Italy: Health Insurance

Overview

If you’re visiting or living or working in Italy, it’s extremely risky not to have health insurance for your family; if you’re uninsured or under-insured, you could be faced with some very high medical bills. When deciding on the type and extent of health insurance, make sure that it covers all your family’s present and future health requirements in Italy before you receive a large bill. A health insurance policy should cover you for all essential health care whatever the reason, including accidents (e.g. sports accidents) and injuries, whether they occur in your home, at your place of work or while travelling. Don’t take anything for granted, but check in advance. When travelling in Italy, you should carry proof of your health insurance with you.

Visitors

Visitors spending short periods in Italy (e.g. up to a month) should have a travel health insurance policy, particularly if you aren’t covered by an international health policy, although you may be covered by a reciprocal agreement between your home country and Italy (see below). If you plan to spend up to six months in Italy, you should either take out a travel policy, a special long-stay policy or an international health policy.

Reciprocal Health Agreements

If you’re entitled to social security health benefits in another EU country or in a country with a reciprocal health agreement with Italy, you will receive free or reduced cost emergency medical treatment in Italy. Participating countries include all EU member states and most other European countries, excluding Albania, Switzerland and Turkey. The US doesn’t have a reciprocal health agreement with Italy, so American students and other Americans who aren’t covered by the Italian national health service must have private health insurance in Italy.

EU residents must apply for a certificate of entitlement to treatment (form E111) at their local social security office (usually around three weeks before they plan to travel to Italy). An E111 is open-ended and valid for life; however, you must continue to make social security contributions in the country where it was issued and, if you become a resident in another country (even another EU country), it becomes invalid. An E111 covers emergency hospital treatment but doesn’t include prescribed medicines, special examinations, X-rays, laboratory tests, physiotherapy and dental treatment. If you use an E111 in Italy, you must apply for reimbursement to Italian social security (instructions are provided with the form), which can take months.

You can still get a large bill from an Italian hospital, as your local health authority assumes only a percentage of the cost.

British visitors or Britons planning to live in Italy can obtain information about reciprocal health treatment in Italy from the Department of Social Security, Pensions and Overseas Benefits Directorate, Newcastle-upon-Tyne, NE98 1BA, UK (0191-218 7777, www.dwp.gov.uk).

Residents

If you’re planning to take up residence in Italy, your family will be entitled to subsidised or free medical treatment under the National Health Service or Servizio Sanitario Nazionale (SSN). The SSN provides hospital accommodation and treatment (including tests, surgery and medication during hospitalisation), visits to family doctors (GPs), specialist medical assistance provided by paediatricians, obstetricians and other specialists, discounted medicines, laboratory services, appliances, ambulance services and free services at a local health unit (consultorio).

If you qualify for health care under the SSN, your dependants will receive the same benefits and will be listed on your membership card. Dependants include your spouse (if she isn’t personally insured), your children under 16 (or 26 if they’re students or unable to work through illness or invalidity); and ascendants, descendants and relatives by marriage supported by you and living in the same household.

Many residents also have a private health insurance policy (assicurazione sulla salute), which pays the portion of medical bills that isn’t paid by SSN.

If you aren’t entitled to public health benefits, you should have private health insurance, which may be mandatory for non-EU residents when applying for a visa or residence permit.

Some foreign health insurance policies may not provide sufficient cover to satisfy the authorities, so you should check the minimum cover necessary with a Italian consulate in your country of residence.

If you’re a retired EU national planning to live permanently in Italy, you need form E121. EU citizens who retire before qualifying for a state pension can receive free health cover for two years by obtaining form E106 from their country’s social security department. If the temporary cover expires before you reach retirement age, you must make voluntary social security contributions or take out private health insurance. For more information see Living and Working in Italy (Survival Books).

Private Health Insurance

Italian Companies

Most Italian health insurance policies don’t pay family doctors’ fees or pay for medication that isn’t provided in a hospital, or charge an excess (deductible), e.g. the equivalent of around €80 for each ‘illness’, which may exceed the cost of treatment. Most, however, pay for 100 per cent of specialists’ fees and hospital treatment in the best Italian hospitals. Private policies vary considerably in price but generally cost from €1,300 to €2,000 per year for a family of four, although costs are higher for the elderly. Many companies, retirement groups and other organisations offer lower group rates.

You should avoid a company that reserves the right to cancel (recesso or facoltà di rescissione) a policy unilaterally when you have a serious illness or when you reach a certain age (shown as età massima assicurabile – ‘maximum insurable age – in policies), as it will prove difficult or impossible to find alternative cover. You should also steer clear of a one-year contract, which a company can refuse to renew. Policies often have a period (e.g. five years) during which the insurance company cannot exclude you from cover (rinuncia alla diritto di recessione), even if you have a serious illness costing the insurance company a lot of money.

The largest insurers in Italy include the National Insurance Institute (Instituto Nazionale delle Assicurazioni/INA), formerly state-owned but now privatised, Europa Assistance, Filo Diretto, Pronto Assistance and Sanicard. Shop around and compare policies, which vary considerably, from good to terrible!

Most Italian polices are supplementary policies for residents who are covered by the national health service, and aren’t intended for foreigners who aren’t covered by the SSN and are seeking a comprehensive health policy.

As in many countries, Italian insurance companies are loath to pay claims (one of the reasons they don’t insist on a medical examination is so that they can refuse to pay a claim because you omitted to tell them you had a heavy cold three years previously). When completing the questionnaire (questionario sanitario) be sure to list ALL previous illnesses, hospitalisation, current ailments and treatment.

Foreign Companies

There are a number of foreign health insurance companies with agents or offices in Italy, including AXA PPP Healthcare, Baltica (Denmark), BUPA International, Columbus Healthcare, Exeter Friendly Society and International Health Insurance (Denmark). These companies offer special policies for expatriates and usually include repatriation to your home country and international cover.

The main advantages of a foreign health insurance policy are that treatment is unrestricted and you can choose any doctor, specialist, clinic or hospital in Italy, and usually abroad as well. A policy may also pay for repatriation of your body for burial in your home country.

Premiums vary considerably and it’s important to shop around. Most international health policies include repatriation or evacuation (although it may be optional), which may also include shipment (by air) of the body of a person who dies abroad to his home country for burial. An international policy also allows you to choose to have non-urgent medical treatment in the country of your choice.

Most international insurance companies offer health policies for different areas, e.g. Europe, world-wide excluding North America, and world-wide including North America. Most companies also offer different levels of cover, e.g. basic, standard, comprehensive and ‘prestige’. There’s always a limit on the total annual medical costs, which should be at least €300,000 (although many companies provide cover of up to €1.2 million) and some companies limit the charges for specific treatment or care such as specialists’ fees, operations and hospital accommodation. A medical examination isn’t usually required for international health policies, although ‘pre-existing’ health problems are excluded for a period, e.g. two years.

Claims are usually settled in major currencies and large claims are usually settled directly by insurance companies (although your choice of hospitals may be limited). Always check whether an insurance company will settle large medical bills directly; if you’re required to pay bills and claim reimbursement from an insurance company, it can take several months before you receive your money (some companies are slow to pay). It isn’t usually necessary to translate bills into English or another language, although you should check a company’s policy. Most international health insurance companies provide emergency telephone assistance.

The cost of international health insurance varies considerably with your age and the extent of cover. With most international policies, you must enrol before you reach a certain age (usually between 60 and 80) to be guaranteed continuous cover in your old age. Premiums can sometimes be paid monthly, quarterly or annually, although some companies insist on payment annually in advance. When comparing policies, carefully check the extent of cover and exactly what’s included and excluded from a policy (often indicated only in the very small print), in addition to premiums and excess charges. In some countries, premium increases are limited by law, although this may apply only to residents in the country where a company is registered.

Although there may be significant differences in premiums, generally you get what you pay for and can tailor premiums to your requirements. The most important questions to ask yourself are: does the policy provide the cover required and is it good value? If you’re in good health and are able to pay for your own outpatient treatment, such as visits to your family doctor and prescriptions, the best value is usually a policy covering only specialist and hospital treatment.

If you have existing private health insurance in another country, you may be able to extend it to include Italy. If you already have a private health insurance policy, you may find you can save a substantial amount by switching to another company without losing any benefits (you may even gain some). To compare policies, it’s best to visit an insurance broker offering policies from a number of companies.

Changing Employers Or Insurance Companies

When changing employers or leaving Italy, you should ensure that you have continuous health insurance. If your family is covered by a company health scheme, your insurance will probably cease after your last official day of employment. If you’re planning to change your health insurance company, you should ensure that important benefits aren’t lost; for example, existing medical conditions won’t usually be covered by a new insurer for a period. When changing health insurance companies, it’s wise to inform your old company if you have any outstanding bills for which they are liable.

© Survival Books Limited 2003

“Buying a Home in Italy” 3rd Edition, David Hampshire.

Reproduced with the permission of Survival Books Limited.

Further information on this topic can be found in “Buying a Home in Italy” 3rd edition, by David Hampshire.

For extensive information about buying a property in Italy, you can purchase this book at www.survivalbooks.net