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VACCINE

UPDATE: Do you need a health card to get vaccinated in Italy?

As Italy rolls out its Covid-19 vaccination campaign to more and more categories, foreign residents who aren't enrolled in the national healthcare system are wondering how and when they'll get their turn.

UPDATE: Do you need a health card to get vaccinated in Italy?
Arriving to be vaccinated at a clinic aboard a vaporetto in Venice. Photo: Andrea Pattaro/AFP

How does someone who doesn’t have an Italian healthcare card get vaccinated against Covid-19? 

The Local has been receiving versions of this question ever since Italy began its vaccination campaign at the end of December, and it’s only becoming more urgent as the programme opens up to more and more sections of the population.

Health officials have repeatedly stressed that Covid-19 vaccines should be offered to everyone in Italy, including foreign nationals. “All people residing or permanently present on the Italian territory, with or without a residence permit or identity documents” are entitled to vaccination here, states the Italian Medicines Agency (AIFA) in its official vaccination FAQs.

The country has a principle of making essential healthcare available to everyone, regardless of nationality or immigration status. That includes vaccinations against potentially severe infectious diseases, such as Covid-19.

So we know that foreigners should be eligible to get vaccinated in Italy. But in practice, it’s a bit more complicated.

Photo: ANDREAS SOLARO / AFP

Italy’s vaccination programme is being administered by the national public healthcare service, the Servizio Sanitario Nazionale (SSN), or rather, by the various separate regional health services (Servizi Sanitari Regionali, SSR) that make it up. Covid-19 vaccines are not available privately.  

AIFA previously stated that to get vaccinated you would need to show “a valid identity document and health card (tessera sanitaria)”: the health card that shows you’re enrolled in your region’s public health system.

As of late April, it has deleted this guidance from its FAQs, without replacing it with updated advice.

But most people will find that it remains the case when they try to register for a jab. Almost every regional health service has an online platform where residents can book an appointment, if they’re in one of the categories currently being vaccinated. Most of these require you to fill in the number of a tessera sanitaria.

READ ALSO: 

If you are signed up to the SSN but your health card is out of date, the good news is that it need not stop you from booking your shot. The Italian authorities have extended expired documents several times over the past year as the pandemic makes it harder to renew paperwork, and AIFA specifies in its FAQs that “holders of an expired health card” are entitled to get vaccinated in Italy.

If this is your situation, try calling your regional health service’s vaccination hotline and registering over the phone. You may be able to identify yourself using your codice fiscale (fiscal code) instead of your tessera sanitaria. Take your expired card to your appointment with you regardless.

Photo: MIGUEL MEDINA / AFP

If you do not have a health card because you are not enrolled in the SSN, things get trickier. 

Italy’s Covid-19 emergency commission has told health services to make exceptions for a few specific categories of people who are not enrolled in the public system, namely Italian citizens who usually live abroad and are only in Italy temporarily; foreign diplomats; and current or retired employees of the EU or other international organizations, as well as their dependent family members. 

READ ALSO: Italy says diplomats and Italians who live abroad can get vaccinated without a health card

Since the commission gave its instructions in late April, a few local health authorities have begun offering alternative means to register for vaccination without a tessera sanitaria – including Liguria, which since early May has directed people who fall into one of these categories to email or call its vaccine help services.  

As well as the categories specified by the commission, Liguria also says it will offer appointments to people with either an STP code (Straniero Temporaneamente Presente – temporarily present foreigner) or an ENI code (Europeo Non Iscritto – non-registered European citizen). Both the ENI code – for EU nationals – and the STP code – for non-EU nationals – are only for foreigners in Italy who cannot afford the cost of medical care.

In the part of the region that borders France, a well-established route for migrants without documents trying to cross the border, health services say they will also vaccinate foreign nationals who are in Italy temporarily and don’t have either of these codes. 

OPINION: Bureaucratic barriers must not stop Italy vaccinating its foreign residents

Photo: Alberto PIZZOLI / AFP

However, no other regions have yet made the same provisions. And in any case, they do not apply to foreign nationals who live in Italy permanently.

The Local has heard from several readers who say they were told flat-out by their local health authorities that they would not be able to register for vaccination without first signing up for national healthcare, which some residents might not do for a variety of reasons – including regional rules that prevent certain foreign nationals opting in to the public system if they’re not working in Italy.

At least one of those barriers came down this week: according to citizens’ rights group Beyond Brexit, Umbria, the region that most tightly restricted foreigners’ access to public healthcare, recently agreed to allow British residents who settled in the region before the UK’s transition out of the EU to opt in to the regional health service even if they don’t work. 

That means UK nationals who moved to Umbria before the end of 2020 now have more options to enrol in the public health service, get a tessera sanitaria and book their vaccination via the usual route. 

READ ALSO: How British citizens in Italy are overcoming bureaucratic Brexit problems

The Local has also heard from a handful of readers who were able to get vaccinated without an Italian health card, including an Austrian national who was (eventually) able to book an appointment in Rome by phone with only a codice fiscale, a British second-home owner who got his shot in Sicily when the island offered AstraZeneca to everyone over 60 without appointments one weekend, and a British teacher in Florence who qualified for vaccination through his job.

But a few success stories aside, Italian authorities have not yet agreed on a standard procedure for those who are not enrolled in the public health service. Until they do, some foreign residents who might otherwise be eligible are likely to face delays in getting vaccinated.

The Local put this question to the British Embassy in Rome back in March, who told us: “Further information is due to be made available on the process for those who live in Italy but who do not hold an Italian healthcare card to book a vaccine so please continue to consult the relevant Italian government websites”, including AIFA’s guidelines, regional health authorities’ websites, and the Ministry of Health’s vaccination site

We have since contacted the Italian Health Ministry and the Covid-19 Emergency Commission to ask how they plan to address this issue.

READ ALSO: ‘It felt like a betrayal’: Foreign residents in Italy report problems getting vaccinated

We will publish any new information as we get it.

In the meantime, the best advice we can give is to contact your local ASL or call your regional vaccination hotline, rather than trying to register online, and to look into whether you are eligible to enrol in Italy’s public health system (find a guide here). 

If you have a regular doctor in Italy, you should also consult them about your options.

Even without enrolling in the Italian health system, ultimately you should be able to get vaccinated at one of the walk-in clinics Italy has promised to set up around the country by the time doses are more widely available. For now, however, vaccination in Italy remains by appointment only.

Have you been able to get vaccinated without an Italian health card? The Local would like to hear from you. Email us with your story.

Member comments

  1. I have investigated deeply and am sorry to say that everywhere I have investigated — ASL, my local hospital, and a vaccination center — I have been informed in no uncertain term that I will not get vaccinated without a tessera sanitaria (without participating in the national health care system.) This is not a British problem; I’m an Austrian citizen residing in Rome. I am in the process of getting the documentation which will lead to an application for a tessera sanitaria, but this will take a long long time. (Austria does not have an exchange agreement with Italy, and anyway, its national health care service only applies to Austrian residents, so that doesn’t help either.) If anyone wants to talk about this, or has other info, I’d love to hear from you: [email protected], Karen Bermann, … Thanks and best wishes!

  2. I can only imagine, it’s hard enough for the Italians, without the proper paperwork i would think they would go into meltdown as Karen says impossible.

  3. Have also been told that we can’t get a tessera sanitaria (hence no vaccine) despite being resident since 2017 (Umbria) and paying Italian taxes. “Sanità per tutti”? I don’t think so. Incredibly frustrating, almost as chaotic as the situation in France. We were told that this ‘wrinkle’ had been solved in Tuscany, would love to know if this is true. So the options are 1) go to the UK but first you have to get a swab result in English, Spanish or French….oh yeah, like the U.K. border police are all trilingual now. LMAO. But first you have to be re-assigned to a GP Surgery with your NHS number (assuming you still have it). Get your (first) jab and then get another swab test before coming back for 5-days quarantine. Not forgetting you’ll have to do this twice. 2) Fly to Serbia where – allegedly – they are offering a choice of vaccines for a price. Not sure if the vaccine certificate will be entirely legible and readily accepted by border police around the world. I mean, Serbian ain’t exactly Spanish or French is it? 3) Wait for the vaccine centres to open up, some time in 2035.

  4. I live in Piemonte, without the health card. I called the regional Covid hotline and referred to what I had read in The Local. «You should not believe what you read in the news» was their answer.

  5. Why don’t Italy just open a vaccination center for a fee? I am interested in getting vaccinated because I am 56 and I have co-morbidities, such as Coronary Disease, Diabetes and Hypertension, putting in the line of vulnerable population. I am not concerned about me dying or getting sick. I don’t want to be the reason why other people might get sick.

  6. I was successfully vaccinated yesterday without a tessera sanitaria.

    It was easy to book an appointment on-line several weeks ago just using my Codice Fiscale. I had no problems being accepted by staff at the vaccination clinic. They did ask for the tessera sanitaria, but were advised that I did not have it yet.

    I do think I was more readily accepted because of having my Codice Fiscale and Permesso, along with being older and having health conditions that made vaccination advisable. I also took an Italian friend with me to facilitate better dialogue in the event there were any wrinkles, but there were none.

    I might suggest reviewing the drop down menu of available vaccination clinic locations on the website and choosing one that is not in a city center. I think staff in the clinics in outlying areas might be more accommodating. Just a thought…..

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READER QUESTIONS

Reader question: Do you need to cancel your residency when leaving Italy?

How do you cancel your residency permit when leaving Italy - and do you even need to do so at all? The Local looks into the rules.

Reader question: Do you need to cancel your residency when leaving Italy?

Question: My partner and I are leaving Italy after several years of living here. Do we need to cancel our residency? If so, can you advise us on how to go about doing this?

Most people know that you need to register as a resident in Italy if spending more then 90 days in the country. But what should you do if you decide to leave?

Do foreign nationals need to deregister as a resident, and under which circumstances? And how do you go about doing cancelling your residency?

We asked the experts to talk us through when you should deregister as an Italian resident and the the steps involved in cancelling your Italian residency.

Should you bother cancelling your residency?

As is so often the case when it comes to complex bureaucratic questions, the answer is: it depends. Both on your personal circumstances and on the type of residency permit you hold.

If you’re relocating away from Italy permanently then deregistering as a resident and informing the authorities of your new address is a legal requirement – and you’d want to do so anyway, says Nicolò Bolla of the tax consultancy firm Accounting Bolla.

READ ALSO: What’s the difference between Italian residency and citizenship?

On the other hand, if you’re moving away on a temporary basis, you’re not required to cancel your Italian residency.

“If, for instance, you undertake a two-year assignment somewhere, you can still remain a resident and benefit from all the coverage a resident has, such as healthcare,” Bolla explains.

You might want to hold on to your Italian residency in the short term if you're not sure whether the move will be permanent.
You might want to hold on to your Italian residency in the short term if you’re not sure whether the move will be permanent. Photo by MIGUEL MEDINA / AFP.

There’s no official time limit for this – you could leave Italy for a number of years while maintaining your residency and then return to live in the country as if there had been no break.

That means that if you’re leaving Italy and aren’t sure whether you want to return, you might want to keep your residency status, at least in the short term (it’s possible to be legally resident in both Italy and another country).

Financial planning and property consultant Daniel Shillito warns: “you want to be sure if you’re leaving the country that it was a permanent decision, and that you weren’t aiming to come back to live – because if you do want to, it could be tricky and quite administrative.”

For British citizens in particular, he points out, “having an Italian residency these days is a valuable thing, it’s not easy to get again.”

This all applies to those with permanent or long-term residency.

If you have a temporary residence permit, you will no longer be considered resident in Italy as soon as it expires – so you may decide it’s not worth bothering to cancel your residency if it’s due to expire anyway shortly after you leave.

Why does it matter?

There are multiple factors to consider here, the biggest of which is taxes.

If you’re resident in Italy, you’re expected to pay taxes here. However, if you’re moving to a country with which Italy has a double taxation agreement or dual tax treaty, you’re protected from being taxed twice on the same income. Many states, including the UK, America, Australia and Canada, have dual taxation treaties with Italy. 

READ ALSO: Can second-home owners get an Italian residence permit?

If you’re moving to a country which doesn’t have a double tax agreement with Italy, on the other hand, you’ll be legally required pay the full amount of Italian tax on your income even if you spend very little time in Italy, so will almost certainly want to cancel your residency.

Even if you’re moving to a country that does have a dual tax treaty with Italy, you may still want to deregister as an Italian resident in order to avoid having to deal with the paperwork involved in proving you’re a dual resident whose tax obligations are limited.

There’s also a third category of emigrant: for those moving to a country on the EU’s tax haven blacklist, such as Panama, simply deregistering as an Italian resident won’t keep the tax authorities at bay. The burden of proof is on the individual to demonstrate they actually reside in the blacklist country and aren’t just trying to evade Italian taxes.

In these situations, Bolla advises clients to register as resident in an intermediate third country after leaving Italy and before moving to the blacklisted country in order to avoid the extra bureaucracy.

READ ALSO: What taxes do you need to pay if you own a second home in Italy?

Do you need to cancel your residency when leaving Italy?

There are multiple factors to consider when deciding whether to cancel your Italian residency. Photo by FABIO MUZZI / AFP.

Other considerations

Besides where you pay your income tax, you’ll want to consider other factors such as official correspondence, tax breaks, and timeframes for residency-based citizenship applications, Bolla says.

If you maintain Italian residency, the authorities will expect to be able to reach you at your registered address, including for things like traffic fines or notifications of tax audits. If you no longer have any link to that address and no one to forward your correspondence on to you, you could end up in a sticky legal situation.

It’s also worth taking into account the fact that new Italian residents can access certain tax breaks that aren’t available to people who’ve lived here for a while. If you cancel your residency and then return to Italy at a later date, you’ll be eligible for those incentives in a way that you wouldn’t be if you’d kept your residency.

On the other hand, Bolla notes, maintaining Italian residency could work in favour of those interested in pursuing citizenship through residency.

An individual must be continuously resident in Italy for 10 years before they can apply for Italian citizenship based on their long-term residence status.

In theory, maintaining your Italian residency while you’re temporarily abroad could mean that period still counts towards towards those ten years and you won’t have to restart the clock on your return – though it’s important to consult a professional if you’re considering this option.

How can you go about cancelling your residency?

There’s no standardised national protocol for cancelling your residency. Instead, you’ll need to contact the comune, or town hall, you’re registered with to inform them of the change and ask them what you need to do.

The process could be as simple as sending a few emails, without even having to set foot in the building. There may also be a form to fill out. Because things vary from one municipality to another, you’ll need to contact your local comune to find out exactly what’s required.

Generally the process can only be completed after, not before, leaving the country, because you’ll need to provide your new address and possibly supporting documentation proving that you’re now resident elsewhere.

“You say me and my family – and then you list all the members – are no longer residing in your town, please deregister us, and our new address is (e.g.) 123, Fifth Avenue, New York,” says Bolla.

If you have a Spid (Sistema Pubblico di Identità Digitale or ‘Public Digital Identity System’) electronic ID, Bolla notes, in many towns and cities (such as Milan), the process can be completed online through the comune‘s website.

You should expect to receive confirmation that you and your dependents have been deregistered as Italian residents, so it’s worth following up until you receive this.

READ ALSO: How to use your Italian ID card to access official services online

Shillito advises using a PEC (Posta Elettronica Certificata, or Electronic Certified Mail) email account if you have one when communicating with your comune about deregistering. 

Messages sent between PEC accounts are certified with a date and time stamp to show when you sent them and when they were received, with a record of receipt automatically emailed to you as an attachment. Within in Italy they have the same legal value as a physical lettera raccomandata (registered letter).

“That secure email communication is official, you’ve got a receipt showing it’s been received,” says Shillito.

“That way you’ve got evidence and a record that you’ve communicated it to them, in case anything went wrong in the future and the Italian government decided to claim you were still living in Italy.”

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