HEALTH CARE WHILE STUDYING IN ITALY
It has always been the policy of the Italian government to guarantee free health care coverage for everyone, regardless of any individual’s financial capabilities or immigration status.
Such assistance is regulated by international conventions. International students are guaranteed coverage for the expense of health care in two different ways, depending, in other words, upon whether or not the student in question comes from a European Union member state.
European Union students
In general, all holders of a European Health Insurance Card (EHIC, or TEAM in Italian) issued in the country of origin are entitled to make use of those health services previously listed by E111 and E128 forms. The EHIC (or a provisional replacement certificate) allows students on a temporary stay in Italy to receive “medically necessary” treatment (and not only emergency treatment as previously assured by the E111 form). Students may go directly to a General Practitioner who works with the National Health Service (SSN, in Italian), and who will provide generic health care and, if necessary, prescribe treatment by specialists, requesting moreover reimbursement from the relevant institution abroad through the Local Health Authority (ASL, in Italian). For a list of doctors working with the National Health Service (SSN), students should contact the Local Health Authority (ASL).
Holders of an E106 form (the expiration of which is determined by the length of the course of study) have the right to register with the National Health Service (SSN) and, therefore, to partake of complete health care by showing the aforementioned form to the Local Health Authority (ASL) along with documentation to verify their enrollment in the university course.
With specific regard to citizens of European Union member states, Italian Law further makes the distinction between three different situations:
1. Citizens of European Union member states who stay in Italy for less than three months
Citizens of European Union member states who stay in Italy for less than three months need not register with the National Health Service (SSN). A European Union member state citizen in need of medical assistance may go directly to the public health facilities to request the required treatment. (If the care requires payment, the patient must pay the appropriate “ticket” in order to receive assitance.) The EU member state citizen must present his or her European Health Insurance Card (EHIC, or TEAM in Italian) to the health care facility, for it is this card that demonstrates the holder’s entitlement to urgent and necessary care during a temporary stay in a European Union member state. In the event that the EU member state citizen does not possess a European Health Insurance Card, he or she must be the holder of some other form of health coverage (e.g., private insurance) in order to receive health assistance. In the event that he or she has neither a European Health Insurance Card nor some alternative form of coverage, a EU member state citizen will have the right only to urgent and necessary forms of care, treatment to protect the health of minors, maternity treatment and treatment for the voluntary interruption of pregnancy as well as the right to vaccinations and to the cure and prophylaxis of infectious disease.
2. Citizens of European Union member states who stay in Italy for more than three months
Citizens of European Union member states who stay in Italy for more than three months either must possess health insurance or must be registered with the National Health Service (SSN). The right to registration applies to people employed by Italian citizens, and to members of the employees’ family. The right to registration also applies to people seconded to work in Italy by companies from other European countries (and to members of their families), to pensioners (and to members of their families) from other EU states and resident in Italy, to the family members of foreign workers employed by another Member State and resident in Italy (holders of E106, E109, E120 or E121 forms). In order to request registration, EU citizens may go directly to the Local Health Authority (ASL) with a declaration of residence within the territorial jurisdiction of that Local Health Authority and with a valid Identification Document. Depending on the circumstances of each individual case, documents shall be required to verify the eligibility of each European citizen (for example, a worker must present a copy of his or her work contract). Other situations, too, may determine the right to register with the National Health Service (SSN), as may be the case, for example, of workers for international organizations with headquarters in Italy.
3. Citizens of European Union member states who, though staying in Italy, do not meet the requirements for registration with the National Health Service (SSN) and who are indigent and unable to obtain health care coverage
European citizens who do not meet the requirements for registration with the National Health Service (SSN) and do not have health care coverage (i.e., without health insurance or a European Health Insurance Card) do still have the right to urgent and necessary treatment. A circular issued by the Ministry of Health (dated 19 February 2008) specifies that “European Union citizens have the right to urgent, non-deferable treatment.” In order to receive such treatment, the European citizen must be identified, and thus must present a valid Identification Document. Because of the identification of the foreigner, the Italian government will then be able to apply to the foreigner’s home country in order to request reimbursement for the expenses incurred by the health care provided. Subsequent, therefore, to the foreigner’s presentation of a passport and of a declaration of domicile within the Region by means of completing the appropriate form, a special card shall be issued to the European citizen indicating a code—the Non-Registered European code (in Italian, E.N.I., for Europeo Non Iscritto). This card shall be valid for six months and is renewable. The card with the Non-Registered European code is issued by the Local Health Authority (ASL) or by the Hospital. The Non-Registered European code may be used only within the region, because it is issued under the authority of the region. The Non-Registered European code entitles the holder to receive those forms of treatment indicated by the Ministry of Health’s circular and, in any case, urgent, necessary and non-deferable treatment.
Students from non-European Union countires
Citizens of non-European Union countries staying in Italy with all necessary permits may choose, regardless of the length of their stay, between two forms of health coverage:
Public coverage offered by the National Health Service (SSN)
This coverage provides complete health care—including the right to choose a General Practitioner (*)—subject to the payment of a fee of 149.77 Euros per calendar year, meaning until 31 December of the year in which the payment is made. To obtain this coverage, students should apply to the Local Health Authority (ASL) and follow all necessary procedures.
Private insurance (purchased directly from an insurance company)
In this case students may choose to purchase a health insurance policy with an Italian insurance company upon their arrival in Italy, or previously from an insurance company within their home country. If arriving in Italy with coverage from a company in a different country, students should first verify that health care agreements are in effect between their home country and Italy. In any case, it is always advisable that all insurance documentation first be reviewed at an Italian Embassy.
(*) Within the Italian health care system, the General Practitioner (in Italian, medico di base, or medico di famiglia) serves to provide generic and first-level health care, meaning not within the hospital, such health care, therefore, in treatment of ordinary, non-emergency illness. The General Practitioner may prescribe drugs, request tests, and recommend consultation with specialists.