Working or self-employed in Spain
Employees and autónomos registered with Spanish Social Security normally start with that system. Recognition and the regional health card are separate stages.
Receiving a qualifying pension or cross-border benefit
An S1 can establish healthcare responsibility in qualifying EU, EEA, Swiss and UK cases. Ask the responsible institution to issue it then register it with the INSS in Spain.
Visiting rather than residing
An EHIC or GHIC supports medically necessary care during a temporary stay. It is not a general substitute for residence healthcare.
No other public entitlement
Some established residents can join the convenio especial after meeting its residence, padrón and no-other-entitlement conditions. It is not a route for a first visa application from abroad.
Family members
A spouse, child or other qualifying dependant may be recognised as a beneficiary, but the relationship and entitlement must be documented for each person.
Not sure which route applies?
Compare public and private access first. If a visa or residence application is involved, check the exact immigration route separately.