The first thing to do when you establish your primary residence—and therefore your tax residence—in Portugal is to register with the social security system in Portugal. If you are hired by a local company, you don’t need to worry about this; your employer will take care of registering you with social security. However, you will need to register your children and spouse yourself.

Social Security in Portugal: How to Get It

Health Center

The health center (centro de saúde) provides access to the Portuguese National Health Service (NHS) for all matters related to «primary» care, such as colds, vaccinations, and so on…

The health center is staffed by administrative personnel, general practitioners, health coordinators, and, of course, nurses. In some centers, you may also find social workers, dentists, nutritionists, and psychologists.

Health centers, or Centro de saúde, are responsible for providing general medical care in non-emergency situations. For colds and the flu, this is where routine checkups and mandatory vaccinations take place. They also provide nursing care, family planning, pediatric care, and vaccinations, among other services. They are similar to the “Maisons de santé” you may be familiar with in France. Each center has its own independent organizational structure for services, but they all have one thing in common: there are no medical specialists.

Diagnoses and care are provided by your family doctor, who will be assigned to you when you enroll. This healthcare professional is a general practitioner and also cares for all other members of your family. This allows for better follow-up care and a closer relationship between the patient and the doctor.

Apply for a Social Security number in Portugal

To apply for and obtain your Social Security number in Portugal (NISS), you must first have the following documents:

• Your SEF Certificate
• Proof of residence in Portugal (water bill, electricity bill, etc.)
• Taxpayer number

If you are an employee, you will need to provide a copy of your employment contract certified by your employer.

If you are an investor, you will need to bring a copy of your articles of incorporation.

Once you have these documents, you’ll need to go to the Segurança Social office nearest you and apply for a social security number in Portugal. For people who are not yet employed and who need this Social Security number in order to be hired by a Portuguese company, this is where things get complicated. 

Applying for a Social Security number in Portugal without an employment contract or other documentation

Whether a European citizen is assigned a Social Security number does not depend solely on whether they work for a local company or are contractor.

If none of the situations listed above apply to you, it will be more complicated to obtain your social security number, but rest assured that it is still possible. The basic principle of the Portuguese social security system is that citizens must pay into it before they’re entitled to benefits. That’s why it’s usually employers who register their employees and apply for a NISS number.

To apply for a Social Security number in Portugal as a European citizen, you must submit an employment contract confirming contributions and payments of taxes and other social security contributions in Portugal. However, companies cannot hire employees until they provide their NISS.

Companies can’t hire people because the employees don’t have a Portuguese social security number, and expats can’t get a NISS because they don’t have an employment contract with the company. As you can see, it’s a vicious cycle.

How to Get Your NISS Without an Employment Contract

If you're about to sign your contract

To resolve this issue, the company must provide you with a promise of employment. If the company already intends to hire a European Union citizen, it can issue a promise of employment. This document will allow you to apply for a Social Security number.

If you work as a freelancer or sole proprietor

European Union nationals who have at least six months of tax payments on record with the Portuguese tax authorities (Finanças) may also apply for a NISS. This allows citizens to start a business work as a freelancer and issue "recibo verde" invoices until they have accumulated the required time to apply for a social security number for foreigners. It is important to remember that you must always be legally present in Portugal; in other words, there is no exemption from providing proof of residence to Social Security.

Register at the Portuguese health center

Registering at your health center is relatively simple, as long as you have all the necessary documents on hand. If you are covered by a special health plan, you will also need to bring documents proving your enrollment in that plan.  

To apply for a Social Security number

• Identification Document
• Taxpayer number
• SEF Document
• Proof of Address
• Form S1 (if you are retired)
  

Medical appointments and costs at the health center

Every health center provides the same basic services, although some centers may offer additional care.

• General Practice/Family Medicine Appointments: Providing health care to patients and their families at different stages of their lives.
• Public Health Service (Health Officer): for requests for mandatory or other medical examinations, such as medical examinations for the renewal of a driver’s license, for example. Medical examinations for civil servants; determination of disability ratings in cases of disability or chronic illness.
• Nursing Services: Nurses provide various types of care, such as vaccinations, wound care, and home care for bedridden patients.
  

As mentioned above, some health centers may offer complementary and highly specialized care.

• Specialized Consultations: For certain situations, such as pregnancy, diabetes, children, family planning, etc.
• Social worker: Provide guidance and support regarding social issues.
• Medical testing: for clinical tests and X-rays.
• Inpatient Units: for the hospitalization of patients.
  

It is also important to know that Portugal requires certain vaccinations; without them, your children will not be able to attend school. All vaccinations included in the national immunization program are free.

For a so-called «routine» visit to a health center, you’ll need to pay €5, and expect to pay about €20 for an emergency room visit at the hospital.

If your family doctor recommends surgery, both the procedure and your hospital stay will be covered by Social Security.

Conditions for Free Healthcare

In 2019, certain categories of people are exempt from medical fees; the costs of the care provided will be covered by health centers and the Portuguese social security system.

• Pregnant women;
• Children up to age 18;
• Users with a disability rating of 60% or higher;
• Blood donors;
• Donors of cells, tissues, and organs;
• Firefighters;
• Transplant patients;
• Active-duty and former members of the armed forces who are permanently disabled;
• Unemployed individuals registered with the employment center who receive benefits equal to or less than 1.5 times the IAS (€653.64), provided they cannot prove financial need under the conditions set forth by law. The exemption from payment extends to the spouse and dependents;
• People facing financial hardship and their dependents (with an income of €653.64 or less).
  

Public or private healthcare?

Above all, it is a personal choice, though one that will ultimately be dictated by your purchasing power and your health insurance plan. If you cannot afford health insurance, you should simply seek treatment through the public healthcare system.