Do I have to renew the Elective Residence permit, and how often?

The Elective Residence Visa leads to a residence permit (permesso di soggiorno) that is not permanent. It must be renewed in Italy, usually on a yearly basis at first, by showing that you still satisfy the conditions that got you in.

At each renewal you generally need to prove that your passive income remains sufficient and that you still hold valid comprehensive health insurance. If your financial situation changes or your insurance lapses, renewal can be refused, so maintaining the original qualifying conditions throughout your stay is important.