Getting health insurance as an expat in Italy

If you're an expat planning to stayin Italy for some period of time—whether as a student or employee—you’ll need to think about health insurance. In Italy, the system provides a dual track with options for either public or private insurance—and the options for each may differ depending on your circumstances. More importantly, the rules depend on whether you are an EU or non-EU citizen. The system may seem difficult to navigate, so we've prepared a short guide to help you get started.

In Italy, health insurance is subject to the law that considers healthcare a fundamental right protected by the Constitution. This right is guaranteed not only for Italian citizens, but for everyone staying in the country. 

EU citizens, namely foreigners from an EU country living in Italy, enjoy a special , protected access to healthcare. Here are the three categories that an EU citizen may fall under:

• EU citizens staying in Italy for a period of less than three months
• EU citizens staying in Italy for a period of more than three months
• EU citizens who, despite being on Italian soil, do not qualify for registration with the Italian National Health Service, and find themselves without the option of obtaining health coverage

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If you are an EU citizen living in Italy for less than three months, registration with the Italian National Health Service is not required. In fact, as an EU citizen, you most likely have the EHIC (European Health and Insurance Card), which allows you to take advantage of urgent healthcare services during a temporary stay in EU countries. 

In Italy, for example, the EHIC number appears on the back of your Italian health insurance card, but each EU country has its own system. With an EHIC, you can go directly to public facilities and get the care you need. If the service you receive requires a co-payment, you’ll pay that just like everyone else.

If you don't have an EHIC as an EU citizen, you’ll need to get private health insurance in order to receive care. If you have neither, you will only have access to: 

• Necessary and urgent care, health care for children, maternity care, and a voluntary termination of pregnancy
• Vaccinations
• Treatment and prevention of infectious diseases 

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If you're an EU citizen living in Italy for a period longer than three months, you must have private health insurance, or be registered with the Italian National Health Service (SSN). 

The right to register applies to those who work in the country as well as their family members, and family members of Italian citizens. A person and their family is also eligible if they’re working for an EU company in Italy, if they’re a pensioner from another EU state who resides in Italy, and for family members of a foreign worker employed by another state residing in Italy. 

To register as an EU citizen, simply head to the ASL (the Italian Local Health Authorities) office in the region where you reside. You’ll need a certification of your residence and a valid ID, and further documents may be required. 

There may be some unique cases wherein you’re unable to enroll in the Italian National Health Service as an EU citizen, do not have private health insurance, and do not have an EHIC card. 

Regardless, you can't legally be denied the right to urgent and necessary care. This category also includes services related to child protection, maternity care, and termination of a pregnancy. You’re also able to participate in vaccination campaigns, as well as in international prevention, diagnosis, and treatment of infectious diseases.

You'll need to identify yourself as an EU citizen because the respective medical institution needs to know where you’re from in order to request reimbursement expenses. For this reason, you’ll need to present a validID. 

 You’ll also have to fill out a form declaring that you are domiciled in the region where you’re requesting assistance. After this, you'll be issued an ENI (European Non-Enrolled) code card, which lasts six months and is renewable. However, it’s important to note that this card is only valid in the region you acquired it in.

As a non-EU citizen in Italy, health care is always available, but in different ways depending on why you are in the country.

If you are a non-EU citizen legally present in Italy but for a short stay (less than 90 days), SSN healthcare for urgent and elective services is possible upon payment of the relevant regional rates.

An alternative for you as a foreigner on a tourist visa is private insurance: European Regulation No. 810/2009 "Visa Code" stipulates that if you apply for a Schengen visa, you must prove that you have an adequate insurance policy for medical treatment and hospitalization due to accident or illness and repatriation expenses for the period of your stay, with a minimum coverage of €30,000. There are plenty of companies online offering this service.

If you're a foreigner with a regular permit to stay for a longer period of time, you can enroll in the Italian National Health Service by applying at the ASL office in your municipality of residence. Alternatively, if you’re not yet a resident, simply head to the municipality listed on your residence permit to submit your application.

Enrolling in the Italian National Health Service allows you to choose a primary care doctor on the ASL registers, and gives you four credits eligible for integration agreement purposes. Health care is extended to your dependents, as long as they also legally reside in Italy.

If you fall into one of the categories and cases of non-EU foreign citizens in Italy, enrollment in the Italian National Health Service is both a right and an obligation:

• If you’re legally residing in Italy and are either employed or are self-employed, or if you are registered on an employment placement list
• If you have applied to renew your permit to stay in Italy for employment or self-employment, family reasons, asylum, subsidiary protection, special cases, special protection, medical treatment, asylum application, waiting for adoption, fostering, acquisition of citizenship
• If you’re awaiting the first issuance of a permit to stay in Italy for employment or family reasons
• For unaccompanied foreign minors, and all other minors regardless of the legality status of their stay

Enrollment in the SSN should be done at the ASL (Local Health Authorities) offices of your region of residence, or at the address indicated on your residence permit.

You'llneed the following documents for to enroll in the SSN (National Health Service):

• A valid residence permit or receipt of application for renewal (or receipt of application for employment in the case that it's your first permit)
• A residence certification (can be self-made) or a declaration of your actual current residence
• A recent tax return

Your health card is validfor the same period of time as your residence permit. While waiting for the permit to arrive, enrollment is temporary and becomes permanent when the permit is issued.

Your health insurance card entitles you to a number of benefits, including:

• A family doctor or pediatrician
• Free hospitalization at public and private hospitals
• Pharmaceutical care and medicine
• General medical examinations at outpatient clinics
• Specialist medical visits
• Home medical visits
• Vaccinations
• Blood tests
• X-rays and ultrasound scans
• Rehabilitation and prosthetic care

If you are a foreigner and are eligible for public healthcare in Italy, be aware that there may be costs even after you've enrolled in the SSN. Every specialist visit involves a healthcare co-payment fee. Just like for Italians, however, there are ways of being exempted from co-payments due to specific conditions relating to your income, age, disability, or disease status.

If you’re a foreigner legally residing in Italy, for a period of more than three months who is not subject to compulsory registration in the cases we’ve listed here, you still have a duty to protect yourself with health insurance. You have two options: Take out private insurance, or voluntarily enroll in the SSN by paying an annual fee.

The following categories of people have the right to voluntarily enroll in Italian National Health Service:

• Students and au pairs, even for periods of less than three months
• Those who hold a residence permit for elective residence and are not engaged in any type of work
• Religious personnel
• Diplomatic and consular staff of foreign missions operating in Italy
• Foreign employees of international organizations operating in Italy
• Foreigners participating in volunteer programs
• Parents over the age of 65 entering Italy for family reasons

Foreign citizens holding permits of stay for medical treatment and tourism cannot be voluntarily enrolled in the SSN.

Voluntary enrollment entitles you to the same Italian National Health Service benefits that foreigners who are compulsorily enrolled have.

However, the length of time is different. Voluntary enrollment in the SSN refers to the calendar year (January 1st-December 31st) regardless of whether the permit of stay expires during the year. Furthermore, it is not divisible or retroactive.

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You’ve just read an article that was compiled with the highest level of accuracy based on official sources, laws, and institutional sites. Despite this, however, it is not featured on an official government site. Given that regulations can change from one moment to the next, we encourage you to consult the relevant government sites before deciding to take tangible action.