In short. The Italian health card for foreigners (tessera sanitaria) is proof of registration with the National Health Service (SSN): you register at the local health authority (ASL) and the Revenue Agency then posts the card to you. Registration is compulsory and free for workers, family permit holders and people with protection status, while students, elective residents and some other groups can join only voluntarily by paying a yearly fee. Confirm eligibility, contributions and documents with your ASL under current national and regional rules.
The Italian health card for foreigners, the tessera sanitaria, is proof that you are registered with the National Health Service (SSN). If you work in Italy, live here for family reasons or hold a protection status, registration is compulsory and free. Students, elective residents and some other groups can only join voluntarily, by paying a yearly fee.
Financial eligibility and any SSN contribution depend on status and national/regional rules. Ask the local health authority for the current official calculation basis and tariff.
What is the difference between SSN registration and the Italian health card for foreigners?
Registering with the SSN gives you the right to healthcare on the same terms as Italian citizens. You register at the local health authority (ASL) where you live, and you can then choose a family doctor or paediatrician. You pay the same prescription and specialist fees as an Italian.
The health card is only the physical proof of that registration. It is not issued by the ASL but by the Revenue Agency, which posts it to your address. The same card also serves as your Italian tax code card.
So the order is always the same. First you get your tax code, then you register with the ASL, and finally the card arrives at home.
Who is entitled to free, compulsory registration?
Article 34 of the Italian Immigration Act lists the people who must be registered without paying any fee. The main groups are:
- holders of a permit for employment or self-employment;
- people registered as job seekers or holding a job-seeking permit;
- holders of a family permit;
- asylum seekers, refugees and holders of subsidiary or special protection;
- holders of a permit pending citizenship or for foster care;
- women holding a medical treatment permit linked to pregnancy.
You do not have to wait for the plastic permit card. The post office receipt of your application is usually enough to register with the ASL. The same applies to renewals filed on time.
Dependent family members who are lawfully in Italy get the same cover, and children are covered from birth. If you hold a residence permit for employment, registration is your right and costs nothing.
Who has to pay for voluntary registration?
Voluntary registration applies to people with a permit longer than three months who do not fall into the compulsory groups. Students and au pairs may also register for shorter stays. The most common cases are:
- students and au pairs;
- holders of an elective residence permit who do not work;
- religious workers, volunteers and staff of international organisations;
- parents over 65 who joined their family after 5 November 2008.
How and when do you pay the fee?
You pay with an F24 form, tax code 8846, stating your region’s code and the year. Cover runs for the calendar year, from 1 January to 31 December. The fee cannot be split into months and is not refunded.
This point matters a lot. If you register in November, you pay the full amount but are covered only until 31 December. In some cases a private health insurance policy is better for the first weeks.
Which documents do you need to register with the ASL?
Each ASL publishes its own list, but the core documents are similar everywhere. Bring originals and copies of:
- your passport or another valid ID;
- your residence permit or the receipt of your application or renewal;
- your permanent tax code;
- a residence certificate or a statement of where you habitually live.
For voluntary registration you also need the F24 payment receipt and a self-declaration of income. Students add their enrolment certificate. If you hold a study permit, you can choose between the SSN and private insurance.
How does the health card arrive and when does it expire?
Once you are registered, the Revenue Agency posts the card to the address on file. Make sure your address is up to date, or the card will not reach you. If you lose it, you can request a duplicate online or at an office.
For foreign nationals, registration lasts as long as the residence permit. When you renew your permit, go back to the ASL with the post office receipt. Your cover continues while you wait for the new permit.
Long-term residents enjoy more stable registration. With a temporary permit, every renewal means a new visit to the ASL. Put both expiry dates in your calendar.
Which mistakes make you lose health cover?
Most problems come from forgotten steps, not from a real refusal. These are the most frequent mistakes:
- not taking your renewal receipt to the ASL, so your registration is suspended;
- paying the voluntary fee late in the year and expecting twelve months of cover;
- using a temporary tax code or one with data that differ from your permit;
- showing a travel policy that does not cover hospital stays and emergencies in Italy;
- not updating your address, so the card is returned to sender.
People without a permit do not receive a health card. They are still entitled to urgent and essential care through an STP code, under Article 35 of the Immigration Act. If your permit has run out, read what to do with an expired residence permit.
For further reading, see Article 34 of the Immigration Act and the Ministry of Health page on care for non-EU nationals.
Frequently asked questions
Does the ASL issue the health card?
No. You register with the SSN at the local health authority (ASL) where you live, but the health card itself is issued by the Revenue Agency, which posts it to the address on file. The same card also works as your Italian tax code card, so keep your address up to date.
Who can register with the SSN for free?
Under Article 34 of the Immigration Act, registration is compulsory and free for holders of a permit for employment or self-employment, job seekers, family permit holders, asylum seekers and people with protection status, holders of a permit pending citizenship or for foster care, and pregnant women with a medical treatment permit.
Does the voluntary fee cover twelve months from payment?
No. The voluntary fee, paid with an F24 form and tax code 8846, covers the calendar year from 1 January to 31 December. It cannot be split into months and is not refunded, so if you register in November you pay the full amount but are covered only until 31 December.
Am I still registered while my permit is being renewed?
Registration lasts as long as your residence permit. When you renew it, take the post office receipt of your renewal application to the ASL and your cover continues while you wait for the new permit. Forgetting this step is a common reason for registration being suspended.
Can a person without a residence permit get medical care?
People without a permit do not receive a health card, but under Article 35 of the Immigration Act they are still entitled to urgent and essential care through an STP code. If your permit has expired, check what to do to restore your status and your SSN registration.
Official sources
- Ministry of Health – foreign nationals’ SSN registration
- Ministry of Health – healthcare for non-EU nationals in Italy
- Agenzia delle Entrate – health card and foreign citizens
- Legislative Decree 286/1998, Article 34 – Normattiva
These sources were consulted on 15 October 2026. Laws, contributions and regional rules can change, so always check the latest instructions from your local health authority (ASL).
How can SH Immigration Specialists help?
Choosing between compulsory registration, voluntary registration and private insurance affects the costs and rights of your whole family, and a mistake can also cause problems at permit renewal, which requires adequate health cover. We can check which registration applies to your permit, prepare the documents for the ASL and the tax code, and keep your renewal dates under control. SH Immigration Specialists provides administrative and document assistance. The outcome depends on the competent authorities. For an assessment, contact us.
This content provides general information and does not constitute legal advice.
