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(JUNE 2021)

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What is it?

The Italian Health Insurance Card - Tessera Sanitaria (TS) - is the personal document issued to all citizens, which have the right to the services provided by the National Health Service (SSN).

It replaces the old green card that contains only the data of the tax code assigned to the citizen and recorded in the Tax Register.

In 2011, a new version with microchip replaced the TS: la Tessera sanitaria - Carta Nazionale dei Servizi (TS-CNS). Once activated, the new version CNS (National Service Card) permits the access, safely and in respect of privacy and respect of the privacy, to the online services of the Public Administration.

What do I need it for?

After issuance, citizens can use the Health Insurance Card when going to a doctor, purchasing a drug in the pharmacy, undergoing specialist checks and for any request at the Italian Health System or, they can use the National Health Card as proof of their tax code for all the cases provided for by law.

What encloses?

Expiration date

From issuance, the card is valid for six years.  A new card is sent automatically to the entitled citizens, before the expiration date, to their residence at the address resulting in the Italian Tax Register.

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The rules to obtain the Italian Health Insurance Card

The Health Card is cost free and it is issued only if:

Citizens holding a valid tax code, in order to receive the Italian Health Insurance Card Health Card must necessarily register to the competent ASL.


If the citizen has not requested the tax code, it is necessary to get it in advance at any Office of the Agenzia delle entrate using the form AA4/8 duly filled in with a copy of a valid identity document attached.

For the issuance of the tax code it is possible to choose one of the streaming “fast services” available on the Agenzia’s website.

Without going to the office it is possible to submit the form AA4/8 duly completed and signed via email or certified email – pec.  

The form can be digitally signed attaching the necessary documentation, and in any case, a valid identity document. The certificate of attribution of the tax code is transmitted to the taxpayer through the chosen channel.

The Italian Health Insurance Card for new-borns

With the issuance of the tax code new-borns automatically receive to the residence address the first Health Card valid for one-year.

A new Italian Health Insurance Card, normally valid for six years, will be prepared and sent to the residence, after the parents (or guardians) have registered the child with the competent ASL (operation also necessary for the choice of pediatrician).

Please note that the Municipality issues the tax code to new-borns after the presentation of the birth certificate by the parents (or guardians) through the computer link to the Tax Register of the Agenzia delle entrate.


In the event that the Municipality does not issue the tax code, it is still possible to submit the form AA4/8, duly signed and subscribed by one of the parents (guardians) at any office of the Agenzia delle entrate.

It is necessary to attach a valid identity document of the parent who signs it, as well as the birth certificate of the new-born issued by the hospital or the birth certificate.

The request can be sent through pec or email.

The message must have attached:

  • Copy of the form AA4/8 duly completed digitally or handwritten and signed
  • Documents for certification (e.g. birth certificate or birth declaration from the hospital; in the latter case the parent him/herself is obliged to check the registration at the Municipality).
  • Copy of a valid identity document of the applicant.

The certification of tax code handwritten signed by the office manager or a delegate will be delivered to the email address or pec used for the application.

The delivery

The Italian Health Insurance Card is sent, by ordinary mail, to the residence address of the citizen registered in the Tax Registry. This address is the one that Municipalities communicate to the Agenzia delle entrate.

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Foreign nationals wishing to apply for a health-card must 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 duration of the residence permit. On expiration, the citizen who has obtained a renewal of their residency permit must contact the competent ASL again to renew their registration and request the issuance of a new Health Card.

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 the provisional numerical code attributed to the foreign citizen, due to a "possible homonym" (e.g. two or more persons with the same personal data generating the same tax code), the ASL will invite the citizen to contact offices of the Agenzia delle entrate to have the definitive tax code attributed.

The tax code requested by citizens and issued by the Agenzia delle entrate within the first 90 days of their stay in Italy is also valid beyond that period, as it has no link with the residency permit. This tax code too, therefore, in the presence of the conditions for the emersion of irregular work, can be used for registration with the National Health Service.

Foreign citizens, who are legally residing in Italy, but who are not included in the categories described above holding a residence permit for a period of more than three months (who are not obliged to register with the National Health Service), can still voluntarily register with the National Health Service by paying an annual flat-rate contribution (further information can be found at: How to do voluntary registration at SSN).

For more info, please visit: “Health assistance to foreign citizens” on the website of the Ministry of Health.


Citizens pending for regularisation can still be enrolled in the National Health Service with a provisional numerical tax code (usually issued by the Sportello Unico dell'Immigrazione or by the Questura), by presenting to the ASL the receipt of the application for regularisation.

In this case, the Health Card will not be sent automatically, but only a substitute certificate, which contains the identification number of the Health Card and can be issued only by ASL.

If the foreign citizen for whom regularisation has been requested does not know the tax code that has been assigned to him/her, the ASLs have a procedure that allows to retrieve it by entering the citizen's full personal data.

A foreign citizen who does not comply with the rules on entry and stay in Italy is, however, entitled to urgent or essential outpatient and hospital care, even if continuous, to sickness and accident treatment in public or private affiliated facilities. To this end, he/she must apply to the ASL for a card called a 'STP' (Straniero Temporaneamente Presente - Temporarily Posted Foreigner), which is valid for six months and may be renewed.

Further information on health care for foreign citizens is available in a section of the Ministry of Health website containing answers to frequently asked questions.

Issuance and validity of the Health Card

At the same time of the registration in the National Health Service, the ASL (Local Health Authority) requests the issuance of the Health Card, electronically transmitting the data relating to the citizen's care to the Health Card System.

The card is valid for the same period as the duration of the stay permit and it is sent to the tax domicile registered in the Agenzia delle entrate database.

If the citizen has changed domicile, he/she must communicate his/her new residence before going to the ASL for registration with the National Health Service.

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If the Card contains errors

If the personal data on the Health Card is incorrect (name, surname, tax code, date and place of birth or gender) it is possible to request a correction presenting a valid ID to any office of the Agenzia delle entrate.

if the Health Card expired and find in need of health assistance

Regardless the expiration date on the card there is the guarantee of receiving all medical services and health assistance presenting a red or a national electronic prescription.

if the Card expired and you have to go abroad

Citizens going abroad, but having not received the Health Card must refer to their Local Health Office asking for a substitute certification of the Health Insurance European Card (T.E.A.M.).

if you do not have the Card with you at the pharmacy

Regarding all the healthcare services paid by the National Health Service, the pharmacy could detect the Tax code directly on the red or electronic prescription. For the healthcare services not paid by the National Health Service the citizen can directly communicate the tax code.

in case of lost, stolen, or damaged Card

If the Card is lost, stolen or in a deteriorated condition it is possible to ask for a new card. In the first two conditions (stolen or lost), it is necessary to file a report directly to the competent Authority.

Citizens can send a request for a new card through the following channels:

  1. online, Agenzia delle entrate Website
  2. via e-mail o PEC to any office of the Agenzia delle entrate
  3. at any office of the Agenzia delle entrate
  4. at the Local Health Office (ASL)
  5. Web service directly on the “Sistema tessera sanitaria” Website.


Applying for a Health Card (without microchip) a registration is not necessary, only filling in a request on the Agenzia delle entrate website in the dedicated area. This service allows requesting for a duplicate communicating only the valid tax code and completing personal data.

In order to avoid a fraudulent or improper use of the service, further considering the security of access to a public area, in some guided steps the users have to indicate data regarding their own income tax return and a motivation for the request. 

Page on the Website “Richiesta del duplicato”, using the tax code or dati anagrafici

If the applicants have no right to receive the Health Card, they will receive a Tax code Card (green card).

In order to receive a New  Health Card with microchip (TS-CNS) it is necessary the access to the reserved area using credential for telematics services – SPID (Public National ID System), CIE (Electronic Identity Card), CNS (National Services Card) or Fisconline credentials.

In this area, only motivating the reason for the request.

As established by Decree-Law no. 76/2020, as of 1 March 2021, citizens must access Public Administration services exclusively through the Public ID System (SPID), the Electronic Identity Card (CIE) or the National Service Card (CNS). From this date onwards, administrations will no longer be able to issue or renew old credentials, also for the ones of Agenzia delle entrate Reserved area, those credentials issued previously may continue to be used until their natural expiry date, and in any case, no later than September, 30th, 2021. For businesses and professionals, the transition to the exclusive use of SPID, CIE and CNS will take place on a date defined in an implementing decree.

The taxpayer can send to an office of the Agenzia delle entrate, via PEC (Certified Electronic Email) or e-mail, the request form, (form AA4/8), filled in and signed enclosing a copy of a valid ID. Form can have a digital signature.

You can find contact details on the website at “gli indirizzi degli uffici locali”.

On the web page you can consult the guide “I servizi agili dell’Agenzia delle entrate” to find out the services you can request by e-mail, PEC or by telephone.


The service allows the download of a paper copy in PDF format of the Health Card. The service is available for Health Cards expiring in 2020 and for those issued in subsequent years. In this case, it is necessary to access the reserved area only using personal credentials: SPID, Fisconline or activated TS-CSN.

Page “Tessera Sanitaria


For further details please visit the “Sistema tessera sanitaria” Website.

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