Healthcare Co-pay Exemption Based on Income in Rome: Codes E01, E02, E03, E04

In a nutshell

If your household income is low, you are unemployed, under 6 or over 65 in a low-income family, or you receive a social allowance or minimum pension, you are entitled to free specialist visits and tests — no co-pay. The exemption is identified by a code starting with the letter E: E01, E02, E03 or E04. In many cases it is applied automatically, with no action needed on your part.

At a glance

Cost	Free (no charge to apply)
Timeline	Card issued the same day at the counter; automatic exemption requires no visit
Where in Rome	CUP/enrolment counter at the ASL serving your Municipio
Documents	Photo ID, Tessera Sanitaria (Italian health-insurance card), self-declaration of income (+ DID for E02 or pension slip for E03/E04)

The four codes explained

Each code covers a specific situation. Income thresholds refer to the total household income in the previous year (in 2026, the relevant year is 2024).

Code E01 — Children and elderly in low-income households You qualify for E01 if you are under 6 or over 65 and the combined gross income of your entire household does not exceed €36,151.98 per year. All household members are included: the main earner, the spouse, and dependent children.

Code E02 — Unemployed You qualify for E02 if you have lost a previous job, you are registered at the Centro per l'Impiego (public employment office) with an active DID (Dichiarazione di Immediata Disponibilità — a formal declaration of immediate availability for work), and the household income does not exceed €8,263.31/year if you live alone, or €11,362.05/year if you have a dependent spouse. Add €516.46 for each dependent child. The exemption extends to fiscally dependent family members.

Code E03 — Social allowance recipients If you receive an assegno sociale from INPS (Italy's social-security agency) — formerly called the pensione sociale — you qualify for E03 with no further income requirement. The exemption extends to fiscally dependent family members.

Code E04 — Minimum-pension recipients over 60 If you receive the minimum guaranteed INPS pension, you are over 60, and your household income stays within the same thresholds as E02 (€8,263.31 or €11,362.05 + €516.46 per dependent child), you qualify for E04. It extends to dependent family members.

Code	Base threshold	With dependent spouse	Per dependent child
E01	€36,151.98 (entire household)	single household threshold	—
E02	€8,263.31	€11,362.05	+ €516.46
E03	no threshold	—	—
E04	€8,263.31	€11,362.05	+ €516.46

These thresholds are set by Legge 537/1993 and Legge 350/2003 and are not indexed to inflation — they apply unchanged for 2026.

When it's automatic — no action needed

The Sistema Tessera Sanitaria (managed by the Ministry of Economy) cross-references data from INPS, Agenzia delle Entrate (Italy's tax-revenue agency), and ANPR (Anagrafe Nazionale — national civil registry database). If you meet the requirements, the exemption appears automatically on the digital prescription when your doctor issues it. You do not need to visit a counter.

You can check your exemption status:

• With the SaluteLazio app (login with SPID — Italy's digital identity for accessing online public services — or CIE, the Italian electronic ID card)
• On the Sistema TS portal at sistemats.it
• At the CUP counter by asking for a "verifica esenzione" (exemption check)

When you need to apply in person

If you do not appear as automatically exempt, go to the CUP counter at the ASL health district of your registered residence with:

• Photo ID (Italian ID card, passport, or permesso di soggiorno — residence permit — for non-EU citizens)
• Tessera Sanitaria
• Self-declaration (autocertificazione) of income requirements (form available on your ASL's website or at salutelazio.it)
• For E02: copy of the DID issued by the Centro per l'Impiego
• For E03/E04: copy of the INPS pension slip showing the type of pension

The self-declaration has full legal weight under DPR 445/2000. The ASL may carry out spot-checks within 5 years; false declarations carry criminal consequences (art. 76 DPR 445/2000).

The card is issued the same day. It is valid until 31 December of the current year and must be renewed by 31 March of the following year.

Where to go in Rome

Go to the health district of the ASL covering your Municipio of residence:

ASL	Municipio	Main office	Phone
Roma 1	I, II, III, XIII, XIV, XV	Borgo S. Spirito 3	06 68351
Roma 2	IV, V, VI, VII, VIII, IX	Via Filippo Meda 35	06 41434001
Roma 3	X, XI, XII	Via Casal Bernocchi 73	06 56487

CUP/enrolment counters are generally open Mon–Fri 8:00–12:30, with some afternoon hours (Tue/Thu 14:30–16:30). Check current hours on your ASL's website: aslroma1.it, aslroma2.it, aslroma3.it.

Mistakes to avoid

1. The income-based exemption does not cover medications. It applies only to specialist visits, tests, and diagnostic services. Prescriptions have a separate cost-sharing scheme — full exemption does not apply to drugs except in specific cases such as E03.
2. You can't choose your code. The exemption is assigned based on your actual circumstances. You cannot request a code other than the one you are entitled to.
3. Don't pay anyone to "get it faster". The exemption is free and issued the same day at the ASL. There are no legitimate paid intermediaries.
4. Don't miss the 31 March renewal deadline. If you don't renew your self-declaration in time, you will pay the full co-pay from April until you complete the renewal.
5. If you find work, notify your ASL immediately. Using the exemption after you no longer qualify is a criminal offence (fraud against the state, art. 640-bis of the Penal Code).

Special cases

You also have a condition-based exemption? The exemptions stack. For oncological services you will use code 048; for other care you may use E02 (or whichever code applies to you). The Sistema TS selects the right one automatically.

Non-EU resident with a permesso di soggiorno? You have full entitlement to exemptions E01–E04 on the same terms as Italian citizens, provided you are validly enrolled with the SSN in Lazio.

Asylum seeker? You will be assigned code X01, which is equivalent to E02 for co-pay purposes.

Foreign student enrolled voluntarily with the SSN? You are not entitled to exemptions E01–E04 because you do not appear in the Italian INPS/Agenzia delle Entrate data systems. You pay the full co-pay.

Who counts as a "dependent family member"? A family member is fiscally dependent if their own income is below €2,840.51/year (€4,000/year if they are a child under 24). Only in that case does the main holder's exemption extend to them.

Official sources

• Salute Lazio — Ticket and exemptions
• Ministry of Health — Income-based exemptions
• Ministry of Health — Exemption codes
• Sistema Tessera Sanitaria
• Lazio Region — Health
• ASL Roma 1 · ASL Roma 2 · ASL Roma 3

Legal references: Legge 537/1993 art. 8 c. 16; Legge 289/2002 art. 52 c. 4; Legge 350/2003 art. 4; DM 22/01/1993; DM 11/12/2009; DPR 445/2000; DPCM 12/01/2017; DGR Lazio 257/2007.