Tessera Sanitaria: what is it and how can I get one?

illustration of a wallet with some cards

What do I need to get a Tessera Sanitaria ?

In order to get your Tessera Sanitaria (Italian Health Insurance Card) you will have to have:

  • Your passport
  • A valid permit to stay or the receipt you get when you ask for it
  • A valid Codice Fiscale (Italian Tax Code) issued by the Agenzia delle Entrate (Italian Revenue Agency)
  • Self-declaration of residency or place of abode (the address written on your permit to stay) – you can use this template
  • The receipt of payment for the registration to the SSN from the Post Office (if required –  see below)
  • If you are a student or au pair, a document confirming you are enrolled at a school or your au pair contract
  • A copy of all above documents. 
  • A pen (it’s incredible how hard it is to borrow one when you need it!) and some entertainment (you might need to wait).
Flip side of the Italian Tessera Sanitaria
Flip side of the Tessera Sanitaria

How can I get a Tessera Sanitaria ?

1 – Get your Codice Fiscale first (Italian Tax Code). You will need to go to the tax authority for getting this done (Agenzia delle entrate). If you don’t know how to do it, don’t panic! Just take a look at our step-by-step article about how to get a Codice Fiscale

2 – Pay a visit to the Local Health Authority office (ASL – find the closest ASL here). This will save you a lot of time later. You should go there first to check if there are any specific requirements, what is the exact fee to pay, and how to fill out the payment form at the Post Office. 

3 – Go to a Post Office (here you can find the closestto pay the annual fee. Just complete a postal order (Bollettino Postale – a paper form you can find at the office to make payments at the post office). Pay and keep the receipt, you will need to show it when applying for  your Tessera Sanitaria (Italian Health Card). 

You receive your personal tessera sanitaria when you register with the Italian National Health Service (SSN – Servizio Sanitario Nazionale).

4 – Make a copy of the receipt you got at the Post Office and go to your ASL (Local Health Authority) office again and this time bring with you all the documents listed on the top of this page.

5 – Keep the receipt you receive after completing the registration, you will use it as a proof of registration until you receive your Tessera Sanitaria (Italian Health Insurance Card) – it will be delivered at your home address by mail.

6 – Bring your registration documents to the Primary Care Physician (Medico di Base or Medico di Famiglia) you picked, so that he/she can register you as an official patient. Expect that each Medico di Base will be part of a small practice with its own business hours and way of doing business. Make sure to take note of office hours and the doctor’s phone number, in case you need to ask for a house call (available if you are too sick to get to the office). 

What is a Tessera Sanitaria ?

The Tessera Sanitaria is the Italian Health Insurance Card that all residents need to show when using the Italian National Health Service (SSN – Servizio Sanitario Nazionale): you will need it when going to a doctor, purchasing a drug in the pharmacy, doing blood analyses, undergoing specialist examinations, diagnostics or requiring admission to a public hospital. 

The Tessera Sanitaria (Italian Health Insurance Card) is not required for seeing a private doctor, either a general practitioner or a specialist, and to buy medications or to do blood tests prescribed by a private doctor.

Types of registration with the Italian SSN

types of registration to the Italian SSN

Foreign non-European Union citizens staying for work, family, international protection, pregnant women, fostering or adoption are entitled to be registered without paying the Italian National Health Service (SSN – Servizio Sanitario Nazionale). This is called mandatory or by rights registration.

Others (e.g. students, au pairs, religious staff, etc) who are staying for more than 90 days may apply for voluntary (or “optional”) registration: they have to pay a yearly lump sum. Only students and au pairs can opt to register with the Italian National Health Service even if they stay for less than 3 months.

Tourists cannot register with the Italian National Health Service (SSN – Servizio Sanitario Nazionale).

a bunch of Italian postal orders

How much does it cost to apply for a Tessera Sanitaria?

If you are entitled to “Mandatory registration” (see above) you don’t have to pay to register with the Italian National Health Service (SSN – Servizio Sanitario Nazionale). If you are not entitled to “Mandatory registration” but you are allowed to register (i.e. “Voluntary registration”) to the Italian National Health Service (SSN – Servizio Sanitario Nazionale) (e.g. students and au pair) you will need to settle a yearly payment. This can be a lump sum for students and au pairs or a variable amount depending on your last year gross income.

Applicants for optional registration (except students and au pairs) must self-certify their gross income.  If the applicant does not have a personal income, the cost of the registration is calculated on that of the family he is dependent on.

a series of Italian euro banknotes

Currently, the annual contribution is € 387.34 for an annual income between 0 and € 5165.00. The rate (“aliquota percentuale”) for an income exceeding € 5165.00 and up to € 20,658.28 is 7.5% rate, while it’s 4% for amounts exceeding € 20,658.28 and up to the limit of € 51,645.69. This means that, for instance, if your gross income for the previous year was € 40,000 you would pay 7.5% up to € 20,658 and 4% for the remainder of € 19,342 yearly for registering to the NHS (i.e. € 2,322).

Without regard to the gross income, the amount of the contribution cannot be less than € 387.34 or higher than € 2.788,86 with the currency exchange rate applicable at the date of the application.

Students and Au Pairs Privileges

If you are staying for study purposes or au pairs you are entitled to two major benefits. You can:

  1. Apply for registration to the Italian National Health Service (SSN – Servizio Sanitario Nazionale) even if staying for less than 3 months
  2. Pay a fixed yearly lump sum: € 149.77 for students and € 219.49 for au pairs (for the latter the sum is usually paid by the member of the family who has signed the au pair agreement)

In any case the payment for optional registration refers to the calendar year (January 1st – December 31st) and cannot be split up (this means that if you pay in November, you have to pay again in January).

For students and au pairs the registration to the Italian National Health Service (SSN – Servizio Sanitario Nazionale) is personal and therefore the dependent family members are excluded (the annual contribution is paid according to the annual income as explained above).

I’ve lost my Tessera Sanitaria, how can I get a duplicate?

You can ask for a duplicate online on this webpage or at your ASL (Local Health Authority) or at any office of the Agenzia delle Entrate (Revenue Agency). 

How do I renew my Italian Health Insurance Card?

The Italian National Health Service (SSN – Servizio Sanitario Nazionale) registration issued to non-EU foreigners will remain valid until the expiry of the permit to stay.

In order to renew the health card, you must bring to the ASL (Local Health Authority):

  1. Your Passport.
  2. The documents confirming the request for renewal of the permit to stay, such as the receipt you get when you pay at the post office or the one issued by the Questura
  3. Your Codice Fiscale (Italian Tax Code).
  4. A certificate of residence (or a self declaration of residence in which you state to live at your current address. You can find a draft here)

With this documentation, the ASL (Local Health Authority) issues the applicant’s temporary registration (6 months) waiting for the confirmation of the renewal of the permit to stay. 

This temporary registration entitles to the same level of assistance. Once the new permit has been issued, you need to bring a copy of it to the ASL (Local Health Authority).

This will confirm your registration to the Italian National Health Service (SSN – Servizio Sanitario Nazionale) and issue the new Tessera Sanitaria with the same expiration date of the new permit to stay.

If you are entitled to the “Mandatory registration” to the Italian National Health Service (SSN – Servizio Sanitario Nazionale) (see above) you will not have to pay.

If you are registered by choice (e.g. students and au pairs) you will need to bring to the ASL (Local Health Authority) also the receipt of the payment at the post office for the registration to the Italian National Health Service (SSN – Servizio Sanitario Nazionale), as you did for the initial registration.

Even if you don’t renew your registration to the Italian National Health Service (SSN – Servizio Sanitario Nazionale), your Tessera Sanitaria (Italian Health Insurance Card) continues to be valid, even after the expiration date, as a substitute for the Codice Fiscale (Italian Tax Code).

We wish to thank Ms Nancy Hampton for her contribution in improving this article.

If you’re curious to see this experience through the eyes of an expat in Rome, check this blog post written by an American in Rome.

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DoctorsinItaly Team

This article was written, curated, and updated by the DoctorsinItaly team, as part of our efforts to share relevant and current information on health and wellness related topics, as well as on life as an expat or traveler in Italy.

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