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Elective residence

Health Card Request for Foreigners with Elective Residence

Article 34 of the Consolidated Immigration Act (Legislative Decree No. 286/1998) establishes that certain categories of legally residing foreign nationals, as well as their dependent family members, must enroll in the National Health Service (SSN).

For foreign nationals holding a valid residence permit who are not subject to this mandatory enrollment, the law provides two alternatives to access healthcare services in Italy:

  1. Purchasing private health insurance to cover medical, accident, and maternity risks.
  2. Voluntary enrollment in the National Health Service (SSN) by paying an annual lump-sum contribution, calculated based on the total income earned both in Italy and abroad in the year preceding the enrollment request.

It is important to note that a residence permit for elective residence does not grant eligibility for mandatory SSN enrollment.

Foreign nationals applying for an elective residence visa must provide proof of private health insurance when submitting their visa application to the relevant Italian diplomatic or consular office.

Once the visa is granted, and after entering Italy and applying for an elective residence permit, the foreign citizen may opt for voluntary enrollment in the SSN by paying the required contribution established by law.

Health card request for foreigners with elective residence

The health card (Tessera Sanitaria) for foreign citizens with elective residence can only be requested by individuals holding a residence permit for elective residence who are voluntarily enrolled in the SSN.

The health card is issued exclusively to individuals registered with the SSN.

To apply for SSN enrollment, the foreign citizen must submit a request to the Local Health Authority (ASL) in their place of residence. Upon registration, the ASL will electronically transmit the applicant’s details and request the issuance of a health card.

The health card for foreign citizens is usually valid for the same duration as the residence permit.

Healthcare services for Non-EU citizens in Italy

Healthcare services for foreign nationals are provided on equal terms with Italian citizens, ensuring full equality of rights and duties, including the contribution obligation. This applies to:

  • Foreign citizens who are mandatorily enrolled in the SSN.
  • Foreign citizens who voluntarily enroll in the SSN.

Whether mandatory or voluntary, SSN enrollment entitles the foreign citizen to all healthcare services available in Italy, equal to those provided to Italian citizens.

Health Card for EU and Non-EU Foreigners

The health card (Tessera Sanitaria) is only issued to EU and non-EU citizens who are enrolled in the National Health Service (SSN).

When a foreign national requests SSN enrollment (whether mandatory or voluntary), the Local Health Authority (ASL) in charge submits a request for the issuance of the health card, electronically transmitting the applicant’s personal details.

The health card, which remains valid for the same period as the residence permit, is subsequently sent to the applicant’s registered tax residence or to the address recorded in the database of the Italian Revenue Agency (Agenzia delle Entrate).

Typical scenarios / Case studies

The typical scenarios have been developed by drawing on the most significant corporate immigration cases that the firm regularly handles, with the aim of creating structured, complex examples that help the reader navigate their own situation. The case studies, by contrast, illustrate individual real-life matters, anonymised to protect client confidentiality, presented with full factual and contextual detail.

Relocation

US professional chooses Italy: elective residence obtained and future planned

American professional obtains an elective residence visa while maintaining ties with the USA. Integrated assistance from legal strategy to property search..

Application completed in approximately 3 months without additional requests
Business

US opera singer obtains work authorization in 7 days

American opera singer with contracts already signed with an Italian theatre. Self employment work authorization obtained on an urgent basis to meet professional commitments.

Work authorization issued within 7 days from submission of the application
Real Estate

US client purchases property in Rome: secure transaction

American client assisted in the purchase of a property in Rome. Urban planning issues and contractual risks identified and resolved before signing, transaction completed through notarial power of attorney.

Purchase completed within one month, entirely managed remotely
Business

American investor: from New York to a villa in Tuscany

Cross-border property transaction with full relocation service. Purchase of a high-end property, with tax status, residency and NHS registration handled remotely.

Complete relocation service, from property due diligence to handing over the keys
Retirement

Canadian couple, retirement property in Puglia

From Toronto to the Itria Valley. Purchase of a farmhouse with cadastral issues, 7% flat tax on foreign pensions, elective residence visa and healthcare transition.

7% flat tax activated, cadastral issues resolved before the deed of sale
Business

British entrepreneur, opening a business in Milan

Post-Brexit, a London-based tech entrepreneur establishes an operational headquarters in Milan. Immigration pathway as a non-EU national, company incorporation, and tax planning.

European operational hub established with self-employment visa successfully obtained
Tax Planning

Swiss retiree: 7% flat tax regime in Southern Italy

A banking executive relocates from Zurich to Calabria. Management of the Swiss occupational pension pillar, Italy-Switzerland Tax Convention, and deregistration from the cantonal tax register.

7% flat tax activated on all foreign-sourced income
Retirement

American couple: retirement project in Abruzzo with visa and flat tax

From Connecticut to Abruzzo. Elective residency visa, 7% flat tax coordinated with IRS and FATCA obligations, and transition from Medicare to the Italian NHS (SSN).

7% flat tax activated on Social Security and 401(k) pension income
Relocation

German couple, from Munich to Tropea

Retired engineers from the Bavarian automotive sector. Multi-tier pension management, Italy-Germany Tax Convention, and the 7% preferential tax regime.

Three German pension pillars optimised with Italian flat tax
Business

Startup tech: apertura filiale italiana per il mercato EU

A Bay Area SaaS company establishes a Milan headquarters. Innovative startup SRL, EU Blue Card for the team, transfer pricing, impatriates tax regime, and GDPR compliance.

Operational within 5 months, payroll cost −35% with impatriates tax regime
Business

Fashion brand, representative office in Milan

Brand premium newyorkese apre presidio a Milano. Strutturazione per evitare stabile organizzazione, trasferimento direttrice creativa e gestione showroom.

Rischio stabile organizzazione prevenuto, presidio EU operativo
Corporate

Manufacturing company, ICT transfers to Italy

Multinazionale giapponese trasferisce 3 figure chiave in Piemonte. Permessi ICT per manager e specialista, coordinamento consolare e regime impatriati per tutti i dipendenti.

3 trasferimenti completati in 4 mesi e mezzo, linea produttiva avviata nei tempi previsti

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    Investor visa: how to prove the source of funds?

    The source of funds must be demonstrated through banking and financial documentation proving ownership, availability, transferability, and lawful origin of the capital: recent bank statements (typically covering the last 3 months), certifications from the financial institution, and documents evidencing the source of funds (income, sale of assets, donations, or other traceable transactions).

    For the Italian investor visa (minimum €500,000 in a company or €250,000 in an innovative startup), documentation must be in Italian or English (or officially translated) and verifiable. Authorities carry out anti-money laundering checks and also require proof of no criminal convictions and of the lawful origin of the funds.

    Real estate purchase as a foreigner: does buying a property grant a residence permit?

    No, purchasing a property in Italy does not automatically grant a residence permit. A non-EU national may freely buy property, subject to the condition of reciprocity, but residing in Italy requires an independent residence title: elective residence, investor visa, work, or another legal ground предусмотрed by law.

    However, owning property can be a useful requirement for several types of residence permits, particularly elective residence. It demonstrates a connection to the territory and satisfies the accommodation requirement, as well as indicating the availability of sufficient financial resources. Therefore, the purchase should be part of an overall immigration strategy.

    Foreigner buying property in Italy: what taxes apply and what incentives are available?

    A foreign buyer pays the same taxes as an Italian citizen: a registration tax of 9%, or reduced to 2% if the “first home” benefit applies; VAT at 4% or 10% if purchasing from a developer. In addition, there are mortgage and cadastral taxes (€200 each for a first home).

    The “first home” benefit is also available to foreigners, provided they establish residence in the municipality where the property is located within 18 months of purchase. Special tax regimes for new residents or inbound workers may offer further advantages on the taxation of foreign

    Elective residence based on property purchase: what is the minimum income required?

    There is no minimum amount set by law. The consulate assesses on a case-by-case basis whether the applicant has sufficient means to support themselves without working in Italy. In practice, an annual income from passive sources (pension, annuities, dividends) of at least €31,000 for a single applicant is generally considered sufficient, with higher thresholds for dependent family members.

    Elective residence is intended for individuals who wish to relocate to Italy without carrying out any work activity. Owning a property or having a long-term rental agreement strengthens the application. Proof of passive income sources is the key requirement.

    Opening a representative office in Italy: what are the tax obligations and advantages?

    A representative office does not carry out commercial activities in Italy: it promotes the business, gathers information, and manages relationships with clients and suppliers without entering into contracts. As it does not constitute a permanent establishment, it does not generate taxable income in Italy and is not subject to corporate income tax (IRES) or VAT on its activities.

    The advantages: a physical presence in the Italian market without direct taxation, low start-up costs, and no obligation to prepare separate financial statements. The obligations: registration with the REA (Economic and Administrative Index) at the Chamber of Commerce, keeping accounting records for expenses incurred, and filing withholding tax returns if employees are hired.

    Innovative startup in Italy: what tax incentives are available for foreign founders?

    Foreign founders of innovative startups may benefit from a 30% personal income tax (IRPEF) deduction (up to 50% in certain cases) on investments in the company’s capital, the favorable tax regime for new residents, and exemption from Chamber of Commerce fees and stamp duties for the first five years.

    The startup must be registered in the special section of the Companies Register and meet the requirements set out in Law Decree 179/2012, which are also verified by the Investor Visa for Italy Committee. As for immigration pathways, the investor visa requires a minimum investment of €250,000 in an innovative startup.

    The ItalyVisaInvestment website is owned by Studio Legale Boschetti and is the go-to resource for foreigners who wish to invest in Italy, obtain elective residence, or apply for an investment visa.

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