Portugal news, in English, every morning. Free.

Subscribe

The Portugal Brief
Subscribe
Guides

Joining ADSE, the Public Sector Health Scheme in Portugal

Researched and written with AI tools from official sources. How we make our guides

Who can join ADSE, the 3.5% contribution, adding your family, using the ADSE network or claiming refunds, and how ADSE works alongside the SNS.

The Portugal Brief 8 min read

Joining ADSE, the Public Sector Health Scheme in Portugal

Last verified: October 2026.

Who this is for

  • You work, or are about to work, for a Portuguese public body, such as a school, university, hospital, or town hall.
  • You are retired from the public sector, or you are the spouse, partner, child, or parent of a public worker.
  • You want to know what ADSE costs and how it works with the SNS.

Not for you if: you work in the private sector and want extra health cover. Read Choosing Private Health Insurance in Portugal instead.

ADSE is the health scheme for people who work for, or retired from, the Portuguese public administration, and their families. If you start a permanent public sector job, your employer enrols you within one month, unless you gave up ADSE before. You pay 3.5% of your gross pay, including holiday and Christmas pay, and nothing more for your family. ADSE gives you cheaper access to about 1,500 private providers, or refunds part of the bill elsewhere. You keep full access to the SNS.

What ADSE is

ADSE is a public institute that reports to the Ministry of Finance, not the health ministry. It was created in 1963. It is not an insurance company and it does not run hospitals. It pays for care you receive from private providers, in two ways: through its own network, or through refunds.

Members' contributions are ADSE's own revenue. Each member pays according to income and gets the same access to care. There is no age limit, no medical questionnaire, no exclusion for existing illness, and no waiting period. You can use it from the day you are enrolled.

Who can join

You can be a main member (beneficiário titular) if you are:

  • a worker with a public employment contract, permanent or fixed term
  • a worker with an individual employment contract, with or without a fixed term, at a public body
  • a retiree who was an ADSE member, with a public sector link, at the date you retired
  • a teacher at a private or cooperative school, if your employer has an agreement with ADSE

You cannot join if you gave up ADSE in the past, or if you are a main member of another public sector health scheme.

Nationality is not a condition. What matters is your contract with a public employer.

How you are enrolled

Your employer handles the enrolment.

If your contract is permanent: your employer must enrol you within one month of the start of your first public employment. This happens automatically. You do not need to apply.

If your contract is fixed term: you are not enrolled automatically. You can choose to join within three months of signing the contract. You have this choice up to your third contract. If you do not use it by then, you are treated as having given up ADSE. If you later get a permanent contract, your employer enrols you automatically.

Service contracts do not count. If you work for a public body on a service contract (as a self-employed provider), you cannot join.

Giving up ADSE

You can leave at any time by giving your employer a signed form. If you are retired, you send it to ADSE. Leaving is permanent. Once you give up ADSE, you can never rejoin. Think carefully before you do it.

If you have a permanent contract, you can only give up ADSE after your employer has enrolled you.

Adding your family

You can add family members (beneficiários familiares) at any time, at no extra cost:

  • Your spouse.
  • Your unmarried partner, if you have lived together for more than two years.
  • Children and stepchildren. Also grandchildren, adopted children, and children in your care by court or official decision. They are covered while under 18, up to 26 if they are studying at secondary level or higher, or at any age if they have a total and permanent disability that stops them working.
  • Your parents or other ascendants who depend on you. One parent's own income must be below 60% of the minimum wage. For a couple, their joint income must be below the minimum wage. In 2026 the minimum wage is €920 a month.

Adult family members cannot join if they work and pay into a compulsory social security scheme. They also cannot be in another public health scheme.

Documents for family members

Requirements depend on the family member. For a spouse, ADSE asks for:

  • a copy of the marriage certificate
  • a statement from Segurança Social showing that your spouse is not covered by a compulsory scheme through paid work
  • if your spouse is not Portuguese, a similar statement from their country
  • if your spouse is not an EU citizen and lives in Portugal, a copy of their residence permit
  • their latest IRS return, or proof they do not have to file one

All documents must be in Portuguese or translated by a competent body. Most family enrolments last one year, so you renew them each year.

What it costs

You pay 3.5% of your base pay, and of your holiday and Christmas pay. Your employer deducts it from your salary. There is no extra premium for your family.

If you are retired, you pay 3.5% of your pension. This only applies if the pension is above €635. The deduction can never leave you with less than €635.

You declare your ADSE contributions on your IRS return, in annex A. See Filing Your Annual Income Tax Return (IRS) in Portugal.

Using the ADSE network

The ADSE network (Rede ADSE, also called the regime convencionado) is made up of about 1,500 private providers that have an agreement with ADSE. When you use them:

  1. Show your ADSE card, on paper or in the MyADSE app, and your photo ID.
  2. Pay only your share of the cost, the co-payment (copagamento). ADSE pays the rest to the provider.
  3. Ask for a receipt for your co-payment and check that it matches the care you received.

ADSE gives the example of a specialist appointment: you pay €5 in the network.

Surgery has a cap. You pay at most €500 for any surgical episode in the network. ADSE pays the rest. Tests and some other items are billed separately.

Before you book, confirm that the doctor and the procedure are still in the network. Providers sometimes remove a doctor or procedure from their agreement. You can search for providers by municipality and type of care on the ADSE website.

Psychology appointments in the network do not need a doctor's prescription. You can have up to 24 a year.

Claiming a refund outside the network

You can see any provider outside the network. This is the free choice route (regime livre). You pay the full bill and ask ADSE for part of it back, based on its price table.

  1. Ask for an invoice with your tax number (NIF) on it. The provider must register it on the e-Fatura system.
  2. Submit it in ADSE Direta (the online portal) or the MyADSE app. You can also send it by post or hand it in at an ADSE shop.
  3. Add any other documents needed, such as a prescription or medical report.

ADSE must receive your claim within six months of the date of the care. If you could not meet the deadline for reasons beyond your control, send the documents with proof of the reason.

Refunds are usually much lower than the bill. ADSE warns that some providers offer "special" price lists that are billed as free choice. Compare with the network price first.

What ADSE does not pay for

  • treatment for purely cosmetic reasons
  • care after an accident at work or a work-related illness
  • care after an accident caused by someone else
  • SNS user fees
  • your co-payment in the network
  • amounts already paid by another public scheme or by an insurer

ADSE and the SNS

ADSE works alongside the SNS. You keep your SNS user number, your family doctor, and access to public hospitals. When you go to a public hospital or health centre, you are treated as an SNS patient, not as an ADSE member. See Healthcare in Portugal.

Medicines you buy at a pharmacy with a prescription get the normal SNS subsidy. See Paying Less for Prescription Medicines in Portugal.

For travel in Europe, you get the European Health Insurance Card from Segurança Social, not from ADSE. See Getting a European Health Insurance Card in Portugal.

When you leave your job

In most cases ADSE ends when your public job ends. You can keep it in some situations, if you keep paying the contribution yourself. These include:

  • leaving a permanent public job by mutual agreement, if the agreement says you keep ADSE
  • working in a state-owned company while keeping your link to your original public employer
  • some types of unpaid leave, such as one year of unpaid leave or leave to join a spouse posted abroad
  • retirement, if you were an ADSE member with a public sector link when you retired

When you pay directly, you use a payment document from ADSE Direta, during the month the payment is for. If you do not pay, your enrolment lapses.

This guide is general information, not medical or legal advice. For your own case, ask your employer's human resources team or ADSE.

Sources

This guide is written from official sources and, where relevant, organisations' own websites.

Last verified October 2026. Rules and fees change; check the official source before acting.

Read next