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HEALTH

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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HEALTH

EXPLAINED: How to make a doctor’s appointment in Italy

Sooner or later, every foreign national living in Italy will need to see a doctor. Here's a guide to making your first appointment.

EXPLAINED: How to make a doctor's appointment in Italy

Making a doctor’s appointment is usually thought of as a fairly uncomplicated task but everything gets a little harder when you’re in a foreign country.

And in Italy, the process can turn out to be surprisngly tricky, especially if you’ve just relocated to the country and are not yet familiar with how the Italian healthcare system (Servizio Sanitario Nazionale, or SSN) works.

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

On top of that, Italian doctors and other healthcare staff are rarely fluent in English and only very few sections of the SSN’s website provide information in languages other than Italian. 

So to make things a little easier, here’s what you need to know about making a doctor’s appointment in Italy.  

Who can make an appointment to see the doctor?

Only people who hold a valid Italian health card (tessera sanitaria) or an equivalent, i.e. a European Health Insurance Card (EHIC) or a UK Global Health Insurance Card (GHIC), can access public health services, including visits to a general practitioner or family doctor (medico di base).

For emergency treatment, the Italian health service provides care to anyone in need regardless of their nationality or immigration status and without asking for upfront payment.

In a medical emergency, call 118 for an ambulance or head to the emergency ward (pronto soccorso) of the nearest hospital.

READ ALSO: Who to call and what to say in an emergency in Italy

A GP making a prescription

Only people that hold a valid Italian health card or a EU equivalent can access public GP’s services. Photo by Thomas SAMSON / AFP

How to register with a doctor

In order to make an appointment (visita) with a general practitioner (medico di base) within the SSN, you must first be registered with that particular doctor.

While in some countries you may call the local doctor’s office and book an appointment with any doctor on duty, that is not how things usually work in Italy and you’ll be under the care of one particular professional.

However, registering with an Italian doctor isn’t nearly as straightforward as it should be. 

Firstly, patients are expected to view the list of doctors operating within the area covered by their local health authority (Azienda Sanitaria Locale, ASL). 

Though in some cases these lists can be found online, in others residents will have to directly ask their ASL to be sent a copy, or visit the ASL office in person to see it.

Then, taking the location and office hours of the listed professionals into account, patients are asked to pick the doctor that’s best suited to their needs and communicate their choice to the ASL.

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

While in some areas this can be done online, most ASLs ask that patients turn up in person at their Scelta e Revoca (Choosing and Cancelling) offices and show an ID card, a valid Italian health card or equivalent (EHIC or GHIC) and a certificate of residence

Registrations are generally processed immediately and the doctor’s contact info and booking details are emailed to the patient right after.

How to book an appointment

Once you’re registered with a family doctor or GP, you can go ahead and book your first appointment. 

A booking can generally be made via phone, email or, in some cases, online.

However, as previously mentioned, healthcare staff, including receptionists, are rarely fluent in English, so email or online bookings might be the better options if you’re not really proficient in Italian – if this option is available.

Doctor speaking on the phone

Patients can book an appointment with their GP via phone, email or, in some cases, a designated online booking platform. Photo by Nicolas TUCAT / AFP

During the first appointment, patients are usually handed a form to fill out with general information about themselves and their overall health. 

Due to these formalities, the first appointment might last a little bit more than normal appointments, which are usually around 15 to 20 minutes.

READ ALSO: Five essential facts about Italy’s public healthcare system  

It’s also worth noting that, though they provide patients with a set appointment time, Italian doctors’ clinics tend to run a little late, so be prepared for a wait once you arrive.

All consultations with an Italian GP, including the first appointment, are free of charge.

Referral to specialists

GPs can refer patients to a specialist for further diagnostic exams or medical procedures.

However, unlike in other European countries, people choosing to see a specialist through the SSN cannot select the doctor they will be referred to as they will be given the earliest available appointment.

The referral comes in the form of a red prescription (ricetta rossa) with letters P, D, B and U indicating the different levels of urgency associated with the consultation – P marks the lowest priority level, whereas D is for consultations that must take place within 72 hours from the time of prescription.

The ricetta rossa allows patients to book their appointments online, in person or over the phone by calling the relevant Regional Central Booking Office (Centro Unico di Prenotazione Regionale, CUP).

Nurse looking at X rays

Patients choosing to see a specialist through the public healthcare system cannot select the doctor they will be referred to. Photo by Alberto PIZZOLI / AFP

Again, foreign nationals with a poor command of Italian may find that online bookings are the best available option given that most operators are not fluent in English.

Private doctors 

As in other European countries, Italian residents can choose to see private GPs or specialists.

Private healthcare is of course provided at a fee – typically anything from €40 to €160, depending on the type of service required – and, in most cases, fees must be paid upfront. 

Unlike public health authorities, private providers do not require patients to have a tessera sanitaria or a valid equivalent.  

Aside from the above distinctions however, booking an appointment in the private sector is no different than booking one within the SSN, with patients being allowed to book via phone, email or a designated online platform. 

If you’re looking for an English-speaking doctor, the US Embassy in Rome and the Consulates General in Milan, Florence and Naples provide lists of English-speaking professionals available for private consultation. These can be downloaded here.

The UK government provides a similar list

Essential vocabulary and useful sentences

  • SSN (Servizio Sanitario Nazionale) – National health system
  • ASL (Azienda Sanitaria Locale) – Regional health unit
  • Medico di base – General practitioner 
  • Ricetta – Prescription
  • Visita – Appointment 
  • Specialista – Specialist doctor
  • Farmaco – Medicine
  • When booking by email or phone, a useful phrase is: Vorrei fissare una visita alle ore X di X (I would like to schedule an appointment for [day] at [time]).
  • Should you need to cancel the appointment, you could say: Purtroppo, devo cancellare la visita.
  • To ask to reschedule it, you could say: Sarebbe possibile spostare la visita?

To describe your illness, you can check out our terminology guide for the most common ailments.

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