How the SSN works
The Servizio Sanitario Nazionale covers residents in Italy and is funded through general taxation and co-payments. Each region organises care through its ASL, and access is proven with the tessera sanitaria, the health card issued together with the codice fiscale.
A practical detail: the Italian tessera sanitaria works as a European Health Insurance Card during temporary stays in another EU country. But to reside in Italy the Spanish card is not enough; you need your own registration in the SSN.
Your subsidiary's employees
Anyone employed by others has compulsory, free registration in the SSN. Registration is processed with hiring: the employer declares the worker to INPS and, with that declaration, the employee can register with the ASL of their comune of residence and choose a medico di base, the equivalent of a GP.
Dependent family members residing with the worker are covered as carichi familiari: they are registered alongside the holder and pay nothing for it. Registration lasts as long as the employment situation or residence permit, and is renewed with them.
Self-employed workers and non-employed partners
Self-employed workers with regular activity in Italy also have compulsory registration, funded through their INPS contributions. An SRL partner without a contract who resides in Italy registers as general population, with the same coverage.
For those who do not fit compulsory registration, there is voluntary registration, which must be paid for: students, au pairs or holders of elective residence. The annual contributo forfettario is around EUR 2,000 for incomes up to EUR 31,925, reduced to EUR 700 for students and EUR 1,200 for au pairs, and for other cases it is calculated on income with a minimum of EUR 2,000.
Newly arrived foreigners
An EU citizen who arrives to work registers with the contract and tax code, with no waiting or qualifying periods. Those who enter with a work permit or through family reunification have the same right. Without a residence permit, care is limited to basic and emergency care (the STP regime), with no right to a tessera sanitaria.
While registration is being processed, the Spanish European Health Insurance Card covers temporary stays and serves as a bridge during the first few weeks.
When private insurance makes sense
Private insurance is necessary when there is no right to the SSN: for example, a partner who lives in Spain and travels to Italy occasionally, or an employee in the days before registration. It is also used as a complement to avoid waiting lists for specialists, with policies covering agreed private healthcare.
For the company, the practical decision is to wait until compulsory registration is active before taking out private cover: paying for both at once is almost never worthwhile.
