Italian Health System

The National health insurance in Italy is managed by the National Health Service “Servicio Sanitario Nacional” (SSN) and funded through direct taxation (IRPEF and IRAP) in addition to indirect taxation.

Registration

Registration is handled at a local level by the Local Health Service “Azienda Sanitaria Locale”, or ASL) which issues a social security number and a health card “Tessera Sanitaria”. This entitles the holder to low or no-cost treatment. Hospital services are provided free and a 75% reduction is given on the cost of out-patient and some dental treatment. However, regardless of coverage, emergency treatment is available at free or low-cost to anyone in need in Italy.

Eligibility for National Health Insurance

Italy recognises those eligible for enrolment in their National Health Service as being either compulsory or voluntary. For instance, the participation of the employed and self-employed is compulsory - they must enrol and are required to make contributions for coverage. Those with a “Carta di Soggiorno “(for EU citizens) or Permesso di Soggiorno or those who apply for renewal of the Carta/Permesso di Soggiorno for the following reasons are also required to enrol:
•    awaiting citizenship, custody or adoption
•    humanitarian reasons
•    seeking political asylum
•    family reasons

Some foreign citizens (and their family members) resident in Italy who are not required to enrol with the SSN may opt to enrol voluntarily. Those eligible to enrol are:
•    foreign students with a Carta/Permesso di Soggiorno
•    people with a Carta/Permesso di Soggiorno that is valid for more than three months
•    employees of companies headquartered outside of Italy

EU Citizens

EU citizens staying in Italy for more than three months must register with the National Health Service if they are:
•    an employee or self-employed
•    a family member (EU or non-EU) of an employee or self-employed person in Italy. (A family member is a spouse, dependant child under 21-years and dependant parent)
•    a family member (EU or non-EU) of an Italian citizen
•    registered as unemployed, or unemployed and enrolled in a vocational program pertaining to their profession
•    Holders of an E106, E109 and other more obscure forms.

Foreign citizens living in Italy with a valid stay permit “Carta di Soggiorno” good for more than three months may enrol in the National Health Service (SSN) and have the same rights to medical care through the National

Health Service as Italian citizens.

An EU national who was employed in Italy for at least one year and was registered for national health insurance, is entitled to continuation of health coverage in case of involuntary unemployment
An EU national on a fixed-duration work contract of less than one year who is formerly registered as involuntarily unemployed is entitled to retain health coverage for up to one year
•    For more information on EU nationals and the Italian National Health System from the Italian Health Ministry via the UK Foreign and Commonwealth Office.
Please note that cohabitating partners are not currently considered family members under Italian Law.

Non-EU citizens

Non-EU citizens must enrol in the National Health Service if they:
•    are an employee or self-employed
•    are a family member of an Italian national
•    have a permanent stay permit and five years of continuous residence

Foreign citizens living in Italy with a valid stay permit “Permesso di Soggiorno” good for more than three months may enrol in the National Health Service (SSN) and have the same rights to medical care through the National Health Service as Italian citizens.

Duration of eligibility for the employed and self-employed

Those employed or self-employed in Italy are required to enrol in the National Health Service, with the cost of coverage paid through tax contributions.
•    Those employed on a long-term basis, remain enrolled in the National Health Service for the duration of their employment
•    Those employed on a fixed-duration contract of less than one year will be eligible for coverage for the duration of the contract. For longer-term contracts, annual renewal is necessary
•    Any employed or self-employed EU national with a seasonal work contract of three months or less is eligible, though not required to register with the ASL and contribute to the National Health Service. This also applies to those with approved E106 applications having a three month validity period. Workers who choose to enrol will be covered for the duration of their work contract

Eligibility for retirees

Retirees who are EU citizens and are legally resident in Italy are entitled to register for state health insurance at no cost provided they have a Form E121. Form E121 should be obtained from the national health service of the former country of residence. It proves that appropriate social security taxes have been paid in the former country of residence, the person has reached the official retirement age and that they are receiving a state pension. Retirees not in possession of a Form E121 will be required to obtain private health insurance.
EU citizens who retire to Italy before qualifying for their state pension may get free health cover for two years (a form E106 is required).

Eligibility for students

Those in Italy for studies and who obtain a Carta/Permesso di Soggiorno may pay to voluntarily enrol with the National Health Service, and may enrol even if the permit is valid for less than three months. Otherwise, private health insurance must be obtained.

Family members of students are not eligible for coverage if the student's permit is valid for less than three months.
•    Payment for coverage is made into the postal account of the ASL and the receipt of payment should be shown when applying at the ASL office.

Before being issued a Carta/Permesso di Soggiorno, the applicant may be required to enrol with the National Health Service (this generally applies to non-EU citizens). If this occurs, obtain a receipt, a “cedolino” from the application office and present it when applying for temporary enrolment at the Local Health Service “Azienda Sanitaria Locale” (ASL). This temporary enrolment will be valid for three months. After the stay permit is granted, take it to the ASL to officially enrol in the National Health Service. Enrolment will expire at the same time as the “stay” permit.

How to Register

Visit the Local Health Service (ASL) to enrol in the National Health Service and obtain a health insurance card (Tessera Sanitaria). Those who are employed or self-employed can enrol as soon as contributions are paid into the Italian National Insurance system.

Required documents for compulsory enrolment in the National Health Service include:

•    the applicant's “codice fiscale”
•    proof of address or declaration of place of residence (must be the same address found on the Carta/Permesso di Soggiorno)
•    valid Carta/Permesso di Soggiorno or proof of renewal in process
•    a statement declaring that any changes to the applicant's personal information will be submitted to the National Health Service
•    if employed, an employment contract or tax records proving employment status and start date
•    if self-employed, certificate of registration with the Chamber of Commerce or a professional association, or tax records
•    if unemployed, proof of enrolment in the employment listings or at an educational institution

For those enrolling voluntarily, the above documents are necessary as well as:
•    if a student, proof of student status
•    a receipt showing payment of enrolment fee

The government's Stranieri in Italia (in Italian) website offers information for those foreigners residing in Italy.

Contribution Costs

Contribution costs are based on factors such as income level and family size. Contact the ASL for more information.

Contributions to the National Health Service are not necessary for the following:
•    applicants for political asylum and refugees
•    those who are unemployed, hold a valid stay permit and are registered on the unemployment listings
•    minor children whose parents belong to either of the above categories

Medical Cards

The ASL will issue the Medical Card “Tessera Sanitaria”. In case a card is lost or stolen, contact the ASL for a replacement

Validity

Unless you are employed or self-employed, enrolment in the National Health Service is valid for the same duration as the Carta/Permesso di Soggiorno. During the renewal of a “stay” permit, a new Medical Card will be issued with an expiration date of 31 December of that year though no additional payment will be required.

We can provide free independent advice regarding the most appropriate health insurance plan for your circumstances. Please feel free to call us or ask for a no obligation quotation:

This is our current understanding of the regulations regarding the Italian health system and no liability can be accepted for any errors or omissions contained therein.