people whose economic life is in one country, but whose physical life is in another.
1. Posted Workers (Entsandte Arbeitnehmer)
- Scenario: You are a nurse employed by a Polish agency but sent to work in a German hospital for 12 months.
- The Rule: You remain employed by the Polish company. You pay Polish taxes and social security (ZUS).
- The Problem: You live in Germany. If you get sick, you need a German doctor.
- The Solution: Your Polish insurer issues an S1. You give it to a German insurer (e.g., AOK). You get a German health card. You pay €0 to the German system, but get full access.
2. Cross-Border Workers (Frontaliers)
- Scenario: You live in France but drive across the border to work in a Swiss or German hospital every day.
- The Rule: You pay taxes/insurance where you work (e.g., Switzerland).
- The Benefit: The S1 form allows you to register with the French health system (CPAM) too. You can see a doctor in both countries.
3. Pensioners
- Scenario: You retire from the Irish health service and move to Spain.
- The Rule: Ireland pays your pension. Ireland issues your S1.
- The Benefit: You register the S1 in Spain and get free Spanish state healthcare, paid for by Ireland.
🆚 S1 vs. EHIC: What’s the Difference?
Many people confuse these two.
- EHIC (European Health Insurance Card): For tourists. It covers emergency care only. It is not valid once you register residency.
- S1 Form: For residents. It covers everything—GP visits, planned surgeries, prescriptions, and maternity care. It is a long-term solution.
📝 How to Get and Register Your S1 (Step-by-Step)
This process can take weeks, so start early.
Step 1: Request it from your “Competent Institution”
Contact the health authority in the country where you are insured (e.g., ZUS in Poland, NHS in UK, HSE in Ireland).
- Note: You usually need a permanent address in the new country to complete the application.
Step 2: The “Portable Document” Arrives
You will receive two copies of the S1 form. Do not lose them. They often come by post, not email.
Step 3: Registration in the Host Country
Take the S1 to the local health authority in your new home.
- Germany: Any Krankenkasse (e.g., TK, AOK).
- France: The CPAM (Caisse Primaire d’Assurance Maladie).
- Spain: The INSS (Instituto Nacional de la Seguridad Social).
Step 4: The Local Card
Once processed, the host country will issue you a local health card (e.g., Carte Vitale in France). You use this card at the doctor’s office. The doctor bills the local system, and the local system bills your home country in the background.
⚠️ Common Pitfalls
- Family Members: If you bring dependents (spouse/children), you often need separate S1 forms for them, or they must be listed on yours. Check this before you leave.
- Validity Dates: The S1 has a start and end date (especially for posted workers). If your contract extends, you must apply for a new S1 immediately, or you will be uninsured.
- A1 Certificate: Posted workers usually need an A1 Certificate (proof of social security payment) alongside the S1. The authorities will ask for both.
Conclusion
The S1 form is a masterpiece of EU bureaucracy—it allows you to live in one country while your healthcare is paid for by another. If you qualify, it saves you the cost of private insurance (which can be €200-€500/month).
Ask your recruitment agency in Europe specifically: “Will I be a local employee or a posted worker?” The answer determines if you need this form.