For members


Tessera sanitaria: How do you apply for or renew your Italian health card?

Getting your tessera sanitaria as a foreign resident in Italy isn't easy at the best of times, and the coronavirus pandemic has only made things harder. Where's all the official information? And do you really have to go to the office in person - twice?

Tessera sanitaria: How do you apply for or renew your Italian health card?
You'll need a health insurance card in Italy, but getting one isn't always straightforward. Photo: Alberto Pizzoli/AFP

It’s one of the first and most important pieces of bureaucracy you’ll need to deal with when you move to Italy. But it’s also one that Italy’s foreign residents frequently report having trouble with: the tessera sanitaria, or Italian health insurance card.

You receive your personal tessera sanitaria when you register with the Italian National Health Service (SSN – Servizio Sanitario Nazionale), something most people resident in the country should do, although there are valid reasons why some foreign residents may not.

Italy is currently trying to move more government services online, a long-overdue process which has been made all the more urgent by the coronavirus pandemic.

READ ALSO: Italian bureaucracy: What is a SPID and how do you get one?

The tessera sanitaria however can’t be applied for online. You need to go in person to the ASL, or Agenzia Sanitaria Locale (local health authority) office.

And not only is it impossible to apply without going in person, for many foreigners in Italy the process takes not just one but two trips to the ASL, as well as a stop at the post office – even during a pandemic.

This is something several of The Local’s readers have asked about recently, as the ongoing coronavirus pandemic makes trekking from office to office a potential health hazard.

The process is made more complicated because many of Italy’s foreign residents need to pay a yearly contribution towards health insurance. (Find more information on who needs to pay below.)

If this applies to you, there is currently no system in place allowing you to make the payment online, meaning you’ll need to visit your local ASL office to find out the price, make a trip to the post office to pay by postal order, and then go back then to the ASL office to complete your registration.

But even if you don’t need to pay and can skip the post office, two visits to the ASL may still be necessary because visiting in person may be the only way to get accurate information on the documents you’ll need, and how much you’ll have to pay.

READ ALSO: Who can register for national healthcare in Italy?

Doing your paperwork online still isn’t always possible in Italy. Photo: Mario Laporta/AFP

Isn’t this information available online?

Several readers have written to The Local recently asking why they can’t get official information about the SSN registration process online or over the phone.

“Four phone calls yesterday turned up no assistance beyond ‘check website/go to the office’. Not surprised, but still disappointed,” said reader Matthew Lever in Turin.

“If there’s an online method to pay, I’d be stunned, frankly but, failing that, just some simple procedural information would go a long way.”

As Matthew and other readers have noted, finding specific information online or asking for it over the phone may be even harder than you’d expect.

This could, of course, depend on where in the country you are as every office differs.

While Italy has a national health service, healthcare provision is managed at a local level by each region’s health authority, meaning fees and registration processes vary around the country.

Your local prefettura’s website should have some information about SSN registration – for example, you can find the requirements for registering in Rome here (in Italian only). 

You might decide to risk arming yourself with as much paperwork as possible and attempting to do everything in one trip. But be aware that you could get to the ASL only to be told that the information you found online was incomplete or out of date.

And this is even riskier if you need to make a payment, as you’ll need to make sure you pay the correct amount.

It seems that going to the office in person – twice – really is the only way to make absolutely sure you get what you need.

Who needs to pay and how much does it cost?

If your SSN registration is deemed “mandatory”, it’s free. This applies to any Italian resident, whether they are an EU citizen or not, who has an employment contract. It also applies to family members of Italian citizens and to pregnant women, for example.

In many other cases, you’ll have to register on a “voluntary” basis and pay an annual fee. This is often set at 387 euros, but it varies depending on your personal circumstances and on the fee structure in the region in which you are registering. Some readers report that they’re paying far more – up to 850 euros (per person, per year) in some cases.

You’ll have to ask your local ASL to confirm whether or not you need to pay, and to confirm the amount before you pay it. Of course, this probably means a trip to the office.

Is renewing the tessera sanitaria any easier?

If you have “mandatory” (free) SSN registration, you don’t have to do anything to renew your tessera sanitaria. The agenzie delle entrate (tax office) will send the new card to you automatically when your current one expires.

If the new card doesn’t turn up however, there’s no way to request a renewal online. You will need to go to your local ASL office in person.

And if you do need to pay a contribution, the card won’t be automatically renewed.

In this case, your tessera sanitaria is likely to only be valid for one year, instead of the usual six – though again the rules can vary.

How to apply for or renew your tessera sanitaria

The first thing to keep in mind is that to apply for the health card, you will need to already be a resident in Italy with the permesso di soggiorno (stay permit) to prove it. Until you have at least applied for this, your registration can’t go ahead. (See more on the required documents below).

Whether you are applying for the first time, or need to pay to renew your card, you’ll need to visit your local ASL office (find your closest ASL here) in person, and probably more than once.

Your first visit to the ASL is a fact-finding mission, on which you’ll find out exactly which documents they require, and the exact price you’ll need to pay (if applicable). 

You’ll then need to go and make the payment at the post office, by postal order, keeping hold of your receipt. Other methods of payment aren’t accepted.

After that, you’ll need to return to the ASL office, taking the documents your ASL has asked for. 

These are likely to include:

  • Identity card or passport

  • Permit to stay (permesso di soggiorno), or the receipt you got when you applied for one. Here’s how to apply.

  • Italian tax code (codice fiscale). Here’s how to get one.

  • A certificate of residence, or a self-declaration of residence in which you state that you live at your current address. Find the form online here.

  • The post office receipt for your SSN payment (if required – see above)

  • Photocopies of each document.

Again though, because the requirements vary, it’s important to find out from your ASL exactly what you’ll need before you go.

Check your local ASL office’s website ahead of time for opening hours and be prepared to wait.

After registering with the ASL you’ll be given a receipt. Keep hold of it, as it can be used as proof of registration until you receive your tessera sanitaria – the card will be mailed to your home address by the Agenzia delle Entrate (tax office) at the ASL’s request.

If you have simply lost your (still valid) health insurance card and need a replacement however, you actually can do this online. Request a new copy of your card here.

Member comments

  1. In the case of the “mandatory” enrollment where you have an employment contract, they sometimes also ask for your three recent payslips or the employment contract (modello UNILAV)

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For members


EXPLAINED: What is Italy’s new digital invoicing rule for freelancers?

Italy is bringing in new rules from July that mean changes for freelancers on the 'flat tax' rate. Here’s what you need to know about the new ‘fatturazione elettronica’, or digital invoicing system.

EXPLAINED: What is Italy’s new digital invoicing rule for freelancers?

Italy has been slowly moving more of its bureaucratic systems online in recent years, and in many cases this has made it quicker and easier for residents to access services and get their considerable amounts of Italian life admin in order.

It was hoped that the new electronic invoicing rule would do the same for freelancers on Italy’s flat-tax regime, by doing away with the existing need to print out invoices and affix tax stamps by hand.

READ ALSO: Beat the queues: 19 bits of Italian bureaucracy you can do online

But a close look at the details of the new rules shows that it probably won’t make life easier for those on the flat tax rate, who have so far been spared the bulk of that infamous Italian red tape – but now need to get to grips with a new online system.

Known as the ‘regime forfettario‘, Italy’s flat-rate tax scheme for individuals and small businesses was introduced in 2015 to encourage more commercial activity by slashing tax rates and simplifying bureaucracy.

New freelancers who choose this tax system generally pay somewhere between just five and 15 percent tax on earnings, regardless of overheads.

READ ALSO: The pros and cons of Italy’s five percent flat tax for freelancers

Little has changed since its inception seven years ago, but freelancers using the scheme now need to be aware of new rules coming into force from July 1st, 2022.

How you invoice – how you send, receive and store receipts, therefore – is due to move from analogue to digital, bringing new requirements and know-how on digital invoicing software.

Here’s what’s changing for freelancers with the so-called ‘fattura elettronica‘.

Who is required to send electronic invoices?

While this was already a requirement for the self-employed on other tax regimes, those on the flat tax rate will now be included from July 1st.

They were previously exempt, but that changed under the PNRR (National recovery and resilience plan or piano nazionale di ripresa e resilienza) – the Italian government’s plan for using EU funding for post-pandemic economic recovery.

Digital invoicing is intended to fight Italy’s major problem with tax evasion, as well as to further automate accounting processes.

For now, not all freelancers under this tax scheme need to move to digital accounting – only those who received an income in excess of €25,000 in the previous year are required to comply with the new rule.

It will then extend to all freelancers using the flat-rate scheme from January 1st, 2024.

From that date, everyone subscribed to the ‘regime forfettario’ will have to switch to electronic invoicing and there are hefty penalties in place for those who don’t.

How will electronic invoices work?

Italy’s tax authority has defined a couple of notable differences between the digital or electronic invoice (fattura elettronica) and a paper invoice (fattura di carta) in its updated guidelines.

Firstly, the digital invoice has to be created using a digital device (a computer, tablet or smartphone), and secondly it has to be sent to the client via an ‘Interchange System’, the so-called Sistema di Interscambio (SdI).

READ ALSO: ‘Smart working’? Here’s what you need to know about going self-employed in Italy

Italy’s flat-rate tax scheme is going digital. Photo by Christian Dubovan on Unsplash

This electronic postal system checks whether the invoice contains the required data for tax purposes, as well as checking the verified e-address (or the so-called PEC address) of the recipient.

In doing so, the electronic invoice automatically checks that the VAT number (partita IVA), or the tax code (codice fiscale) depending on who you send the invoice to, really exist.

Once the checks are completed, the system sends the invoice to the client, which will trigger an alert to the freelancer with a delivery receipt, showing the date and time the document was delivered.

How can you send an e-invoice?

There are a few accounting software options on the market if you’re now faced with having to send electronic invoices.

Some charge a fee of around €1-€4 per month or come at a cost per transaction.

Platforms such as ‘Aruba‘ or ‘Fatture in Cloud‘, are competitive and may offer you a free trial before you deciding to buy.

The Italian revenue agency (Agenzie delle Entrate) has also created free-of-charge services to help send and receive e-invoices. These include websites as well as apps for completing the required steps, which are detailed in their guide here.

You can access their Invoices and Receipts (‘Fatture e Corrispettivi‘) portal to benefit from these free services.

You’ll either need a Spid ID (‘Sistema Pubblico dell’Identità Digitale‘), a Carta Nazionale dei Servizi (CNS) or accounting credentials known as Fisconline/Entrate, which are issued by the Agenzie delle Entrate.

You can also delegate this task to an intermediary, such as an accountant (commercialista) who would do this on your behalf, the revenue agency stipulates 

What about the Italian tax stamp?

Until now, freelancers issuing invoices under the ‘regime forfettario‘ have had to attach a €2 stamp, called a ‘marca da bollo’, to every invoice over the value of €77,47.

So what happens when e-receipts go digital and you can’t physically stick a stamp on a document? Well, that goes digital too and the Inland Revenue has issued a 16-page guide on how you need to go about it.

It seems the previously attractive ‘light’ accounting of this regime is about to get bogged down by time-consuming bureaucracy too.

Authorities will systematically check that the fee has been paid each quarter for all the invoices that require it.

As a general rule, you can see if there are any discrepancies by the 15th day of the first month following each quarter on their Invoices and Receipts portal.

You or your intermediary have until the end of that month to fix any accounting errors, but make sure to check with an accountant if you have any difficulties or need specific advice for your personal circumstances.

Once you receive your final stamp duty bill for each quarter, you can pay either via IBAN, which you set up on the portal, or by filling out an electronic F24 form – details of how to do that are included in the guide.

For further information and FAQ’s, see Italy’s Inland Revenue Agency website on the electronic invoice here.

Please note The Local cannot advise on personal cases and seeking expert financial advice is recommended.