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. 30 dicembre 1992, n. 502 — healthcare system reform (SSN);
D.L. 30 settembre 2003, n. 269 — introduction of the electronic Tessera Sanitaria;
D.P.C.M. 12 gennaio 2017 — Livelli Essenziali di Assistenza (LEA) — defines the essential healthcare benefits guaranteed to all SSN-enrolled persons;
D.Lgs. 286/1998 (T.U. Immigrazione), artt. 34–35 — right to healthcare for foreign nationals;
Legge 30 dicembre 2023, n. 213 + D.L. 2 aprile 2024, n. 39 — updated contributo SSN amounts for voluntary enrolment;
Circolare Ministero della Salute prot. 0002292/2026 — Codice X22 for Ukrainian nationals valid until 31.12.2026;
Legge 26/2026 — Italian temporary protection extended until 4 March 2027.
👤 3. Who can obtain it
| Category | Entitlement |
| Italian citizens | Full Tessera Sanitaria |
| EU citizens residing in Italy | Full Tessera Sanitaria |
| Non-EU citizens with permesso di soggiorno | Full Tessera Sanitaria |
| International/humanitarian protection holders | Full Tessera Sanitaria |
| Ukrainian nationals under protezione temporanea | Full Tessera Sanitaria + Codice X22 |
| Tourists without permesso | STP only (urgent care) |
| EU citizens without residenza | ENI only (basic and 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
| Category | Validity |
| Italian citizens | 10 years |
| Non-EU citizens | Equals the permesso di soggiorno duration |
| Protezione temporanea (Ukraine) | Currently valid until 4 March 2027 (Legge 26/2026); card renewed in line with permesso extensions |
When the permesso is extended, the Tessera Sanitaria must also be updated at the ASL or Agenzia delle Entrate.
💰 7. Cost
The Tessera Sanitaria itself is free of charge.
Contributo SSN for voluntary enrolment (iscrizione volontaria)
⚠️ Updated: Amounts revised by Legge 213/2023 and D.L. 39/2024 (effective 2024).
| Category | Annual contribution |
| General (standard) | €2,000 |
| University students (studenti universitari) | €700 |
| Religiosi, volunteers | €700 |
| Au pair | €1,200 |
The old amounts of €150–€400 are no longer valid.
Codice X22 — Ukrainian Nationals
📌 Specific to Ukrainian nationals: Those not enrolled in SSN through employment access healthcare via Codice X22 — a specific registration code for temporary protection holders. Valid until 31 December 2026 (Circolare Ministero della Salute prot. 0002292/2026).
Ukrainian nationals with active employment are enrolled in SSN through their employer in the normal way.
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
- 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.
- Required documents:
o Tessera Sanitaria with chip (TS-CNS);
o Documento d’identità (passport/carta d’identità);
o Codice fiscale.
- 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
- 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.
- 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).
- ASL certificates
o Certificates of esenzione (exemptions), certificates for the medico di base, data updates.
- 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)
Every purchase of medicines or medical services processed via your Tessera Sanitaria is transmitted to the Sistema Tessera Sanitaria (STS) and appears automatically in the pre-filled 730 precompilata.
Deduction: 19% of qualifying expenses exceeding the €129.11 annual deductible (Art. 15 TUIR).
Example: Total expenses €500 → (€500 − €129.11) × 19% = €70.47 tax deduction.
Qualifying expenses: prescription medicines (scontrino parlante); medical visits; lab tests; hospitalisations.
Additional benefits:
- Expenses for persons with disabilities: often fully deductible (100%);
- Expenses for dependants (figli a carico): counted if paid using their Tessera.
How to opt out: mark oscuramento in the FSE — expenses will not be sent to Agenzia delle Entrate. Useful for sensitive treatments (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
- https://www.salute.gov.it
- https://www.agenziaentrate.gov.it/portale/web/guest/tessera-sanitaria
- https://www.interno.gov.it/it/temi/immigrazione-e-asilo
Frequently Asked Questions (FAQ)
1. Can foreign nationals obtain a Tessera Sanitaria? Yes. All foreign nationals with a valid permesso di soggiorno and ASL registration are entitled to a free Tessera Sanitaria. Without a permesso: STP (non-EU) or ENI (EU without residenza).
2. Tessera Sanitaria vs. STP/ENI? The Tessera gives full SSN access (family doctor, prescriptions, hospitalisation). STP/ENI are temporary codes for urgent and basic services, convertible to a full Tessera once status is regularised.
3. Do foreign children need a Tessera? Yes — on the same terms as adults. If parents lack a permesso, the child may receive STP for vaccinations and basic care.
4. Validity of the Tessera Sanitaria? Italians: 10 years. Non-EU: equal to permesso. Ukrainian nationals under protezione temporanea: aligned with the permesso, currently valid until 4 March 2027 (Legge 26/2026).
5. Can the Tessera be used as a Codice Fiscale? Yes — the CF is printed on the card and accepted in most contexts as a CF identifier.
6. What is TS-CNS and why activate PIN/PUK? TS-CNS is the chip version of the Tessera (Carta Nazionale dei Servizi). Activating PIN/PUK enables access to FSE, prescriptions, CUP bookings, and INPS/AE services in some regions.
7. How does the Tessera help with tax deductions? Every qualifying medical expense registered via your Tessera is transmitted to the STS and appears in your pre-filled 730. You receive a 19% deduction on expenses above €129.11/year. Sensitive expenses can be excluded via the oscuramento function.
8. What if the Tessera is lost or never arrived? Request a duplicate online via agenziaentrate.gov.it or at the ASL. While waiting, obtain a temporary certificate (attestazione provvisoria) at the desk.
9. Is the Tessera valid abroad? Yes — if it carries the TEAM on the back. Covers urgent medical care in EU/EEA countries and Switzerland. For long-term treatment abroad, additional forms (S1, E121) are needed.
10. Can the Tessera be used for online government services? Yes — but only in the TS-CNS format (with chip). After activating PIN/PUK, it enables access to FSE, CUP bookings, and in some regions 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!