Health Care – Tessera Sanitaria

italy photography photos   - CuriousCatExpat.com

What?

The Tessera Sanitaria is your Italian health insurance card.

“Tessera” = Card     “Sanitaria” = Health

The Italian health insurance is managed by the agency ASL (Aziende Sanitarie Locali). The locals pronounce the agency ASL as a word “aah-zil” (versus saying the initials “A.S.L.” – this may seems like an insignificant point as you read this, but when I moved to Rome and asked where the ”A.S.L” was located, no one knew.  But, they did know where the ”Aah-zil” office was located :))

The Italian national medical system is managed by the SSN (Servicio Sanitario Nacional).

The Tessera Sanitaria (healthcare card) is used each time that the citizen goes to the doctor, gets/buys medicine in a pharmacy (farmacia), books an examination in a laboratory, or benefits from a specialist in hospital and ASL.

  • It contains biographical data and welfare information
  • It contains the tax code (Codice Fiscale) on magnetic band format as well as barcode
  • It is valid throughout Italy
  • It grants the holder the right to obtain health services throughout the European Union
  • It’s a plastic card, similar to a bank debit card.
  • The front of the card also includes Braille characters for the blind.
  • On the back of the card is the tax code barcodes, the magnetic strip, and the words, Tessera europea di assicurazione malattia (TEAM), meaning “European health insurance card”.

Why?

Being registered with the ASL, provides the holder to:

  • low or no-cost treatment
  • hospitalization and treatment (including tests, surgical operation and medication during hospitalization)
  • basic medical care (General Practitioners and pediatricians)
  • specialist medical care by pediatricians, midwives and other specialist doctors
  • either free or subsidized medication
  • laboratory tests, aids and devices
  • ambulance service and other free services provided by the local healthcare authority (e.g. family planning clinics)

Where to Apply:

Apply at your local ASL office.  Find your local ASL here:  this website – only in Italian)

By selecting the region/province you will see the full list of ASL agency locations with the specific:

  • link to the website of that agency/ASL location
  • contact details of the URP (Ufficio Relazioni con il Pubblico) – Office of Public Relations or other offices from which to request information
  • phone number of CUP (Central Reservations) or, where there is a unified center, the reference – the section of the website of the ASL that shows useful information to make a reservation

How?

Once in Italy, you may register with the SSN at the ASL agency in your area. The following documents are generally what you will need to register: (varies based on your immigration status in Italy)

 

  • Permit of stay or the receipt issued by the Post office at the moment of the application
  • Passport with visa if non-EU citizen
  • Tax identification number (Codice Fiscale)
  • Self certification of your domicile (the same address you have written in your permit of stay) or certificate of residence
  • if necessary: Receipt of payment ‘Bollitino’ from the post office (depending on your foreigner/straniere status)
    bollettino postale

    BOLLETTINO – This is the form you need to complete and submit with payment at the Post Office/Poste Italiene.

Please remember that you must pay the fee before you go to the ASL.

The health card will be issued immediately and free of further charges**.

Upon registration at the ASL, you also choose a General Practitioner*** from the list that will be shown to you (or possibly your region lists the available doctors online on the local ASL website).

** The term ‘free’ is used lightly.  There are some charges for services/medication …it all depends on what your base doctor prescribes.  If you’re American, you can think of it as a co-pay.  There are co-pays for services & medication in Italy.  Personally, I feel the charges are reasonable compared to a USA based insurance program – but all services are not free.  The negative of the cost effective system in Italy is that you may have to wait a period of time before you can see a specialist.

***Remember to ask for a General Practitioner or a Pediatrician that can speak foreign languages.  In cities like Rome, the agency will most likely give you a list of doctors and you’ll need to pick from the list.  The agency has no idea which languages the doctors speak or from my experience, they don’t care much to help you.

TIP: try to find a name that is not Italian is my only recommendation.  In Rome, I found a doctor with a Polish name and I lucked out that they spoke some English.  When I moved to a small town, the ASL actually had their local doctor list online on their website, but no languages were listed and the agency personnel didn’t know.  I called every doctor on the list to check about the languages spoken – none spoke English.

 

Who/Cost?

It all depends on your status/reason for living in Italy. (Read more)

In general:  if you have an Italian work contract or are married to someone who has a work contract, the health insurance/Tessera Sanitaria is free.

If you are a student: payment of 149.77 euro
Persons, with a valid Visa without a work permit pay 387.34€ annually (based on when this was written 2014)

1)     If you are in a fee-based category, PAY the fee AT THE POST OFFICE FIRST.

2)     Go to a Tabaccheria or somewhere and make a printed copy of your receipt

3)     Once you have your receipt & copy, THEN go to the ASL agency with your documents to register.

 icon-bug Confusion Factor:

If you are non-EU and are staying in Italy for more than three months, you need a Visa/Visto.  If you have a Visa type which requires you to have private insurance for the first year, I am not quite sure of the ‘WHEN’ you are permitted to apply for the Italian national health system – ASL & SSN.  I don’t know if there is a minimum amount of time you need to be in Italy before you may register as a resident/ASL/SSN.

Example: I came to Italy with an Elective Residency Visa.  To get my Visa, I had to show I had international health insurance coverage for one year.  I paid for a policy from a company like Bupa International (costs starting from $3,000 US or something like that.  All I remember, it was expensive!!).  After one year, I had registered with the Anagrafe in Roma (records office) and was a ‘certified resident’.  At this point, I went to the ASL and started my health coverage with the Italian system, ASL.  Because I didn’t have a work Visa, but instead an Elective Residency Visa, I had to pay 387,34€.

I wonder IF I could have registered as an official resident of Rome/Italy early on, let’s say after 3 months of living in Italy…Would I have been able to cancel my expensive private international insurance and register with the ASL???

 

 icon-thumb-tack More key information:

The paid health care is an annual registration (January-Dec) and expires on December 31st of each year.  It does not get prorated –  meaning if you arrive in Italy in October and you register with payment, you will be required to pay the full year amount (eg 149.77€ student fee).

  • Registration is made on an individual basis and dependent family members are not included. If you come to Italy with your family, your family members may be voluntary registered with the SSN – Servizio Sanitario Nazionale, depending on the reasons for their stay as mentioned in the permit of stay. For dependant family members that are registered on your permit of stay, you will have to pay an extra fee of 387.34 euro (confirm the specifics with your local ASL office.  Rules change often in Italy).
  • Attention: if you have only the receipt issued by the Post office of the application of the permit to stay, you can only apply for a temporary one-month registration with the SSN after payment of the relevant fee; the temporary health card can be renewed until 31st December of the same year and will have “ISCRIZIONE PROVVISORIA” (temporary registration) written on it.
  • If your permit of stay is being renewed, you can register for a maximum period of 4 months.

 

 icon-book Glossary:

TEAM = Tessera Europea di Assicurazione Malattia

SSN= Servizio Sanitario Nazionale

ASL= Aziende Sanitarie Locali

14 Comments

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  • Razib says:

    Hi i am Razib from Bangladesh. and i am living in italy since 2011. i have permesso di seggiorno for 1 year as asyle humanitarian rights. i have the tessera sanitaria card. i want to go to Germany to study. they required my health insuerance covorage in Germany too but i can use my card only in italy. so i am confused how can i have a health insuerance in Germany too ? is there anyway you can help by information? thank <you

  • Denise says:

    Dear Curious Cat,
    I really want very much to move to Rome. I moved here to Los Angeles nearly 12 years ago to be with my Mom. Now, sadly, she has passed away and I have nothing here in Los Angeles except sad memories. I really want to move to Rome, as I visited there many years ago and just loved it! The problem is, I have read on some websites that you have to buy American private insurance the first year you in Italy. I’ve priced it and it’s about $5000.00 a year! Since I am 62 and on a very TINY pension, that would of course make the move impossible. Do you know if there is any way I can buy Servizio Sanitario Nazionale – SSN immediately on moving to Italy? Thank you very much. Sincerely, Denise

    • Inta -Curious Cat Expat says:

      Dear Denise,
      I’ll try to provide some information, though I make a note that when I researched my move it was in 2010. I am not sure if the rules have changed (I don’t think so, but I can’t say for sure)

      You do need to show that you have private insurance for one year to get your long-term Visa. FYI – I got Bupa International insurance (yes, expensive! though they were good and speak english, based out of the UK). However, to get the national health insurance SSN, you need to show your VIsa and your residency. I wasn’t smart enough to to do this myself, but it may be possible for you to get the one year insurance to tick the box to acquire the VIsa. Once in Italy, get your residency and then cancel your private insurance once you get the SSN. Check with the private insurance company if you can cancel and get a refund. That is my best recommendation.

      On a personal note – Rome is a beautiful city, though a tough place to live (at least I thought so), it’s chaotic and it’s pricey (rent). If you know the language and/or know someone there it would be easier to get assimilated. To get through your daily life and maintenance, they only speak Italian! I’ll send you an email with a couple of expat groups I recommend to network with others in Italy & Rome. The bureaucracy is never ending and challenging but if you’re up for it, do your research and make the leap. I don’t intend to discourage you about your move, but just make sure your eyes are open and you know what you’re getting into. It’s much different living there than vacationing. Lastly, you’ll never know, if you never go 🙂

  • Lorenzo says:

    I am a dual national US and Italian currently in the USA. My health Insurance for my family costs 18 thousand us dollars for myself and my wife n 2 kids per year. Would like to retire in italy. Since I never worked in italy what would it cost to insure my self n wife n kids.

    • Inta -Curious Cat Expat says:

      Hi Lorenzo, you’re going to have to do research about your personal situation. I don’t know the laws about health care for Italian citizens since this is something I’m not. Italian law is confusing (mostly to find what you need to know) and I’ve only invested the time to research factors for the non-EU citizen choosing to live in Italy. I do know that an EU citizen (I have no idea if this includes Italians), living in Italy needs to be employed or married to someone who is employed or have an Italian pension to qualify for ‘free’ healthcare. I’d recommend looking atGoogling the following: Azienda Sanitaria Locale – ASL (Local health offices), SSN: Servizio Sanitario Nazionale and the Ministry of Health http://www.salute.gov.it/.

      If you speak Italian it’ll help since most every official website with information will be in Italian. It would probably be easiest to find an email for an ASL agency and start with your question there. ASL agencies are by location, so if you know the city you may relocate to, google for ‘ASL Rome’ for example. Tip: though contacting an agency in a smaller city or town is beneficial since cities like Rome, Florence, etc are mostly unresponsive.

  • Colin Groves says:

    Thanks for this information. I think you have been very fortunate with your contributions or my info is erroneous. I would be very happy if you were able to correct my understanding.

    My understanding is that the minimum charge for those without extenuating circumstances, studying etc, is not less than €387.34. The exact contribution should be calculated and is based on earnings received, both in Italy and abroad, which are supposed to be declared. The calculation is 7.5% of earnings to €20658.27 plus 4% of any additional earnings up to a maximum of €51645.69. This is from a document extant since 1986.

    Kind Regards,

    Colin

    • Inta -Curious Cat Expat says:

      Colin, I admit I am not an expert on Italy’s laws, I write about what I have personally experienced or have found in my research. I don’t know if you’re in Italy already or preparing for a move. It sounds lame for me to say this, but Italy’s laws change frequently and are difficult to find.

      What I can say is: from my previous research, In very general terms I understood that if you’re you have a work permit or are married to someone with a work permit you quality for the national health coverage. Students, aupairs and certain Visas fit in a category where you need to pay for Voluntary Subscription. I thought the 387€ was the max anyone had to pay (if you have the proper documentation: Visa, residency, etc)

      I wasn’t permitted to work with my Visa, so I am not aware of any % of income. Nor have I heard that from other expats, but I could be wrong. (Please do let me know if the information I’ve posted is incorrect, I don’t want to give incorrect info)

      The best thing is to ask your local ASL (Azienda Sanitaria) office. Do a google search “ASL xxxx” the XXX being the italian version of your city. Eg: ASL Firenze.

      Some additional information is here:

      http://www.stranieriinitalia.it/index.php?option=com_content&task=view&id=1150&Itemid=173

      If you don’t speak italian and the website is in Italian, use the Chrome browser and set it to auto-translate.

      I hope this helps

      • Colin Groves says:

        I am not an expert either. To obtain residency without seeking employment I had to provide evidence that I had sufficient income and healthcare cover to not become a burden on the Italian state. Although this was provided at the time of application the documentation implied that this should be maintained for the duration of my stay. It explicitly stated a certain amount/minimum to be held in my Italian bank account. I am an EU citizen, early retiree, not at state pension age, and am married to an Italian. Options for healthcare were private or voluntary contributions to the SSN based upon the calculations as detailed in my previous post. See link

        http://salute.regione.emilia-romagna.it/documentazione/leggi/regionali/circolari1/Circolare%20n%202%20del%2023.01.2014_App.Dgr.2099.2013.pdf

        The health options do not change now that I have residency. This is mainly because neither of us are contributing via working/taxes. My understanding is that most non-working visas are only issued on the basis of evidence of sufficient income or assets to cover the duration of stay be it short or full retirement and this includes healthcare, private or through voluntary contributions, based on assets, to SSN once in Italy.

        As I said previously you appear to have been fortunate when your contribution was calculated.

        As a resident you may wish to investigate your tax position. I understand that an annual return is required even if you do not earn any money in Italy and assets and accounts abroad may need to be declared.

        • Inta -Curious Cat Expat says:

          Hi Colin,
          You’ve confirmed once again how confusing Italian bureaucracy can be 🙂 I came to Italy as a non-EU citizen, a non-working Visa (I did have to have private health insurance for the first year – very pricey!). It seems there is a difference in the fees to SSN/ASL if you’re a non-working EU-Citizen. (eve though one would think an EU citizen would have to pay less) I wish I had an answer for you, but I simply don’t know the scenario that you fit into.

  • Theresa Telesca says:

    OMG, how lucky was I that I stumbled on to your site. Thank you so much for this information. I am American, but have been married to an Italian for 9 years.

    I had a job working for a global airline based in NYC and so I split my time between the US and Italy. 2 years ago I finally got around to getting my Italian residency, but didn’t really care about anything else as my health coverage in the US was top notch.

    Now that I’ve decided to give up a life of flying the globe and settling down in one place, I find it nearly impossible to get accurate information. And I’m fluent in Italian. Even my husband was confused and it took him a while to find the correct information regarding the proper office. Geez. I bet we you and I can sit for hours and compare notes! LOL
    In any case, thank you so so so much for the information. Big hug to you and may you have a fantastic 2015!

    • Inta -Curious Cat Expat says:

      Hi Theresa, I’m so glad the information helped you. It really is difficult in Italy – the rules are constantly changing! I don’t speak Italian and at first it was daunting but then I figured it out (as best as can be done 😉 and decided to share my findings with others to try & ease the pain. Happy New Year to you as well!

  • Inta -Curious Cat Expat says:

    HI Jacqueline,
    Very interesting about your friend. I’m going to assume she switched to private health insurance which is why her premiums are so high. The 389 makes sense if she was here on an Elective Residency visa, that’s the going rate for that visa type. As far as I’ve read, 389e is the highest any one person needs to pay for the National health coverage. Many expats opt-in for private insurance. I have stuck with the National coverage and have paid out-of-pocket for a couple of private specialist doctors when I needed to make sure I could speak English with them.

  • Jacqueline Mariani says:

    I have my own health insurance from the U.S. via my retirement plan. However, I am friends with a retired American who has been living in Italy for over 4 years. The first two years, her annual cost was 389 euro. The third year, it rose to 1,700 euro, and this year it is 2,100 euro per year for her health coverage!

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