Tessera Sanitaria

🩺 1. What is Tessera Sanitaria

Tessera Sanitaria (TS) is the official card that confirms a person’s right to use Italy’s public healthcare system (Servizio Sanitario Nazionale – SSN).


• It functions as a health insurance certificate.

• It is used to access medical services, purchase prescription medicines, and for hospital admissions.
• In its electronic version, it contains a chip and can substitute the Codice Fiscale.

📌 For foreign nationals, the tessera sanitaria is a key document for accessing healthcare on the same basis as Italian citizens.

⚖️ 2. Legal framework

• D.Lgs. 502/1992 — healthcare system reform (SSN).

• D.L. 269/2003 — introduction of the electronic Tessera Sanitaria.

• Regulations by Agenzia delle Entrate and Ministero della Salute.

• For foreign nationals — provisions of T.U. Immigrazione (D.Lgs. 286/1998), arts. 34–35 (right to healthcare).

👤 3. Who can obtain it

• Italian citizens.

• EU citizens residing in Italy.

• Non-EU citizens with a permesso di soggiorno (temporary or long-term).

• Persons with international or humanitarian protection (refugees, protezione speciale, temporary protection). 📌 Tourists without a permesso di soggiorno receive only STP (Straniero Temporaneamente Presente) — a temporary code for access to urgent care.

📄 4. Required documents

For non-EU foreign nationals:

• A valid passport.

• Permesso di soggiorno (or the receipt confirming the application).

• Codice Fiscale.

• Proof of residenza or a dichiarazione di domicilio (depends on the Comune).

🏥 5. Where it is issued

• At the ASL / ATS (Azienda Sanitaria Locale / Territoriale) for your place of residence.
• In some cases — via CUP desks or CAF (as assistance with the application).

⏳6. Validity period

• For Italian citizens: 10 years.

• For foreign nationals: validity of the tessera sanitaria equals the validity of the permesso di soggiorno.

• For persons with temporary protection (e.g., Ukrainians): usually 1 year, with the possibility of renewal.

💰 7. Cost

• Tessera Sanitaria is free of charge.

• For certain categories of foreign nationals (e.g., when voluntarily enrolling in the SSN), an annual contribution may be required (contributo SSN, ≈ €150–€400 depending on the category).

8. TS-CNS (Carta Nazionale dei Servizi)

🔑 What it is

TS-CNS is a Tessera Sanitaria with Carta Nazionale dei Servizi functions, i.e., an electronic key to access government online services.

The card contains a chip and a personal PIN/PUK, allowing authentication via a computer or smartphone with a reader.

🛠️ How to activate TS-CNS

  1. Obtaining PIN/PUK:

o At the ASL, a pharmacy, or a dedicated Regione desk;
o PIN is often provided in two parts: the first immediately, the second by post.

  1. Required documents:

o Tessera Sanitaria with chip (TS-CNS);

o Documento d’identità (passport/carta d’identità);

o Codice fiscale.

  1. PIN recovery:

o Through the same channel (ASL/pharmacy);

o Sometimes online (depends on the region), but in-person presence is usually required.

⚙️ What an activated TS-CNS provides

  1. Fascicolo Sanitario Elettronico (FSE)

o Access to medical history (discharge summaries, tests, X-rays);

o View prescriptions and vaccinations;

o Option to hide (oscurare) certain data.

  1. Prescriptions and CUP

o Book GP/specialist appointments online (CUP Regione);

o Obtain e-prescriptions without paper (at the pharmacy, codice fiscale + TS are enough).

  1. ASL certificates

o Certificates of esenzione (exemptions), certificates for the medico di base, data updates.

  1. INPS and Agenzia delle Entrate services (not in all regions)

o View contributions;

o Access 730/Redditi precompilata;

o Check benefits (bonuses, assegni).

💶 9. Tax deductions (detrazioni fiscali)

Using TS-CNS directly affects tax deductions in Italy.

Automatic inclusion of medical expenses in the tax return (730/Redditi precompilata)

  • Each purchase of medicines or medical services at a pharmacy/clinic is processed via Tessera Sanitaria.
  • Data are automatically transmitted to the Sistema Tessera Sanitaria (STS).
  • These data then appear in the pre-filled 730 in Agenzia delle Entrate.

Which expenses are considered:

  • Medicines (with an scontrino parlante);
  • Medical visits;
  • Lab tests and analyses;
  • Hospitalizations and special procedures.

Deduction amount:

  • 19% of expenses exceeding the €129.11 annual deductible (art. 15 TUIR).
  • Example: if you spent €500, then €500 – €129.11 = €370.89. 19% of this amount = €70.47 tax deduction.

Additional benefits:

  • Expenses for persons with disabilities (disabili) are often fully deductible (100%) or have higher limits;
  • Expenses for dependants (figli a carico) are also counted if the invoice/prescription was paid using that person’s Tessera Sanitaria.

How to opt out of having expenses included:

  • In the FSE you can mark oscuramento of expenses so they are not sent to Agenzia delle Entrate;
  • Useful for those wishing to keep certain treatments confidential (e.g., psychotherapy, reproductive medicine).

🆘 10. STP / ENI — temporary healthcare access codes

🔹 What is STP

STP (Straniero Temporaneamente Presente) is a temporary identification code issued to a non-EU foreign national who is in Italy:

• without a permesso di soggiorno;

• as a tourist/visitor or while awaiting regularization;

• in emergency situations (refugees, humanitarian aid).

📌 The STP looks like an 11-character alphanumeric code, generally valid for 6 months, renewable.

🔹 What is ENI

ENI (Europeo Non Iscritto) is a similar temporary code for EU citizens in Italy who:

• have not yet registered residenza;

• have not filed a declaration with the Anagrafe;

• are not yet entitled to a full tessera sanitaria.

ENI grants access to basic and urgent healthcare services.

🏥 Where STP / ENI are issued

• At the ASL/ATS (Azienda Sanitaria Locale/Territoriale) for your place of stay.

• Sometimes the code can also be obtained at Pronto Soccorso (emergency room) or via humanitarian organizations partnered with the ASL.

⚕️ What rights STP / ENI provide

• Urgent medical care (pronto soccorso).

• Treatment of acute and chronic illnesses.

• Vaccinations (general and pediatric).

• Assistance for infectious diseases (testing, treatment, prevention).

• For pregnant persons — full obstetric-gynecological care, including childbirth.

📌 Important: healthcare staff do not report the absence of a permesso di soggiorno to the Questura when STP is used. This is expressly provided by art. 35, paragraph 5, D.Lgs. 286/1998.

⏳ Validity

• STP is usually issued for 6 months, and can be renewed for another 6 if the status has not changed.

• ENI applies until the EU citizen registers residenza and enrolls with the ASL.

🔄 Conversion to a full Tessera Sanitaria

• STP → Tessera Sanitaria: as soon as the foreign national applies for or obtains a permesso di soggiorno (even with the ricevuta postale), they can go to the ASL to obtain the tessera sanitaria.

• ENI → Tessera Sanitaria: after registering residenza with the Comune, an EU citizen becomes entitled to a full tessera sanitaria.

👉 In both cases, the old STP/ENI becomes invalid, and all data are transferred to the new card.

⚠️ Differences from a full Tessera Sanitaria

• STP/ENI do not grant full access to a family doctor (medico di base) or long-term ASL enrollment.

• They are limited in validity and scope of services.

• They are temporary solutions to ensure access to care while a person regularizes their status.

11. Useful links

Frequently Asked Questions (FAQ)

1. Can foreign nationals obtain a Tessera Sanitaria?

✅ Yes. All foreign nationals with a valid permesso di soggiorno and registration with the ASL are entitled to a full tessera sanitaria. Without a permesso, only STP (for non-EU) or ENI (for EU citizens without residenza) is issued.

2. What is the difference between Tessera Sanitaria and STP/ENI?

🔹 Tessera Sanitaria gives full access to the SSN (family doctor, pediatrician, prescriptions, hospitalization).

🔹 STP and ENI are temporary codes for basic and urgent services and vaccinations, pregnancy care. They can be converted into a full Tessera after regularizing status.

3. Do foreign children need a Tessera Sanitaria?

✅ Yes. Children are entitled to a tessera on the same terms as adults. If parents do not yet have a permesso, the child may be issued STP for vaccinations and basic care.

4. What is the validity of the Tessera Sanitaria?

• Italians: 10 years.

• Non-EU foreign nationals: validity = validity of the permesso di soggiorno.

• Protezione temporanea (e.g., Ukrainians): usually 1 year, then renewal together with the permesso.

5. Can the Tessera Sanitaria be used as a Codice Fiscale?

✅ Yes. Your CF is printed on the card. In many cases, the TS substitutes a separate CF certificate.

6. What is TS-CNS and why activate PIN/PUK?

🔑 TS-CNS is the version of the Tessera Sanitaria with a chip (Carta Nazionale dei Servizi).
By activating PIN/PUK, you can:

• access the Fascicolo Sanitario Elettronico (FSE);

• view prescriptions and certificates online;

• book appointments via CUP;

• use some INPS and Agenzia delle Entrate services.

7. How does Tessera Sanitaria help with tax deductions?

💶 Every purchase of medicines or medical services is recorded via TS in the Sistema Tessera Sanitaria (STS).

These expenses are automatically included in the 730 precompilata and entitle you to a 19% deduction above the €129.11 deductible.

For confidential expenses (psychotherapy, reproductive medicine), you can set oscuramento in the FSE so the data are not sent to Agenzia delle Entrate.

8. What if the Tessera Sanitaria is lost or never arrived by post?

📌 Request a duplicate online on the Sistema Tessera Sanitaria portal or at the ASL.
While waiting, you can obtain a temporary certificate (foglio sostitutivo).

9. Is the Tessera Sanitaria valid abroad?

🌍 Yes, if the back of the card has the TEAM (Tessera Europea di Assicurazione Malattia). It allows access to urgent care in EU/EEA countries and Switzerland. For long-term treatment, additional forms are needed (S1, E121).

10. Can the Tessera Sanitaria be used to access online government services?

✅ Yes, but only in the TS-CNS format (with chip). After activating PIN/PUK, the card allows access to the FSE, booking via CUP, and in some regions to INPS and Agenzia delle Entrate services.

We’ve prepared a detailed PDF Guide for you — covering all the steps and procedures for obtaining a Tessera Sanitaria.

Download and use it as a ready-to-go manual!

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