State-Regional Agreement on Medical Assistance to Foreigners in Italy (2012, Rep. N 255/CSR)
Official regulatory act - Accordo Rep. Atti n. 255/CSR del 20/12/2012 Conferenza Permanente per i Rapporti tra lo Stato, le Regioni e le Province autonome di Trento e Bolzano. Agreement on "Guidelines for the correct application of regulations for healthcare assistance to the foreign population by Regions and Autonomous Provinces."
Official source of the document:Text of the agreement in the Gazzetta Ufficialeverified 2026-09-11
About this document
An official normative act - agreement Rep. Atti n. 255/CSR of 20.12.2012 of the permanent conference for relations between the State, the regions and the autonomous provinces of Trento and Bolzano on the correct application of healthcare rules for the foreign population. The document sets a single nationwide standard: regions must consolidate all rules on healthcare for foreigners into one operational instrument and remove the regional access gaps identified by a 2008 study. The legal basis is the Testo Unico Immigrazione (D.Lgs. 286/1998), the rules on international protection and EU citizens, and the European regulations on social security coordination. It is the baseline document on the healthcare rights of foreigners in Italy, including care for undocumented people under the STP code. Adopted unanimously by the State and the regions. Text recognition quality is average (OCR from PDF).
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How to use it
This is a reference legal act, not a step-by-step guide: use it as a primary source when an ASL or a region interprets your healthcare rights their own way - citing the agreement strengthens your position. Read it together with the practical SSN and STP write-ups on our site; note the average text recognition quality. The document can be viewed page by page in the protected viewer.
Why you need it
Establishes a unified federal standard for the application of healthcare regulations to the foreign population in Italy across all regions. A basic regulatory document on the rights of foreigners to medical care in Italy - including undocumented individuals (STP).
Key information
- Legal basis: D.Lgs 286/1998 (Testo Unico Immigrazione); D.Lgs 251/2007 (international protection); D.Lgs 30/2007 (EU citizens); EU Regulations 883/2004, 988/2009, 1231/2010 on social security coordination.
- D.P.R. 394/1999 (Regolamento attuativo TUI) delegates specific mechanisms for providing medical assistance to regions.
- Objective: to eliminate regional discrepancies in access to medical assistance for foreigners (identified in a 2008 study).
- Obliges regions to compile all regulations on medical assistance to foreigners into a single operational tool.
- OCR quality is average - text is machine-translated from PDF (pdf-ocr).
- Unanimously adopted by the state, regions, and autonomous provinces.
Key provisions of the document
Quotes from the Italian original with an unofficial translation. The 2012 text of the agreement; contribution amounts and some procedures have changed since - check against the official source.
Who must enrol in the SSN (art. 34 of the Testo Unico)
“Hanno l'obbligo di iscrizione al servizio sanitario nazionale e hanno parità di trattamento e piena uguaglianza di diritti e doveri rispetto ai cittadini italiani per quanto attiene all'obbligo contributivo, all'assistenza erogata in Italia dal servizio sanitario nazionale e alla sua validità temporale: a) gli stranieri regolarmente soggiornanti che abbiano in corso regolari attività di lavoro subordinato o di lavoro autonomo o siano iscritti nelle liste di collocamento; b) gli stranieri regolarmente soggiornanti o che abbiano chiesto il rinnovo del titolo di soggiorno, per lavoro subordinato, per iavoro autonomo, per motivi familiari, per asilo politico, per asilo umanitario, per richiesta di asilo, per attesa adozione, per affidamento, per acquisto della cittadinanza”."They are required to register with the national health service and have equal treatment and full equality of rights and duties with Italian citizens regarding the obligation to contribute, the assistance provided in Italy by the national health service, and its temporal validity: a) foreigners legally residing who are engaged in regular subordinate work activities or self-employment or are registered in the employment lists; b) foreigners legally residing or who have applied for the renewal of the residence permit, for subordinate work, for self-employment, for family reasons, for political asylum, for humanitarian asylum, for asylum request, for awaiting adoption, for custody, for acquisition of citizenship."
SSN enrolment before the first permesso is issued
In tutti i casi in cui il cittadino straniero sia in attesa di primo rilascio di permesso di soggiorno per uno dei motivi che determinano il diritto all'iscrizione obbligatoria al SSR, si procede all'iscrizione temporanea sulla base della documentazione attestante l'avvenuta richiesta del permesso di soggiorno, ivi compresi coloro che hanno fatto domanda di regolarizzazione o emersione dal lavoro nero.In all cases where a foreign citizen is awaiting the first issuance of a permesso di soggiorno for one of the reasons that determine the right to mandatory registration with the SSR, temporary registration is carried out based on the documentation proving the request for the permesso di soggiorno, including those who have applied for regularization or emergence from undeclared work.
Enrolment stays valid during renewal
L'iscrizione al SSR è valida dalla data di ingresso fino alla scadenza del permesso di soggiorno e non decade nella fase di rinnovo del permesso di soggiorno stesso in base alla norma del salvo buon fine e nell’ottica della continuità assistenziale”.Registration with the SSR is valid from the date of entry until the expiration of the permesso di soggiorno and does not lapse during the renewal phase of the permesso di soggiorno itself according to the salvo buon fine rule and with the aim of ensuring continuity of care."
Stays shorter than three months
Agli stranieri non appartenenti all’UE regolarmente soggiornanti sul territorio nazionale per periodi inferiori ai tre mesi (visto per turismo, visita, affari, ecc.), non tenuti all'iscrizione obbligatoria né iscrivibili volontariamente al SSR, vengono assicurate nelle strutture sanitarie tutte le prestazioni, urgenti e di elezione. Le cure urgenti (in regime ambulatoriale, di ricovero o di day hospital) vengono prestate immediatamente; il pagamento avviene al momento delle dimissioni del paziente.Non-EU foreigners legally residing on national territory for periods of less than three months (visa for tourism, visit, business, etc.), who are not required to register and cannot voluntarily register with the SSR, are provided with all urgent and elective medical services in healthcare facilities. Urgent care (in outpatient, inpatient, or day hospital settings) is provided immediately; payment is made at the time of the patient's discharge.
Without a permesso: the STP code
Gli Stranieri Temporaneamente Presenti, STP, sono coloro che, non essendo in regola con il permesso di soggiorno, non sono di norma iscrivibili al SSR. Per costoro la legge prevede: “Agli stranieri non in regola con le norme relative all'ingresso e al soggiorno sono assicurate, nei presidi pubblici ed accreditati, le cure ambulatoriali ed ospedaliere urgenti o comunque ESSENZIALI, ancorché continuative, per malattia ed infortunio e sono estesi i programmi di medicina preventiva a salvaguardia della salute individuale e collettiva”.Foreigners Temporarily Present, STP, are those who, not being in compliance with the permesso di soggiorno, are generally not eligible for registration with the SSR. For them, the law provides: "Foreigners not in compliance with the rules regarding entry and stay are assured, in public and accredited facilities, urgent or otherwise ESSENTIAL outpatient and hospital care, even if continuous, for illness and injury, and preventive medicine programs are extended to safeguard individual and collective health."
Related materials
Reference documents
- Decree of the Ministry of Foreign Affairs of Italy of May 11, 2011 - Types of Visas and Requirements
- Directive of the Ministry of Interior of Italy on the Rights of Foreigners During the Waiting Period for Permesso Renewal (August 2006)
- Price List: Urgent Request for Criminal Record Certificate with Apostille from Russia
- Press Release EC: Complete Suspension of Visa Facilitation Agreement with Russia (September 2022)
- Table of Credits for the Integration Agreement (Annex B, Regulation 2011)
- Circular of the Italian Ministry of Interior: Exit and Re-entry with Expired permesso di soggiorno (2010 + 2016)
A real document from community materials. Not legal advice - verify the official blank and current requirements on the authority site (esteri.it, interno.gov.it, portaleimmigrazione.it, questure.poliziadistato.it).