SSN Registration: How a Foreigner Gets a Family Doctor and Health Card in Italy

What the SSN is and why you should register

SSN (Servizio Sanitario Nazionale) is Italy's national health service, built on universal access: basic care is provided to everyone who legally resides in the country, regardless of citizenship. Registration (iscrizione al Servizio Sanitario Nazionale) opens up almost free access to a family doctor, a pediatrician for your child, hospitalisation, emergency care, tests and prescription medicines at subsidised prices.

For a foreigner who has just arrived, this is one of the first practical steps after sorting out the residence permit. Many assume that simply holding a permesso di soggiorno is enough for a doctor to become available on its own. In reality you must contact your local health authority separately — the ASL (Azienda Sanitaria Locale, called ASST, AUSL or ATS in some regions) — for the area where you live, submit your documents and choose a doctor.

Without registration you can, in theory, see private doctors at full cost or use the emergency department (pronto soccorso) in critical situations. But that is expensive and inconvenient: prescriptions for ongoing medication, specialist referrals and routine tests all hinge on your medico di base — the family doctor you select when you register.

Who has the right and the obligation to register, how this depends on your permit type and how much it costs — we cover it all below. The rules differ depending on whether your stay entitles you to mandatory or only voluntary registration.

Mandatory vs voluntary registration (with a fee)

Understand this from the start: SSN registration comes in two forms — mandatory (iscrizione obbligatoria) and voluntary with a fee (iscrizione volontaria). Which applies to you determines whether you pay an annual contribution.

Mandatory registration — free of charge

The right to free mandatory registration belongs to foreigners who legally reside in Italy on grounds treated, for healthcare access, on a par with Italian citizens. This includes:

• holders of a permesso di soggiorno for employed or self-employed work (lavoro subordinato / autonomo);
• holders of a permit on family grounds (ricongiungimento familiare);
• holders of the EU long-term residence permit (permesso di soggiorno UE per soggiornanti di lungo periodo);
• people granted asylum, subsidiary or temporary protection — including Ukrainians under protezione temporanea;
• those awaiting refugee status, plus certain other protected categories (minors, pregnant women and so on).

For these categories, registration is not only free — it effectively puts you on an equal footing with an Italian citizen for healthcare: a family doctor, a pediatrician for your child, and access to hospitals and tests on the same terms as local residents.

Voluntary registration — with an annual fee

If your grounds are not on the mandatory list — for example, a study permit without the right to work, a permit on religious grounds, or an elective-residence visa — registration is possible on a voluntary basis. You then pay a fixed annual contribution (contributo), set each year by category. It covers the calendar year and is not refunded pro rata if you register partway through.

The alternative is private health insurance (assicurazione sanitaria privata), often required precisely for study permits and some other permit types. Which option is cheaper depends on your age, health and the volume of care you expect to need.

Tessera sanitaria: the health card and codice fiscale

After you register with the SSN, you are issued a tessera sanitaria — your personal health card. It is a plastic card the size of a bank card, showing your name, your codice fiscale (tax code) and an expiry date. On the reverse it doubles as the European Health Insurance Card (TEAM / EHIC), which entitles you to emergency care in other EU countries.

Do not confuse two documents people often mix up:

• Codice fiscale — the tax code assigned by the Agenzia delle Entrate. You need it for any official act in Italy: a rental contract, a bank account, a job. It is simply an identifier and does not in itself grant access to healthcare.
• Tessera sanitaria — the card confirming you are registered with the SSN and entitled to medical services. It contains your codice fiscale, but is issued only after you register with the ASL.

The card's validity is usually tied to that of your permesso di soggiorno. When you renew the permit, renew your SSN registration too — otherwise the card "freezes" and your doctor temporarily cannot write prescriptions through the state system. If lost or damaged, it can be reissued via the Agenzia delle Entrate or your regional portal.

While the physical card is being produced and posted (which can take a few weeks), the ASL issues a temporary paper certificate — the attestato di iscrizione. It is fully valid: with it you can already visit your family doctor and get prescriptions.

Choosing a medico di base and a pediatra for children

The central figure in the Italian system is the medico di base (officially medico di medicina generale), your family doctor — the first person you turn to for any non-emergency problem. They write prescriptions, issue referrals (impegnativa) to specialists and for tests, produce sick-leave certificates and keep your history.

When you register with the ASL you choose a doctor from the list of those working in your area who still have places available (each doctor has a patient cap). You can choose by several criteria:

• how close the surgery (ambulatorio) is to your home;
• consultation hours and working days;
• language — some doctors speak English or other languages;
• recommendations from acquaintances or the community.

A visit to your medico di base within the SSN is free. You can change doctor at any time — the change (cambio medico) is simple, free and often available online through the regional health portal.

Pediatra for children

Children have a separate doctor — the pediatra di libera scelta (pediatrician of "free choice"). Children up to roughly age 14 are followed by a pediatrician rather than the family doctor. Assignment is compulsory up to age 6; between 6 and 14 parents may keep the child with the pediatrician or move them to the family doctor. After 14 the child transfers automatically to the medico di base.

The pediatrician manages the compulsory vaccination schedule and routine check-ups (bilanci di salute) and writes the child's prescriptions and referrals. You choose one on the same basis as a family doctor — when you register the child with the ASL, from the list available in your area.

While your permesso is being processed: the STP code and emergency care

A very common question: what do you do about healthcare while your residence permit is still being processed? For instance, you have filed your documents at the questura and received a cedolino (the submission receipt), but the physical permesso di soggiorno card is not there yet — and you need care now.

Here you need to distinguish two situations.

If you already have a submission receipt

If you applied for a permesso di soggiorno on grounds that entitle you to mandatory registration (work, family, protection), you can usually register with the SSN on the strength of the submission receipt, together with your passport and codice fiscale. ASL practice varies by region, so check locally which documents they accept while you wait.

The STP code — for those still without a permit

For foreigners in Italy without a residence permit, who therefore cannot yet register with the SSN, there is a special mechanism — the STP code (Straniero Temporaneamente Presente, "temporarily present foreigner"). It is an anonymous 16-digit code, issued free of charge, valid for up to 6 months and renewable.

The STP code entitles you to:

• urgent and essential medical care (cure urgenti ed essenziali);
• maternity care, before and after childbirth;
• healthcare for children;
• vaccinations and prevention of infectious diseases;
• treatment within the limits set by law, at subsidised prices or free for those without means.

The STP code does not replace full registration and does not let you choose a family doctor — it is a "safety net" for a transitional period, obtained at specialised clinics attached to hospitals or the ASL. Importantly: seeking care with an STP code does not trigger any report to the police and does not affect your immigration situation — this is expressly guaranteed by law.

Regardless of status, in genuinely critical situations — injuries, acute pain, a threat to life — the pronto soccorso is obliged to treat anyone who comes in, whatever their documents or citizenship.

Children's rights to healthcare

Italian law consistently places the child's interests above the parents' immigration status. So minors have the right to full access to healthcare regardless of whether they or their parents hold a residence permit.

In practice:

• Children on grounds entitling them to mandatory registration (family, protection, a parent's work) are registered on an equal footing with adults and assigned a pediatrician.
• Children of foreigners without a permit may register and choose a pediatrician like any other child — a separate guarantee, broader than the STP regime for adults.
• Compulsory vaccinations, routine check-ups and emergency care are provided to all children without exception.

To register a child with the ASL you need the child's documents (birth certificate or passport), their codice fiscale and one parent's documents. Under ricongiungimento familiare, children are usually registered together with the parents, each assigned a pediatrician.

How to register: step by step at the ASL

The procedure is straightforward if you gather your documents in advance. Here is the general sequence — details may differ by region (Lombardy, Lazio, Emilia-Romagna and others each have their own portals).

Step 1. Gather your documents

Registration usually requires:

• a valid permesso di soggiorno or the receipt for its submission (cedolino);
• your foreign passport;
• your codice fiscale (issued by the Agenzia delle Entrate);
• proof of where you live — registered residenza in the comune or at least a declaration of actual residence (domicilio), depending on your ASL;
• for voluntary registration — the receipt for the annual contribution;
• for employees — sometimes the employer's details or employment contract.

Step 2. Find your ASL

The ASL is tied to your area of residence. Work out which authority covers your address and find the nearest registration desk (sportello). In many regions you can book online or take a ticket on the spot.

Step 3. Submit the application and choose your doctor

At the appointment you fill in the application, hand over your documents and choose a medico di base (and, for a child, a pediatra) from those available in your area. The operator enters your data and issues the attestato di iscrizione — proof of registration bearing your doctor's name.

Step 4. Wait for the tessera sanitaria

The plastic card arrives by post within a few weeks. Until then, use the paper confirmation. If it does not arrive in reasonable time, check the status through the Agenzia delle Entrate or the regional portal and confirm your address.

Step 5. Do not forget to renew

Registration lasts as long as your residence permit. When you renew your permesso di soggiorno, renew your SSN registration in good time, so there is no gap in access to a doctor and prescriptions.

Frequently asked questions

Can I use a doctor in another city, away from where I am registered?

Your medico di base is tied to your area of residence. If you are temporarily elsewhere, you can see a local doctor for a modest fee or use emergency care. When you move permanently you re-register with the new ASL and choose a new doctor. The tessera sanitaria stays valid throughout Italy for emergencies.

How much does a visit to the family doctor and medication cost?

A visit to your medico di base or pediatrician within the SSN is free. For tests, specialist appointments and some medicines you may pay a ticket — a partial co-payment that depends on the region and your income. Many categories (children, pregnant women, low-income households, the chronically ill) qualify for exemption (esenzione).

What do I do if my permesso is still being processed?

If you are on grounds entitling you to mandatory registration, in most regions you can register on the strength of the submission receipt. If registration is not yet possible, use the STP code for urgent care, and remember that the pronto soccorso treats everyone in critical situations regardless of documents.

Does each family member need a separate registration?

Yes, every family member registers separately and gets their own tessera sanitaria. Adults choose a medico di base, children a pediatra. Under ricongiungimento familiare it is convenient to do everyone at once, bringing each person's documents.

Which is better for a student — voluntary SSN registration or private insurance?

It depends on age and needs. Voluntary SSN registration gives full access to a family doctor and public healthcare for a fixed annual fee. Private insurance is sometimes cheaper for a young, healthy person, but often has limited coverage. Compare the contribution, the coverage and your permit type's requirements before deciding.

SSN registration is the step that turns a formal residence permit into real access to healthcare: your own doctor, a pediatrician for your child, tests and hospitals on the same terms as local residents. Sort out the category of your permesso di soggiorno, gather your documents, choose a doctor at the nearest ASL — and renew your registration together with your permit.

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