Foreign nationals living in Italy can access the country’s public healthcare system by obtaining a tessera sanitaria, a personal health card that grants access to services under the Servizio Sanitario Nazionale (SSN). The process, while straightforward, requires completing several key steps.
The tessera sanitaria (TS) is used to visit a general practitioner, purchase prescription medication, book medical exams or specialist visits and verify your tax code (codice fiscale). The card also functions as the European Health Insurance Card (EHIC), providing access to healthcare across EU countries, as well as Norway, Iceland, Liechtenstein and Switzerland. The card is valid for six years for most residents, though for foreign nationals it typically matches the duration of their residence permit.
Before applying for the health card, you must have a codice fiscale (Italian tax identification number). If you don’t have one, you can request it from the Italian Revenue Agency (Agenzia delle Entrate) by submitting form AA4/8 along with a valid ID. This can be done in person, or remotely via email or certified email (PEC). The certificate confirming your tax code will be sent through the same channel you used to apply.
Once you have your codice fiscale, you must register with your local health authority (Azienda Sanitaria Locale, or ASL), which will send your information to the national Sistema Tessera Sanitaria. Without this step, the card cannot be issued, even if you already have a tax code.
Foreign nationals must enroll in the SSN to access healthcare and receive the tessera sanitaria. Enrollment typically lasts as long as your residence permit. Bear in mind that if your permit is renewed, you must return to the ASL to renew your healthcare registration and request a new card. Most individuals are required to enrol, while others such as certain students, religious personnel or specific visa holders may do so voluntarily by paying an annual fee of between 700 and 2,000 euro if they are staying in Italy for more than three months but are not otherwise eligible.
Some special cases exist for foreign nationals. The ASL can temporarily register individuals using a provisional tax code issued by authorities such as immigration offices or police headquarters. Foreign nationals awaiting legal status in Italy can still register with the SSN using a temporary numeric tax code and proof of their application. In this case, they may receive a temporary certificate instead of the physical card. Even without legal residency, undocumented individuals are entitled to urgent or essential care. They can request a temporary STP (Straniero Temporaneamente Presente) card from the ASL, valid for six months and renewable.
Once issued, your tessera sanitaria is sent by post to the address registered in the Italian tax database (Anagrafe Tributaria), so make sure your address is up to date before starting the application process. You’ll need to activate it online using the instructions provided.
Upon expiration, a new card is usually sent automatically. However, foreign nationals must ensure their residence permit and SSN registration are still valid.
If your tessera sanitaria is lost, stolen or damaged, you can request a replacement at the Agenzia delle Entrate or the Sistema Tessera Sanitaria websites, via certified email (PEC) to the Agenzia delle Entrate, at an office of the Agenzia delle Entrate or through your local ASL. It’s recommended that you file a police report if your tessera sanitaria has been lost or stolen.
Useful weblinks
Agenzia delle Entrate
Sistema Tessera Sanitaria
www.sistemats1.sanita.finanze.it
Azienda USL Toscana Centro with a list of all the ASL offices in Florence, Empoli, Pistoia and Prato
