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


Five expert tips for getting your Italian elective residency visa approved

Here are the main things you should know if you want to succeed first time round when applying for Italy's popular - but elusive - elective residency visa.

Five expert tips for getting your Italian elective residency visa approved

The elective residency visa (ERV) is a popular route to permanently relocating to Italy, but the application process can be hard to navigate and the rejection rate high.

To help readers who are considering taking the plunge maximise their chance of success first time round, The Local spoke to three experts about how to put together the best application possible.

Based on what they told us, we put together a detailed guide to the process, as well as specific advice for UK applicants.

Here are five key takeaways on how to make a successful elective residency visa application.

Write a convincing cover letter

Most consulates require a letter of motivation along with your application explaining why you want to move to Italy.

Applicants often put minimal effort into this, simply saying they love the Italian food and weather, says Elze Obrikyte from Giambrone & Partners – and that’s a mistake.

She says ‘pre-rejection’ decisions are often issued on the basis of this letter alone, even if all the other requirements are met. 

EXPLAINED: How to apply for an elective residency visa to move to Italy

That’s because consular officials want to see you have a strong interest in moving to Italy permanently, not just coming for short stints on holiday.

Because of this, you want to make sure you underscore your ties to Italy, your familiarity with the town you plan to move to, and any other supporting information.

While language skills aren’t a requirement, “if you mention that you are studying Italian or you know Italian, which helps you to integrate better, this is also an advantage for your application,” says Obrikyte.

You should provide as much evidence as you can for a successful ERV application. Photo by Filippo MONTEFORTE / AFP.
Showing you have a strong connection to Italy will help your application. Photo by Filippo MONTEFORTE / AFP.

Get your finances in order

Because you’re not allowed to work or receive an ‘active’ income when you come to Italy on an ERV, you need to be able to demonstrate that you have a ‘passive income’ of at least €31,000 per year (€38,000 joint income for married couples).

Nick Metta of Studio Legale Metta says applicants sometimes think that having a large amount of money invested in bonds or the stock market is sufficient, but this won’t satisfy the officials reviewing your application.

READ ALSO: Visas and residency permits: How to move to Italy (and stay here)

Whether it’s in the form of a pension, annuity, rent, or some other mechanism, you need to prove that you receive a regular income stream in perpetuity and won’t become a burden on the Italian state.

If you don’t currently have passive income of at least €31,000 you may want to speak to a consultant about restructuring your finances, as you won’t be granted an ERV unless the consulate can check this box.

More is more

Consulates can differ in their exact requirements for the ERV, with some saying you don’t necessarily have to provide a letter of motivation or travel tickets to Italy.

But our experts were all agreed: it’s always best to include as much documentation as possible with your application to be on the safe side.

Even though not all consulates require travel tickets, “it’s always better just to enclose them,” says Obrikyte; “I always advise our clients to close as many documents as possible, just to reduce the risk of rejection”.

READ ALSO: How to apply for an Italian elective residency visa from the UK

“The cover letter for some consulates is not a requirement, for some consulates it is a requirement,” says Metta. “We always recommend that you prepare and file a cover letter with every single elective residency visa application.”

The experts also recommend providing a separate cover page with a contents summary for all the documentation submitted, to make things easy for the consular official reviewing your application.

Agencies can assist you in making sure all your paperwork is in order.

You should provide as much evidence as you can for a successful ERV application. Photo: Andreas Solaro/AFP

Be polite and deferential

The Italian consulate in charge of reviewing your ERV application has total power over whether or not it’s accepted – including the ability to raise the income threshold above the official minimum.

That means you want to be as deferential as possible all your interactions with staff, and avoid coming across as entitled or demanding.

READ ALSO: ‘Seek legal advice’: Your advice on applying for Italian visas post-Brexit

“You don’t want to go there and say ‘oh, here is the printing of the law’ and this and that – absolutely not,” says Metta.

You’ll also want to make sure you book your travel tickets for at least 90 days after your appointment date – the full period allotted for the consulate to review the application – so it doesn’t seem like you’re trying to rush their decision.

There’s room to negotiate

Finally, our experts stressed that if your application is rejected, that decision isn’t necessarily final.

Obrikyte says it’s typical for consulates to issue a ‘pre-rejection’ notice before delivering their final answer that specifies what the sticking point is, giving you a chance to fix the issue.

“In that occasion it is possible to try to negotiate and change their mind, and this happens very very often,” she says.

When a client of his was told he needed income of at least €100,000, “we contacted the person in charge, exchanged correspondence, provided some extra legal support in terms of evidence and official sources, and we got another appointment and the person finally got their visa,” Metta says.

While you can appeal a rejection in court, Metta says he advises his clients just to reapply, as it’s “so much faster, easier.”

Please note that The Local cannot advise on individual cases. For further information on the ERV and how to apply, visit the Italian foreign ministry’s visa website.