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The European Health Insurance Card [EHIC] allows you to receive medically necessary [hence not only urgent] care previously covered by forms E 110, E 111, E 119 and E 128, when you are in Italy for a temporary stay.
How and where to use it
You can obtain healthcare services directly from a public or contracted provider by presenting the EHIC, which entitles you to receive treatment under the same conditions as people registered with the NHS of your residence country. You will be provided the service free of charge, except for any co-payment which is paid directly by patients and is not reimbursable.
Please note that you cannot use the EHIC in Italy for planned specialised treatment abroad, which must be authorised in advance by your local health competent structure.
For people registered with the Italian National Health Service only
The European Health Insurance Card [EHIC] entered into force in Italy on 1 November 2004. The card, which is the reverse side of the National Health Card [Tessera Sanitaria nazionale – TS] or the Regional Service Card, allows you to receive medically necessary [hence not only urgent] care previously covered by forms E 110, E 111, E 119 and E 128, when you are in an European Country, EAA and Switzerland for a temporary stay.
To whom is it issued?
As a rule, all Italian citizens registered with the Italian National Health Service [SSN] and living in Italy may receive the EHIC. Exceptions concern:
- workers under Italian law registered in the Registry of Italians Resident Abroad [Anagrafe italiani residenti all’estero – AIRE] and posted abroad
- students [E106 or S1 form holders] registered in the AIRE
- pensioners [and their family members] having an E121 or S1 form [from 1 May 2010, when the new EU Regulations on the coordination of social security schemes entered into force]
- members of a worker’s family who do not reside in the same country as the worker, having an E109 or S1 form.
The EHIC is also issued to EU and non-EU citizens registered with the Italian NHS who fulfil the requirements and conditions laid down in EU and national legislation respectively.
How and where to use the EHIC
You can obtain healthcare services directly from a public or contracted provider by presenting the EHIC, which entitles you to receive treatment under the same conditions as people insured in the country you are in. You will be provided the service free of charge, except for any co-payment [for example, in France, patients are charged 20 % on all treatments including hospitalisation] which is paid directly by patients and is not reimbursable.
Please note that in Switzerland and France [which have reimbursement-based systems], most often you will be required to pay for treatment upfront. You can then claim reimbursement [except for the co-payment share, which is non-reimbursable] directly from the national institution while still in the country [LAMal in Switzerland and the competent CPAM in France]. Alternatively, you can ask for reimbursement from your local health authority [ASL] when you get back to Italy, presenting your medical bills and treatment reports.
Note that you cannot use the EHIC for planned specialised treatment abroad, which must be authorised in advance by your local health authority.
Validity
The EHIC is valid for six years, unless otherwise specified by your regional authority/local health authority [Decree of the Ministry of Economy and Finance of 25 February 2010, updating the Decree of 11 March 2004]. Before it expires, the Italian Revenue Agency [Agenzia delle entrate] will automatically send you a new card.
Replacement certificate
You can only apply for an EHIC replacement certificate from your health authority in the following exceptional cases:
- if your card was lost or stolen after you received it; in this case you have to submit a copy of your police report;
- if you are going to travel before obtaining your card, if you have not yet received it.
In this case, the Revenue Agency allows the health authorities to request the EHIC online, on the patients’ request. The EHIC will be delivered about 30 days from the request. In this case, the health authority can also issue a provisional replacement certificate filled in by hand.
If your personal details shown in the EHIC are incorrect, you must ask the Revenue Agency to correct them. If your card is lost or stolen, you can request issue of a replacement card.
Please note that the Ministry of Health plays no role in issuing and sending the EHIC.
Relevant legislation:
Last update 11 december 2020
The Italian Health Insurance Card - Tessera Sanitaria [TS] - is the personal document issued to all citizens, entitled to the benefits of the National Health Service [SSN].
It replaces the old green card that only contained the data of the tax code.
Since 2011, the TS has been equipped with a microchip and allows secure access to the online services of the Public Administration, in compliance with data protection regulation.
It is necessary to activate the Health Insurance Card [TS-CNS] according to the instructions in “Modalità di accesso con TS-CSN”.
What do I need it for?
Once issued, it can be used when going to a doctor, when buying medicines at the pharmacy, when undergoing specialist examinations at the ASL [Local Health Authority] or Hospital or as proof of tax code for all the cases provided for by law.
What encloses?
On the front side:
- The owner’s tax code
- Personal data
- Expiration date.
The reverse side is the European Insurance Card [T.E.A.M.].
In this case, the T.E.A.M. Health Card guarantees health assistance in the European Member States, Norway, Iceland, Lichtenstein and Switzerland under the current rules of the above-mentioned countries
Expiration date
The card is valid for six years from the date of issue. Before the expiry date, a new card will automatically be sent to the address registered in the “Italian Tax Register” [Anagrafe Tributaria].
How to get it
The Health Card is free of charge and available to all citizens who:
- have the correct tax code assigned by the Agenzia delle Entrate [Revenue Agency]
- are registered with the competent ASL [Local Health Authority] which has transmitted the data to the "Health Card System".
Citizens, who have a valid tax code, must necessarily register with the competent ASL in order to obtain the Italian health card.
Citizens who do not have the tax code, can get it at any Office of the Agenzia delle Entrate click here to book an appointment by filling out the form AA4/8 properly, and attaching a copy of a valid ID.
Citizens without a tax code can submit the request by email or Pec using the form AA4/8, duly filled in and signed, without going to the office. You can find here the mail and Pec addresses.
The form can be digitally signed and must be accompanied by the required documents, and in any case, a valid identity document. The certificate of attribution of the tax code will be sent to the taxpayer through the channel chosen for the request.
The delivery
The health card is sent by ordinary mail to the address of residence resulting in the Italian Tax Register, the databases of the Tax Authority. It is the address of residence that is transmitted by the municipalities to the Revenue Agency.
Foreign nationals who wish to apply for a health-card must first register with the National Health Service [SSN].
Registration with the National Health Service
Registration with the National Health Service is normally valid for the same period as the residence permit. After the period of validity has expired, the citizen who has obtained an extension of his/her residence permit must contact the competent ASL.
In order to register the citizen in the National Health Service, the ASL can also use the provisional tax code assigned by the Agenzia delle Entrate [also following requests from the Ministry of the Interior [SUI/Questura, procedure for emersion from irregular work].
If two or more persons with the same personal data generate the same tax code, the ASL requests the foreign citizen to contact the offices of the Agenzia delle Entrate to be assigned the final tax code assigned.
The tax code requested by citizens and issued by the Agenzia delle Entrate within the first 90 days of their stay in Italy is valid even after this period, as it is no linked to the residence permit. This tax code can also be used for registration with the National Health Service.
Foreign citizens legally residing in Italy who do not belong to the categories mentioned in the box "Registering with the SSN", who have a residence permit for a period of more than three months [and who are not obliged to register with the National Health Service], can still register voluntarily with the National Health Service by paying an annual lump-sum contribution [for more information, see: How to do voluntary registration at SSN].
For more information, please visit “Health assistance for foreigners ” on the Ministry of Health website.
CITIZENS PENDING REGULARISATION
Citizens pending for regularisation can be enrolled in the National Health Service with a temporary numerical tax code [usually issued by the Sportello Unico dell'Immigrazione or the Questura], by presenting the ASL receipt for the regularisation application to the ASL.
In this case, the Health Card will not be sent automatically, but only a replacement certificate, containing the Health Card identification number, which can only be issued by the ASL.
If the foreign citizen for whom regularisation has been requested does not know the tax code assigned to him/her, the ASLs have a procedure to retrieve it by entering the citizen's complete personal data.
However, a foreign citizen who does not comply with the rules for entry and stay in Italy is entitled to urgent or necessary outpatient and inpatient treatment, even if it is ongoing, and to treatment for illness and accident in public or private affiliated institutions. For this purpose, he/she must apply to the ASL for a card called 'STP' [Straniero Temporaneamente Presente –Temporarily Present Foreigner], which is valid for six months and can be renewed.
For more information on health care for foreign citizens, see a section on the Ministry of Health website with answers to frequently asked questions.
Issuance and validity of the health card for everyone
Upon enrolment in the National Health Service, the ASL [local health authority] applies for the issuance of the health card and electronically transfers the citizen’s data to the health card system.
The card is valid for the same period as the residence permit and is sent to the applicant's tax domicile registered in the Agenzia delle Entrate database.
If the citizen has changed domicile, he/she must notify his/her new domicile before reporting to the ASL for registration with the National Health Service.