Health Insurance in San Marino: A Guide for Foreign Workers

San Marino, the small republic enclaved within Italy, runs its own national health service through a single body that also handles pensions and social security. Registered residents get comprehensive care, and private-sector employees and most self-employed people are compulsorily insured with it. Because the republic is tiny and surrounded by Italy, its system works hand in hand with Italian hospitals for the most complex care. For a foreign worker, the route in is residence and employment. This guide explains how the system works, what it covers, what it costs, and what foreign workers and professional drivers need, including how cover ties in with residence. San Marino is not in the European Union, but it uses the euro by agreement, which keeps prices familiar to European arrivals.

The short version: healthcare is run by the Institute for Social Security, which provides comprehensive care to all registered residents and also administers pensions and welfare. It is funded mainly through general taxation and the national budget, alongside social contributions. The State Hospital handles general medicine, surgery and most specialists, while complex cases go to nearby Italian hospitals. There are out-of-pocket charges for care and medicines outside the state package. Crucially, taking up residence requires private health insurance covering costs in both San Marino and Italy.

How health insurance in San Marino works

San Marino uses a tax-funded national health service run by the Institute for Social Security, which provides comprehensive healthcare to all registered residents and also administers pensions and welfare. It operates under the Secretariat of State for Health and Social Security, the equivalent of a ministry of health, which, together with the Council of Health, is responsible for planning, financing, and providing care. Funding comes mainly from general taxation and the national budget, alongside social contributions. All private-sector employees and most self-employed people are compulsorily insured with the Institute. The main facility is the State Hospital, which handles general medicine, surgery, and most specialist consultations; for highly complex cases, the republic relies on nearby Italian hospitals, so residents effectively have access to Italy’s wider healthcare infrastructure.

The types of cover you will come across.

A few kinds of cover sit side by side in San Marino. The national health service through the Institute for Social Security is the public layer for registered residents. Private health insurance is taken out for faster access, for care not covered by the state, and — importantly — it is required to take up residence, covering costs in both San Marino and Italy. International health insurance covers you inside San Marino, in Italy and further afield. Travel insurance is short-term cover for visitors only. Because San Marino is not in the European Union but cooperates with the European healthcare framework, European Union citizens arriving before they register as residents can use the European Health Insurance Card for emergency and necessary treatment, after which residence brings them into the Institute’s system.

Who actually needs health insurance?

The Institute covers registered residents for Social Security, and all private-sector employees and most self-employed people are compulsorily insured with it, so for a foreign worker the route in is residence and employment. The catch for newcomers is that taking up residence in the first place requires private health insurance covering all medical costs in both San Marino and Italy, as a condition of the application, before the Institute’s cover applies. European Union citizens can use the European Health Insurance Card for emergency and necessary care during a temporary stay before registering. Family members are covered within the social-security framework. The clearest message for a newcomer is that the public cover follows residence and employment, but you need private insurance to get residence in the first place.

What the public system covers

For registered residents, the Institute provides comprehensive care: general medicine, surgery, most specialist consultations, hospital treatment, emergency care and maternity care, centred on the State Hospital. Because the republic is small, the system is closely integrated with Italy. For highly complex cases or procedures needing specialist equipment, residents are treated in Italian hospitals in nearby cities, with the Institute cooperating with the Italian health service. The main out-of-pocket charges are for inpatient and outpatient care not generally covered by the state, and for medicines that are not on the reimbursable list or are sold to foreigners and tourists. Emergency care is provided through the system. The compactness of the republic means routine care is local and personal, while the most specialised treatment draws on Italy’s larger hospitals.

What it costs

For employees there is no separate health premium — the public service is funded mainly through general taxation and the national budget, with compulsory social contributions to the Institute alongside, deducted in the usual way. Once you are a registered resident, comprehensive care is provided, with out-of-pocket charges for care outside the state package and for non-reimbursable medicines. On top of the public system, private insurance costs more and is in any case required to take up residence. In contrast, comprehensive international plans cost more still, depending on age and benefits. All amounts are in euros, which San Marino uses by agreement despite being outside the European Union. The cost to budget for is the private insurance needed for residence, covering both San Marino and Italy.

Why do most foreign workers add private cover?

For San Marino, private cover is not only about speed and comfort—it is a requirement for taking up residence, covering medical costs in both the republic and Italy. Beyond that, private or international cover buys faster access, treatment not covered by the state, and continuous care across the border in Italian private hospitals. International plans add medical evacuation and cover further afield. When you compare policies, the key checks for San Marino are that the policy explicitly covers costs in both San Marino and Italy as required by residence, plus the benefits for a hospital stay, the outpatient and dental limits, any waiting periods, and whether pre-existing conditions are excluded. Because the republic leans on Italian hospitals for complex care, cross-border cover is especially valuable here.

Health insurance for your residence permit

This is the heart of the matter for newcomers. Taking up residence in San Marino requires valid private health insurance covering all medical costs in both San Marino and Italy, as a standard condition of the application, alongside proof of income, accommodation and a clean criminal record. Applications are submitted to the Foreign Office of the Gendarmerie in the City of San Marino, which handles residence permits and stay authorisations, with the residence framework overseen by the Secretariat of State for Foreign Affairs; there is also an investor route. After approval, you register at the civil registry to obtain a San Marino identity card, and your compulsory cover with the Institute for Social Security follows. Because the rules are specific and can change, always confirm the current requirements with the Sammarinese authorities before you apply.

Health insurance for truck and transport drivers

Professional drivers carry more health risk than most workers — long hours at the wheel, time away from home and the constant risk of a road accident. San Marino is tiny and landlocked within Italy, so professional driving here is inseparable from Italy: routes immediately cross into the surrounding Italian provinces and on towards the Adriatic coast, Rimini and beyond. Because the republic’s own hospital handles general cases and complex care is given in Italy, cross-border cover matters: check on-road emergency cover in both San Marino and Italy, accident and injury cover including hospitalisation and rehabilitation, and the occupational-health provisions for the medical examinations a professional licence requires. A policy that covers both San Marino and Italy — as residence requires in any case — is the practical answer for drivers here.

Using your insurance day to day

Day to day, registered residents use the Health Centre and the State Hospital for routine and specialist care, with an online service for prescriptions and some requests. For complex treatment, you may be referred to an Italian hospital nearby, with the Institute coordinating cross-border care. You pay out-of-pocket charges for care outside the state package and for non-reimbursable medicines. If you hold private or international cover, you book through your insurer’s network. In an emergency, call 112, the European emergency number, or 113. Because the republic is small and Italian-speaking, Italian is the language of care, and the close ties with Italy mean the Italian hospitals of the surrounding region are part of everyday healthcare for residents who need specialised treatment.

Choosing a private insurer

For private or international cover in San Marino, the single most important check is that the policy covers medical costs in both San Marino and Italy, since residence requires exactly that and since complex care is given in Italy. Confirm the benefits for a hospital stay on both sides of the border, the outpatient and dental limits, and whether Italian private hospitals are in the network. Read the exclusions line by line—pre-existing conditions are a common gap—and check the waiting periods that apply to planned treatment and maternity. If you travel more widely, make sure cover extends beyond San Marino and Italy. Compare any policy with cover your employer may provide. No insurer is singled out on this page; the purpose is honest advice so you can make your own choice.

For professional drivers in San Marino

If you are relocating to drive in San Marino, arrange the private health insurance covering both San Marino and Italy that residence requires, register at the civil registry, and your compulsory cover with the Institute for Social Security follows. Every employer on our platform complies with Sammarinese labour and social security law, including the contributions that connect you to the public system.

• Browse driver vacancies in San Marino.
• Register a driver profile.
• For employers — guidance on employment package requirements

Health insurance by San Marino municipality

San Marino is divided into nine municipalities, known as castelli, and the rules are the same in each — comprehensive cover for registered residents, private cover on top. The whole republic is small, so the State Hospital and the Health Centre serve everyone. Here is the picture municipality by municipality.

Città di San Marino

The capital, the historic city on Monte Titano and the seat of government, home to the Foreign Office that handles residence. Driver jobs in Città di San Marino.

Serravalle

The most populous municipality and the republic’s commercial and industrial centre, the main base for business and logistics. Driver jobs in Serravalle.

Borgo Maggiore

The municipality below the capital, home to the State Hospital and the Institute for Social Security at Cailungo, the heart of the health system. Driver jobs in Borgo Maggiore.

Domagnano

A central municipality on the main road through the republic, served by the national health service and the State Hospital nearby. Driver jobs in Domagnano.

Fiorentino

A southern municipality served, like the whole republic, by the State Hospital and the national health service. Driver jobs in Fiorentino.

Acquaviva

A western municipality close to the Italian border, served by the national health service and the State Hospital. Driver jobs in Acquaviva.

Faetano

An eastern municipality near the Italian border, served by the national health service and the State Hospital. Driver jobs in Faetano.

Chiesanuova

A small south-western municipality near the Italian border, served by the national health service and the State Hospital. Driver jobs in Chiesanuova.

Montegiardino

The smallest municipality by population, in the south-east, served by the national health service and the State Hospital. Driver jobs in Montegiardino.

Related guides

• Health insurance in Europe — overview
• San Marino residence permit guide
• Sammarinese citizenship guide

Official government sources

• Institute for Social Security (ISS) — the national health service.
• Secretariat of State for Health and Social Security — health policy.
• Secretariat of State for Foreign Affairs — the residence framework.
• Government of San Marino — public administration and online services.
• Central Bank of San Marino — currency and the euro.

Information only — not legal, medical or insurance advice. Rules, covered services and residence requirements can change. Always confirm current details with the official Sammarinese authorities above before you act.