Registration with the Italian National Health Service (SSN) for Expats – Costs, Procedures, Regulations

Agreement, pursuant to Article 4 of the Legislative Decree of 28 August 1997, n. 281, between the Government, the Regions and the Autonomous Provinces of Trento and Bolzano on the document containing: ‘Indications for the correct application of health care legislation to the foreign population by the Regions and Autonomous Provinces’. (Rep. Atti n. 255/CSR). (13A00918)  (OJ no. 32 of 7-2-2013 – Ordinary Supplement no. 9)

THE PERMANENT CONFERENCE FOR RELATIONS BETWEEN THE STATE, THE REGIONS AND AUTONOMOUS PROVINCES OF TRENTO AND BOLZANO At today’s sitting of 20 December 2012: Having regard to the delegation conferred on the Chairman of today’s sitting to the Undersecretary of State to the Presidency of the Council of Ministers Prof. Giampaolo Vittorio D’Andrea;

Having regard to Articles 2(2)(b) and 4(1) of the Decree, Legislative Decree No. 281 of 28 August 1997, which entrust this Conference with the the task of promoting and sanctioning agreements between the Government and the Regions, in particular implementation of the principle of sincere cooperation, in order to coordinate the exercise of their respective competences and carry out activities of common interest;

Having regard to the letter received on 17 December 2012 by which the Ministry of Health has transmitted, for the purpose of perfecting an Agreement at this Conference, the document containing: “Indications for the correct application of the regulations for assistance health care for the foreign population by the Regions and Autonomous Provinces’ which, on 18 December last, was issued to the Regions and Autonomous Provinces;

Having regard to the note of the same date with which the Veneto Region, Coordinator of the Health Commission, communicated the opinion of the technical favourable;

Having obtained the Government’s assent during today’s meeting, of the Regions and Autonomous Provinces; Ratifies agreement between the Government, the Regions and the Autonomous Provinces, in the following Terms: Considered: Legislative Decree No 286/1998 of 25 July 1998 on the ‘Consolidated Law the provisions relating to the regulation of immigration, and rules on the status of foreigners’ and subsequent amendments;

Legislative Decree No 251 of 19 November 2007 ‘Implementation of Directive 2004/83/EC on minimum standards on the attribution to third-country nationals or stateless persons of the qualification of the refugee or person otherwise in need of international protection, as well as minimum standards on the content of the recognised protection’;

Legislative Decree No 30 of 6 February 2007 on the ‘Implementation of the Directive 2004/38/EC on the right of citizens of the Union and of their family members to move and reside freely in the territory of the Member States’;

Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security; Regulation (EC) No 988/2009 of the European Parliament and of the Council of 16 September 2009 amending Regulation (EC) No. Regulation (EC) No 883/2004 on the coordination of social security systems and determines the content of the relevant annexes;

Regulation (EU) No 1231/2010 of the European Parliament and of the Council of 24 November 2010 extending Regulation (EC) No. 883/2004 and Regulation (EC) No. 987/2009 to citizens of third parties to whom these regulations are not already applicable only to cause of nationality;

Decree No 394 of the President of the Republic of 31 August 1999, Regulation implementing the consolidated text the provisions relating to the regulation of immigration, and rules on the status of foreigners, pursuant to art. 1, paragraph 6, of Legislative Decree No 286 of 25 July 1998′ et seq. Modifications;

Circular No. 5 of the Ministry of Health of 24 March 2000, with the which has been provided for the application of the above-mentioned Legislative Decree no. 286 of 25 July 1998;

Art. 1 of Legislative Decree no. 502 of 30 December 1992 and subsequent amendments, which guarantees health as a right fundamental of the individual and interest of the community;

the decree of the President of the Council of Ministers of 29 November 2001, as amended, laying down ‘Definition of the essential levels of care’, which sets out the essential levels of health care provided by the National Health Service, Pursuant to art. 1 of Legislative Decree no. 502 of 30 December 1992 and subsequent amendments;

the results of the work of the Interregional Table on Immigrants and health services’, set up as part of the ‘Promotion of of the health of the immigrant population’, promoted by the Centre for National Disease Control and Prevention Ministry of Health, the implementation of which has been entrusted to the Marche region in 2007;

the National Survey on the Health of the Immigrant Population, produced by the above-mentioned Table and published in March 2008, with the how has the degree of adherence of the regions to the national legislation and, in particular, the provisions of the aforementioned D.P.R. no. 394 of 1999, which delegates to the regions themselves the implementation of the most appropriate ways to ensure the essential and continuous care for the immigrant population;

the document drawn up by the above-mentioned Table, containing: ‘Indications for the correct application of the regulations for assistance health care for the foreign population by the Regions and Autonomous Provinces of Trento and Bolzano’, transmitted by the Minister to the President of the Conference of the Regions and Autonomous Provinces with note of 12 October 2012;

the note of 13 December 2012, by which the Chairman of the Conference of Regions and Autonomous Provinces has communicated to the Minister of Health to share its contents, so that the itself was the subject of an Agreement at this Conference;

whereas a discrepancy has been found on the national territory response to access to care by the population Immigrant; that it is necessary to identify, with regard to this category of population, the most effective initiatives to be implemented to ensure greater uniformity in the Regions and Autonomous Provinces, the pathways for accessing and providing health services, pursuant to the Decree of the President of the Council of Ministers on essential levels of care;

whereas it is appropriate to bring together in a single operational instrument the National and regional regulatory provisions relating to assistance immigrants, also with a view to simplifying the correct circulation of information among health professionals;

It is convenient to on the document entitled ‘Indications for the correct application of the regulations for health care for the foreign population from part of the Regions and Autonomous Provinces’, Annex A), an integral part of this Act. The activities provided for in this Agreement shall be carried out within the limits of the of the human, instrumental and financial resources available to legislation in force and in any case without new or increased burdens to be borne by public finances.

Rome, 20 December 2012 The President: D’Andrea The Secretary: Siniscalchi Attachment Indications for the correct application of the Regulations for health care at the foreign population by the regions and                      province autonome italiane  Index Introduction Note 

1. Foreigners from outside the European Union

1.1. Foreigners who do not belong to the European Union regularly Staying

1.1.1. Registration Required

1.1.2. Voluntary Registration

1.1.3. non-enrollees (residents for periods of less than three years) months, subjugated for medical treatment)

1.2. Foreigners not belonging to the European Union without residence permit (Foreigners Temporarily Present – STP)

1.2.1. STP Code

2. Citizens of the European Union

2.1. Registration required

2.2. Health Insurance Contract and Registration Voluntary

2.3. EHICs and Attestations of Right, issued by Institutions Community Forms (Community Forms)

2.3.1. EHIC (European Health Insurance Card)

2.3.2. Attestation of rights issued by institutions Community Forms (Community Forms)

2.4. indigent residents, without EHIC, without certificate of right of residence, without requirements for registration with the SSR (code ENI) 

3. Summary of procedures (Synoptic tables)

4. Attachments

4.1. Forms

4. 2 List of reference standards Introduction The purpose of this document is to provide, in accordance with current legislation, Operational guidelines for the homogeneous application of the legislation health care for the foreign population. The aim is to systematize the indications issued in the years, in order to facilitate the most correct application of the Current legislation for health care for the population immigrants and foreigners in Italy, to make them homogeneous in the various territories the way in which it is provided, reduce the difficulties in accessing benefits and discretion interpretation of the rules for access to care that undermine the guarantee of essential levels of care and equity,

improve the circulation of correct information between healthcare professionals and simplify the work of healthcare professionals. The Document is the result of a careful reconnaissance of the current regulatory provisions on the Interregional Table ‘Immigrants and Health Services’, set up as part of the project “Promoting the Health of the Immigrant Population”, promoted by the Ministry of Health, National Centre for Prevention and Prevention Disease Control, the implementation of which has been entrusted to the Marche region in 2007.

The Document collects not only the numerous regulatory indications and regional health care for immigrants as such, but also captures the inspiring principles of these European regulations and directives. Note  A) The administrative status of “foreigners” Foreigners:

1) if they come from non-European countries, they can be regularly present as they are in possession of a residence permit or be present but do not have a residence permit (irregular: in previously had a residence permit that they could not renew; Illegal immigrants: they do not have and have never had a permit of stay);

2) if they come from countries belonging to the European Union1 are no longer required to apply for a residence permit at the Police Headquarters. An EU citizen who meets the requirements The right of residence for periods of more than three months is required to register in the population registry resident or in cases where residence is maintained abroad, to the temporary population register.

B) For each chapter, the following shall be obtained: • described the characteristics of the assistance (with the same or not of Italians) • Annotated the relevant regulations • listed the documents required for registration (Chapter 3, Summary of procedures – Synoptic tables) • described the characteristics of participation in the expenditure C) Acronyms EC: Community’ Europea Legislative Decree: Legislative Decree DG RUERI: Directorate-General for Relations with the European Union and for International Relations D.M.: Ministerial Decree Prime Minister’s Decree: Decree of the President of the Council of Ministers DPR: Presidential Decree of the Republic ENI: Non-attached Europeans LEA: Essential Levels of Care

GP: General Practitioner P.A.: Autonomous Province Pds: Residence Permit PSE: Electronic Residence Permit NHS: National Health Service SSR: Regional Health Service STP: Foreigners temporarily present EHIC: European cards Health insurance T.U.: Consolidated text of the provisions concerning the discipline of Immigration and Regulations on the Status of Foreigners, Legislative Decree no.

n. 286/1998 and subsequent amendments and additions. EU: European Union

 ——–  1 Since 2007, there have been 27 EU countries: Belgium, West Germany, France, Italy, Luxembourg and the Netherlands (since 1951), United Kingdom. Ireland and Denmark (since 1973), Greece (since 1981), Spain and Portugal (since 1986), East Germany (since 1990), Austria, Sweden and Finland (since 1995), Cyprus, Estonia, Latvia, Lithuania, Malta, Poland, Slovakia, Slovenia, the Czech Republic and Hungary (from 2004), Bulgaria, Romania (since 2007). In addition, the EEC regulations in Switzerland, Iceland, Lichtenstein, Norway

1. Foreigners from outside the European Union

1.1. Foreigners who do not belong to the European Union regularly Staying

1.1.1. Compulsory registration with the SRG The following are the reasons for the stay that determine compulsory registration with the SSR in accordance with Art. 34, paragraph 1 of the Consolidated Law (T.U.) and subsequent legislation on the subject2 ,3 .

– subordinate work (including seasonal work)

– self-employment

– family reasons (including family members over the age of sixty-five with entry into Italy before 5 November 20084 )

– political asylum/refugee

– Humanitarian asylum/humanitarian grounds/subsidiary protection5 ,6

– application for international protection

– request for asylum (also “Dublin Convention”)7

– Waiting for adoption8 – Waiting for adoption

– foster care, including unaccompanied minors9 ,10

– application for citizenship

– holders of residence cards11 and long-term residents Period12

– non-EU family members13 of EU citizens registered with the   SSR14 ,15 

– waiting for occupancy16

– waiting for regularization (temporary registration, pending of the definition of the practice, for those who have applied regularisation or emergence from undeclared work)17

– foreign minors present in the territory, regardless of the possession of a residence permit18 ,19

– parent who works with a permit to Stay for Child Care20 ,21 ,22

– a woman in possession of a residence permit for treatment, in a state of pregnancy and up to six months after the birth of the child which it provides for

– study reasons for adults previously enrolled in Compulsory title23

– detainees in adult and juvenile prisons, and internees in judicial psychiatric hospitals; in semi-freedom, subject to alternative measures to punishment, with or without a permit to stay24 – detainees in adult and adult prisons minors and internees in judicial psychiatric hospitals; in semi-liberty, subject to alternative measures to punishment, with or without a residence permit

– Permits for reasons of justice25

– religious motives for religious who carry out an activity and receive remuneration subject to withholding taxes Fiscali (Es. Parroci)26

– Stateless status27

– study reasons if they are students who carry out activities Working

– elective residence with entitlement to a contributory pension Italian

– health/humanitarian reasons (with the exception of residents of the Pursuant to art. 36 of the T.U.; entrance for medical treatment). Yes it does reference to residence permits for health reasons or issued in the event of expiry of a previous stay and occurrence of illness or accident that does not allow to leave the national territory28 , It should be noted that the woman in possession of a residence permit for pregnant and up to six months after birth of the child to whom he/she is responsible, has the right to enrolment compulsory to the SSR for themselves and the child29 .

The father of the child is treated in the same way as the mother and therefore must be registered with the SSR30 . To foreign minors residing for psycho-physical recovery in some regions and hosted by families, institutions or associations, in the context of solidarity programmes for temporary reception authorized by the Ministry of Solidarity – Committee for Foreign Minors elo from the Regions, must be guaranteed health care for the duration of the stay behind Presentation of documentation by the adult in custody certifying temporary foster care under the aforementioned Programs.

 ——–  2 It will be referred to hereinafter as the Consolidated Text of the provisions on immigration law and rules on the of the foreigner (T.U.) Legislative Decree no. 286/1998 and subsequent Amendments and additions.

 ——–  3 Pursuant to Art. 34, paragraph 1, of the T.U. “They are required to register with the National Health Service and have equal treatment and full equality of rights and duties with respect to Italian citizens with regard to the obligation to the assistance provided in Italy by the and its temporal validity:

(a) legally resident foreigners who have regular employment or self-employment or are registered on the employment lists;

(b) foreigners who are legally resident or who have applied for the renewal of residence permit, for subordinate work, for work self-employed, for family reasons, for political asylum, for asylum humanitarian assistance, for asylum seekers, for pending adoption, for for the acquisition of citizenship”.

 ——–  4 Circ. Ministry of Labour, Health and Policies DGRUERINI/1.3.ba19682/P of 4 May 2009.

 ——–  5 Art. 27 of Legislative Decree no. 251 of 19 November 2007: “1 holders of subsidiary protection are entitled to the same treatment granted to Italian citizens in the field of social assistance and health.”

 ——–  6 Ministry of Health Circ. no. 5 of 24 March 2000: “Asylum humanitarian: the reference is to the articles of the T.U. ’18, paragraph 1 (residence for social protection reasons), 19(2)(a)

(a) and (d) (prohibition of expulsion and refoulement of minors under the age of 19) eighteen and pregnant and postpartum women up to one maximum of six months), 20, paragraph 1 (extraordinary measures of reception for exceptional events) and 40, paragraph 1, (foreigners hosted in reception centres, if they have no other qualification compulsory insurance or the provision of benefits “Healthcare Regulations)”, Prime Ministerial Decree of 5 April 2011 issued pursuant to Article 20,  comma ldel T.U. 

 ——–  7 The Dublin Convention, to which all the Member States are parties of the European Union, Norway and Iceland, establishes a system of to identify – through a series of specific criteria – the State responsible for examining asylum applications. Among the various criteria, there are It is also the one for which the competent authority to examine the application is the the first country in which the applicant arrives. The legal status of the foreign national who is issued a residence permit to the within the meaning of the Dublin Convention is that of an asylum seeker (or as an applicant for international protection).

 ——–  8 It should be noted that a foreign child who is adopted or in PRE-ADOPTIVE FOSTER CARE IS NOT ISSUED (See Directive of the Ministry of the Interior and Ministry of Justice) Family of February 21, 2007). The child enjoys, however, all the rights attributed to the Italian child in foster care since from the time of entry on the basis of a foreign order adoption or pre-adoptive foster care (art. 34, paragraph 1, L. n.

184/1983). In particular, registration with the SSN must take place with the the same procedures as for the first enrolment of the minor Italian (i.e. the following are required: identity document of the parent, Family status or self-certification and tax code of the minor (Circ. Ministry of Health DGRUERINI/1.3.b.a/5719/P of 17 April  2007). 

 ——–  9 Art. 19, comma 2 of the T.U.

 ——–  10 The costs of determining the age are borne by the Prefecture.

 ——–  11 Article 9, paragraph 1 of the Consolidated Law and Article 16, paragraph 2 of Presidential Decree no. 394/1999.

 ——–  12 “The EC residence permit for long-term residents” (pds CESLP), previously referred to as “residence card”, pursuant to art. 9 of the T.U. and art. 16, paragraph 2 of Presidential Decree no. 394/1999, (as amended by the entry into force of Legislative Decree no. 3 of 8 January 2007) is a residence permit of indefinite duration and gives the right to register with the NHS for an indefinite period.

 ——–  13 Art. 2 of Legislative Decree no. 30/2007, paragraph 3, and Circ. Health DG RUERI/II/12712/1.3.b of 3 August 2007, where for “Family” means:

(1) your spouse;

(2) the partner who has contracted with the Union citizen a registered partnership on the basis of the law of a Member State Member State, where the legislation of the host Member State equate a registered partnership with marriage and in compliance with the conditions laid down in the relevant legislation of the Member State host

(3) direct descendants under 21 years of age or dependents, and those of the spouse or partner;

(4) the dependent direct relatives in the ascending line and those of the spouse referred to in letter For dependent family members, please refer to the paragraph ” Notes for non-EU foreigners on a regular basis stayers”.

 ——–  14 Art. 10 of Legislative Decree no. 30/2007: “1 non-EU family members of’ Union citizen, three months after entry into the national territory, request the competent Police Headquarters to territory of residence, the “Residence card of a family member of a citizen of the Union’.

 ——–  15 Art. 17 of Legislative Decree no. 30/2007: “to the family members of the citizen not nationals of a Member State of the European Union, who have acquired the right of residence the Police Headquarters issues a “Permanent Residence Card” for a family member of a European citizen”

 ——–  16 Including:

– students who have obtained a doctorate or master’s degree in Italy second-level university students, as they can have the residence permit for 12 months for “pending employment”. Circ. Ministry of the Interior, prot. no. 0004820 of 27 August 2009;

– those over sixty-five years of age with a permit “awaiting employment” who are not registered with the Employment Centre.

 ——–  17 Telex Min. S DPS-X-40-286/98 of 3 April 2000; DG Reports note with the European Union and International Organizations, uff.VI, of 23 November 2009: registration with the NHS for domestic helpers and carers could be made in provisional, with an extension until the issuance of the stay and unless terminated in the event that the the closure of the proceedings or the rejection of the declaration … or there is termination of employment.”

See also indications in this regard of the Regions Emilia-Romagna, Lazio, Lombardy, Piedmont, Veneto.

 ——–  18 Law no. 176 of 27 May 1991 “Ratification and execution of the Convention on the Rights of the Child” and Article 35(3)(a) b) of the T.U.

 ——–  19 Resolution A7-0032/2011 of the E! February 2011. The Parliament calls on the Member States “to ensure that the most important groups in the vulnerable people, including undocumented migrants, have rights and can in fact benefit from equal access to the health system” (point 5), “to ensure that all women in pregnancy and children, regardless of their status, have right to social protection as defined in their national legislation, and in fact receive it” (paragraph 22).

 ——–  20 Art. 29, paragraph 6 of the Consolidated Law on Finance: “to the authorized family member upon entry or stay on the national territory to pursuant to Article 31, paragraph 3, shall be issued, by way of derogation from the provisions of the provided for in Article 5, paragraph 3-bis, a permit for assistance minor, renewable, with a duration corresponding to that established by the Juvenile Court. The residence permit allows you to work but cannot be converted into a leave for work purposes”.

 ——–  21 Article 11 of Presidential Decree no. 394/1999.

 ——–  22 Ministry of Health Circ. DGRUERINI/Bba/8489/P of 16 April  2009. 

 ——–  23 Circ. Ministry of Health, DGRUERINI/11494/1.3.b.a./P of 19 July 2007. Residence permit for study purposes issued upon reaching the age of majority (to foreigners already legally resident) does not entail the payment of the contribution to the SRG if you have previously registered on a compulsory basis. “Previous compulsory registration allows, in fact, the retention of registration with the SSN on the same basis, i.e. without the payment of the contribution to the NHS”.

 ——–  24 Art. 1 of Legislative Decree no. 230 of 22 June 1999, “Reorganisation of the Penitentiary Medicine in accordance with Article 5 of Law 30 November 1998, no. 419”, paragraphs 5 and 6: “The following are registered with the foreigners, limited to the period in which are detained or interned in penitentiary institutions. These subjects have equal treatment and full equality of rights with respect to the to free citizens, regardless of the regular permit of stay in Italy. Prisoners and internees are excluded from the Cost-sharing system for health services provided by the National Health Service”. For performance provided to prisoners and internees, regardless of the nationality, exemption code F01 applies.

 ——–  25 Article 11(1)(c bis) of Presidential Decree 394/1999.

 ——–  26 For the purposes of compulsory registration, they must produce A certificate from the employer or the Central Institute for Occupational Health and Security. Sustenance of the Clergy. Circ. Ministry of Health DGRUERI VI/AG4/2591 of 4 June 2004 and Circ. Ministry of Health DG RUERINI/Bba/8489/P of 16 April 2009.

 ——–  27 Stateless status is granted to persons who do not can prove that they are nationals of a State or that are no longer treated as citizens by the competent authorities of the country of origin and who, as a consequence, no longer benefit from No administrative assistance, such as the issuance of documents such as identity or marital status.

 ——–  28 Ministry of Health Circ. no. 5 of 24 March 2000.

 ——–  29 Article 19(2)(d) of the Consolidated Law on Finance, Article 28(1)(d) of the Consolidated Law

(c) Part of DPR 394/1999.

 ——–  30 Judgment of the Constitutional Court no. 376 of 27 July 2000. General notes for non-EU foreigners regularly Staying Registration with the SSR pending the first issuance of the Living room In all cases where the foreign national is waiting for first issue of a residence permit for one of the reasons determine the entitlement to compulsory registration with the SSR, Proceeds with temporary registration on the basis of the documentation certifying that the application for a residence permit has been made, including those who have applied for regularisation or Emergence from undeclared work31 .

Enrolment with the SSR and carrying out work or Registration with Job Centres The rules currently in force32 affirm the principle that the performance of an activity or registration on the employment lists (current Job Centres), in compliance with labour legislation, entitles the foreign citizen to compulsory registration legally resident, regardless of whether the permit has been issued for employment or self-employment or the fact that the reason for the residence permit does not include compulsory enrolment (e.g. students with a fixed-term work, parent caring for the child…)

Check SSR Registration Requirements In all cases where the foreign national is in possession of a residence permit for which registration is mandatory, the ASL must proceed with the registration with the SSR, without the verification of’ additional requirements. The presentation of the certification attesting to the performance of work is necessary only in cases where the foreign national carries out work even though he is not in possession of a residence permit for which registration is required SSR.

Residence/Actual residence Foreigners insured with the national health service are registered, together with their dependent family members, in the lists of of the ASL in whose territory he/she resides or, in absence of it, in whose territory it has its actual residence (for the Place of actual residence means the place indicated in the permit of stay)33 . A person who is homeless shall be deemed to be resident in the municipality where it has the dornicilio34 . For Applicants for Protection regardless of the indication of domicile on the residence permit and, in the absence of residence, refers to the self-certification of actual residence or the Declaration of Hospitality35 .

Foreigners in possession of an application or residence permits for international protection, political asylum, protection subsidiary, humanitarian reasons at the time of initial enrolment may be register with the SSR temporarily, for the duration of the stay in the ASL where they declare to domicile, with the obligation, when renewing the residence permit, to request a change of domicile from the competent Police Headquarters and submit to the ASL the residence permit showing the actual domicile.

Dependents “Health care is the responsibility of regularly dependent family members Staying. Pending registration with the National Health Service, Minors who are children of foreigners who are members of the SSR are insured from the the same treatment as enrolled minors.” (T.U., art. 34, paragraph 2). It should be noted that with regard to the identification of those who are subject to the regulatory provisions that regulate the receipt of family allowances or deductions Taxes for family expenses36 : “All members of the family are considered to be dependent family members for tax purposes of households who did not have an income in 2009 of more than €2,840.51, gross of charges Deductible.

They may be considered dependents, even if they do not cohabiting with the taxpayer or residing abroad:

– the spouse who is not legally and effectively separated;

– children (including recognised, adopted, fostered natural children) or affiliates) regardless of whether certain age limits and whether or not they are engaged in studies or Free internship. The following others may also be considered dependents family members, provided that they live with the taxpayer or that receive maintenance payments from the same person who are not entitled to measures of the Judicial Authority: the spouse legally and effectively separate; the descendants of the children; Parents (including birth and adoptive parents); Genres and daughters-in-law; father-in-law and mother-in-law; brothers and sisters (also unilateral); grandfathers and grandmothers (including natural ones)”

Duration of Health Enrollment Registration with the SSR is valid from the date of entry until the expiry of the residence permit and does not lapse in the renewal of the residence permit itself in accordance with the subject to successful completion and with a view to continuity of care37 . Foreigners legally residing and registered with the SSR are entitled to issued, like Italian citizens, the European Security Card Health Insurance (EHIC) and are applied in their Comparisons. the social security rules referred to in EU regulations38 , on an equal footing with citizens Italians who are members of the SSR.

Automatic registration If, at the time of the request for assistance, the non-EU foreigner legally present in the territory has not yet formally registered with the SSR, health facilities must still provide the provision of assistance and the contextual registration ex officio to the SRG. “The possession of a residence permit makes the right retroactive the health care of the foreigner, as he regularly on the date of entry into Italy”39 .

Self-declarations Citizens of non-EU countries regularly residents of Italy, can use the declarations substitute certifications40 and self-declarations of the affidavit41 , limited to states, personal qualities and facts certifiable or attestable by public bodies Italians42 . Electronic Residence Permit (P.S.E.) The Decree of 3 August 2004 of the Ministry of the Interior provides for the adoption of the residence permit in electronic format (P.S.E.).

This format of residence permit does not always state the reason of residence and residence (or actual abode). Therefore, the ASL Registry Offices will collect the necessary data registration with the SSR by means of self-declarations of the user. Fiscal Code The Tax Code is normally issued by the Tax Agency. Revenue. This can also be issued by other subjects such as, for example, e.g. the One-Stop Immigration Desk (U.S.I.)

 ——–  31 Ministry of Health Circ. No 5 of 24 March 2000, Telex Ministry of Health DPS-X-40-286/98-240 of 1 April 2000. Ministry of Health DGRUERI/V1/1.3.b.a/5719/12 of 17 April 2007, Ministry of Health Circ. DGRUERINI/1.3.b.a/20114113 of 19 November 2007.

 ——–  32 Art. 34 T.U., Ministry of Health Circ. No. 5 of 24 March  2000. 

 ——–  33 Article 42, paragraphs 1 and 2 of Presidential Decree no. 394/1999.

 ——–  34 Art. 2, Law no. 1228 of 24 December 1954, ad. 3, paragraphs 38 and 39 of Law 94/2009.

 ——–  35 The Lazio Region issued a specific note: No 42013/AV/09 of 5 April 2006.

 ——–  36 Provv. Revenue Agency, prot. No. 12293/2010. The family status, issued by the registry office or self-certified, does not define dependent family members, but certifies only the persons registered in the “family file”, i.e. all persons living in the same dwelling and who are linked by kinship, or even simply by ties Affective.

 ——–  37 Art. 42 of Presidential Decree no. 394 of 31 August 1999 amended by Art. 39 of Presidential Decree no. 334 of 18 October 2004.

 ——–  38 EC Regulations No. 1408 of 1971, No. 574 of 1972, pending of the transposition of EC Regulation number 883 of 2004.

 ——–  39 Ministry of Health Circ. no. 5 of 24 March 2000.

 ——–  40 Art. 46 of Presidential Decree no. 445 of 28 December 2000.

 ——–  41 Article 47 of Presidential Decree no. 445 of 28 December 2000.

 ——–  42 Art. 3, paragraphs 2 and 3 of Presidential Decree no. 445 of 28 December 2000.

1.1.2. Voluntary Registration Non-EU citizens in possession of a residence permit duration of more than three months (except students and au pairs) who can ask for voluntary registration even for periods of time. and who are not among those who are entitled to members of the SSR, are required to insure themselves by taking out a insurance policy with an Italian insurance institution or valid on the national territory or, alternatively, they can apply for voluntary registration with the SSR, subject to payment of the contribution due pursuant to Ministerial Decree 8.10.198643   . 

The following are the reasons for your stay that allow you to Voluntary registration with the SRG:

– residents for study purposes

– placed on an equal footing44

– elective residence

– religious personnel45

– foreigners participating in volunteer programmes46

– family members over the age of sixty-five who have entered Italy for family reunification, after 5 November 200847 .48

– foreign employees of international organisations operating in Italy and staff accredited to diplomatic representations and Consular Offices, with the exclusion, of course, of personnel contracted in Italy for which it is mandatory Registration with the SSR

– other categories that can be identified by exclusion with reference to the above regarding registration Mandatory. The following amounts must be paid by bank account. postal current or F24 identified by the Region or Province Autonomous. It should be noted that voluntary registration with the SSR refers to per calendar year (1 January – 31 December) regardless of the possible intra-annual expiry of the residence permit49 , it cannot be divided and does not have retroactive effect.

Voluntary registration with the SRG is carried out after payment of the minimum amount of € 387.34 and is also valid for dependent family members. For students without dependent family members and no income other than scholarships or subsidies provided by public bodies The amount is € 149.77. For those placed au pair50 the amount is € 219.49. This enrolment (for students and au pairs) does not include any dependents.

To extend health care to dependent family members, The amount of the payment must be calculated on the basis of income and shall not be less than € 387.345851 .52 . Persons in possession of a residence permit for reasons of study that documents, showing employment contract, the performance of of working activity, has the right to compulsory registration with the   SSR. 

 ——–  43 Art. 34, paragraph 3 of the T.U. and Art. 42, paragraph 6 of Presidential Decree 394/99.

 ——–  Amendment No 44 on au pairing, adopted in Strasbourg on 24 November 1969, ratified and made enforceable pursuant to Law no. 304 of 18 May 1973.

 ——–  45 For compulsory registration, please refer to p. 13

 ——–  46 Art. 27 bis of the T U., Circ. Ministry of Health DGRUERI/ VI/1

3.b.a/20114/P of 19 November 2007.

 ——–  47 Art. 1, paragraph d), Legislative Decree no. 160, 3 October 2008, Ministry Circ. DGRUERIA/1/.3.b.a145371P of 24 February 2009, Circ Ministry of Health DGRUERIA/1/.3.b.a19682 of 4 May 2009.

 ——–  48 See: Circ. Regione Lazio prot. 84775 of 17 July 2009, Circ. Regione Marche prot. 456561/SO4/CR of 12 August 2009, Cire. P.A. Trentino Alto Adige prot. 23.2/5507/49465 of 27 January 2010, Veneto Region Circ. prot. 593050/50.00.04/E.900.02.15 of 27 October 2009, Emilia Romagna Region Circ. prot. PG 2010/188856 of July 23, 2010.

 ——–  49 Circ. Ministry of Health, DGRUERIA11/11494/1.3b.a./P of 19 July 2007. “… in the process of renewing the residence permit, II upon payment of the annual fee, it may allow the retention of the registration with the SSR, pending the submission of the residence permit to the ASL by the interested party”.

 ——–  50 European Agreement on Au Pairing, adopted in Strasbourg on 24 November 1969, ratified and made enforceable under the of Law no. 304. of 18 May 1973.

 ——–  51 For the amount, please refer to the Ministerial Decree of 8.10.1986: involves the payment of an annual contribution the total income earned in Italy and/or abroad during the year prior to the date of registration, which sets the percentage of the contribution to the extent of 7.50% of the total income up to 20,658.27 E. per annum; on the portion exceeding the aforesaid amount and up to up to the limit of 51,645.68 E. a contribution is due in the amount of  4%. 

However, the amount of the contribution cannot be less to the amount of E387.34.”

 ——–  52 Ministry of Health Circ. no. 5 of 24 March 2000. General notes for foreigners with voluntary registration Residence/Actual residence A foreign national insured with the SSR sr is registered, if necessary, together with dependent family members, in the lists of those eligible for assistance of the ASL in whose territory he/she resides or, in the absence of in whose territory he or she has an actual residence (by actual residence means the place indicated in the residence permit53 ). them foreign citizens are required to notify the ASL of the change of residence. Documentation for a change of residence It is a valid document for registration.

Self-declarations Citizens of non-EU countries regularly residents of Italy, can use the declarations substitute certifications54 and self-declarations of the affidavit55 , limited to the states, qualities and facts that can be certified or attested by Italian public entities56 .

 ——–  53 Art. 42, paragraphs 1 and 2 of Presidential Decree 394199.

 ——–  54 Article 46 of Presidential Decree no. 445 of 28 December 2000.

 ——–  55 Article 47 of Presidential Decree no. 445 of 28 December 2000.

 ——–  56 Article 3, paragraphs 2 and 3 of Presidential Decree no. 445 of 28 December 2000.

1.1.3. Non-European Union Foreigners Who Are Not Eligible Staying for periods of less than three months. Non-EU foreigners legally residing on the national territory for periods of less than three months (visa for tourism, visits, business, etc.), not required to register compulsory or voluntarily enrollable with the SSR, are All urgent services are provided in health facilities and of choice.

Urgent care (outpatient, inpatient or day care) hospital) are provided immediately; Payment is made at time of the patient’s discharge. The health services of Elections are provided upon payment of the relevant fees. The tariffs for health services are determined by the Regions and Autonomous Provinces57 . For any emergency services that remain unpaid, the charges are paid for by the Ministry of the Interior; therefore the ASL, the Company Hospital or accredited facilities should apply for the reimbursement of the services provided, to the Office Territorial of the territorially competent Government58 .

This is without prejudice to the international agreements governing the reciprocity for the provision of health care59 . Those who are covered by the above-mentioned agreements and are bearers of specific forms issued by the country to which they belong, may use the assistance directly or in the manner provided based on the type of specific model per agreement or through registration with the SSR and in any case upon payment of the PARTICIPATION IN EXPENDITURE ON EQUAL TERMS WITH CITIZENS Italian.

The countries with which there are international agreements are the following: -Argentina

–Macedonia

  – Australia 

  – Montenegro 

–Brazil

  – Serbia 

  – Bosnia-Erzegovina 

– Republic of S. Marino

– Cape Verde (temporarily suspended)

  – Tunisia 

–Croatia

– Vatican City and the Holy See

– Principality of Monaco Residents for medical treatment pursuant to art. 36 of T.U.60 Stays pursuant to art. 36 of the T.U. are authorised in three Different cases: a) Entry for treatment in Italy upon payment of the relevant charges. The non-EU foreigner who intends to undergo treatment medical conditions in Italy, require a visa, under the conditions established by the decree of the Minister of Foreign Affairs, to the competent diplomatic or consular representation and the relevant permission to stay at the Police Headquarters, attaching the following documentation:

– a declaration from the chosen health facility, public or accredited private car, indicating the type of treatment, the start date and the expected duration of the same, the duration of any hospitalization, in compliance with the provisions in force for the protection of personal data;

– proof of the deposit of a sum of money by way of security deposit based on the estimated cost of the services Requests. The security deposit, in euros or dollars U.S. taxpayers, will have to pay 30 percent of the cost of the services required and must be paid to the chosen facility;

– documentation proving the availability of resources in Italy sufficient for the full payment of health and health care costs. those of board and lodging outside the health facility and the repatriation for the patient and any accompanying person;

– health certification, attesting to the applicant’s pathology in compliance with data protection regulations Personal. The certification issued abroad must be accompanied by a translation into Italian;

The stay for medical treatment does not allow registration with the SSR and the health services are the full responsibility of the user61 . b) Transfer for treatment in Italy as part of interventions authorised by the Ministry of Health in agreement with the Ministry of Foreign Affairs62 . “This intervention takes the form of the authorization of entry for treatment in Italy, by the Ministry of Health, agreement with the Ministry of Foreign Affairs, citizens foreigners residing in countries without suitable health facilities and Appropriate. The identification of the beneficiaries of this intervention falls within the scope of the political discretion of the two ministers.

Ministry of Health, on the basis of the documentation acquired, identifies the structures that are considered to be suitable for the provision of the required health services and reimburse directly to the same structures the burden of the health services63 . c) Transfer to Italy as part of intervention programmes of the Regions. Pursuant to art. 32, paragraph 15 of Law no. 449 of 27 December 1997 the Regions, as part of the National Health Fund’s share authorise them, in agreement with the Ministry of Health, Health, Local Health Authorities, Hospitals and IRCCS to provide services that are part of the approved by the regions themselves, for high Specialization in favor of:

– citizens from non-IJE countries where there are no or Medical-specialist skills are not easily accessible for the treatment of specific serious pathologies and are not in Reciprocal agreements relating to health care are in place;

– citizens of countries whose particular contingent situation does not makes it feasible, for political, military or other reasons, any existing agreements with the Health Service National Health Care Unit.

 ——–  57 Art. 8, paragraphs 5 and 7 of Legislative Decree no. 502 of 30 December 1992 and subsequent amendments.

 ——–  58 Ministry of Health Circ. no. 5 of 24 March 2000.

 ——–  59 Art. 35, comma 2 of the T.U.

 ——–  60 The residence permit for “medical treatment” issued pursuant to Pursuant to art. 36 of the T. U.: Admission and stay for treatment Medical examinations do not entitle you to compulsory registration with the SSR. Spending for the care provided is supported by the patient himself or falls on the National or Regional Health Fund in the context of interventions of the Ministry of Health or the Regions.

 ——–  61 N.B. It should be noted that the pregnant woman and the father of the child up to six months after the birth of the child. child they provide, are entitled to a residence permit for health/humanitarian reasons with mandatory registration with the SSR and not for medical treatment. The same applies to individuals who have not been expelled by the State for serious health reasons

 ——–  62 Art. 12, paragraph 2, letter c) of Legislative Decree 502/92 as well as amended by Legislative Decree 517/93.

 ——–  63 Ministry of Health Circ no. 5 of 24 March 2000.

1.2. Foreigners not belonging to the European Union without a permit to stay (Foreigners Temporarily Present – STP) Temporarily Present Foreigners, STPs, are those who, being in good standing with the residence permit, they are not normally SSR. For them, the law64 provides: “Foreigners who are not in compliance with the rules relating to entry and The stay is insured, in public and accredited facilities, urgent or otherwise ESSENTIAL outpatient and hospital care, even if continuous, due to illness and accidents, and the Preventive Medicine Programs to Safeguard Health individual and collective”.

In particular, the following are guaranteed:

(a) the social protection of pregnancy and maternity, on an equal footing processing with Italian citizens, pursuant to 29 405 of July 1975 and No 194 of 22 May 1978, and of the Decree of Minister of Health 6 March 1995, published in the Official Gazette Official Decision No. 87 of 13 April 1995, on an equal footing with Italian citizens;

(b) the protection of the health of the child in compliance with the Convention on the Rights of the Child of 20 November 198965; c) vaccinations in accordance with the regulations and as part of interventions collective prevention campaigns authorised by the regions;

d) international prophylaxis interventions;

(e) the prophylaxis, diagnosis and treatment of infectious diseases, and possible remediation of the relevant outbreaks;

(f) treatment, prevention and rehabilitation of Drug addiction66 . Urgent Care: treatment that cannot be postponed without danger or damage to the health of the person. Essential Care: Health, Diagnostic and Diagnostic Services therapeutic, related to pathologies that are not dangerous in the immediate future and in the short term, but which over time could lead to greater damage to health or risk to life (complications, chronicization or aggravation)67 Essential Care: Performance health, diagnostic and therapeutic, related to non-medical pathologies dangerous in the immediate and short term, but which over time could lead to greater damage to health or risks to the life (complications, chronicisation or aggravation)68 Treatments

Essential: Health, diagnostic and therapeutic services, related to pathologies that are not dangerous in the immediate and short term term, but which over time could lead to greater damage health or life-threatening risks (complications, chronic or aggravations)69 It has also been affirmed by law the principle of continuity of urgent and essential care, in the sense of ensure the therapeutic and rehabilitative cycle of the sick person complete regarding the possible resolution of the morbid event70   . 

For the purpose of transplantation, including bone marrow transplantation, considered essential therapies, the STP foreigner is treated at the equal to the Italian citizen. The modalities of hospitalization in Italian hospitals are similar to those for Italians (urgent if necessary, scheduled, ordinary and day hospital). With regard to the modalities of delivery of assistance Presidential Decree 394/99, delegated to the Italian regions the organisation of health services, i.e. the definition of who must provide primary health care71 : “The Regions shall identify the most appropriate ways to ensure essential and ongoing care, which can be provided within the framework of local medical structures or in the

Accredited health facilities, outpatient facilities or hospitals, possibly in collaboration with volunteering with specific experience. Such assumptions organisational structures, as they function as primary level, they will still have to provide for direct access without reservation nor obligation”.72 As a result, in order to guarantee essential assistance, the Regions and P.A. can provide for the assignment to the GP and the PLS.

For immigrants who do not have a valid residence permit reference should also be made to Parliament’s resolution February 201173 .

 ——–  64 Art. 35, comma 3 of the T.U.

 ——–  65 ratified and made enforceable pursuant to Law no. 176 of 27 May 1991.

 ——–  66 Consolidated Law on the Discipline of narcotic drugs and psychotropic substances, prevention, treatment and rehabilitation of the related states of drug dependence, issued with the Presidential Decree no. 309 of 9 October 1990 (Suppl. Ord. to the Official Gazette no. 255 of 31 October 1990 October 1990) and subsequent amendments and additions.

 ——–  67 Ministry of Health Circ. no. 5 of 24 March 2000.

 ——–  68 Ministry of Health Circ. no. 5 of 24 March 2000: The identification of essential care is the sole responsibility of of the Ministry of Health and the ascertainment of the essentiality of the service, as in the case of urgency, falls within the scope of the responsibility of the doctor”.

 ——–  69 For prosthetic assistance covered by the LEA, the Regions are required to identify the most suitable paths to provide the Required services It should be noted that the Regions of Lazio and Piedmont have included the prosthetic care services are among the essential care with specific resolutions, as provided for by the Prime Ministerial Decree of 29 November 2001 – State-Regions Conference, 8 August 2001.

 ——–  70 Ministry of Health Circ. no. 5 of 24 March 2000.

 ——–  71 Art. 43, paragraph 8 of Presidential Decree 394/99.

 ——–  72 To date, 13 Regions and Public Administrations have issued indications to their local health authorities for the organisation of health care for STP in accordance with the provisions of Presidential Decree 39411999 (“National Survey Immigrants and health services in Italy: the systems’ responses regional health services” by the Marche Inequalities Observatory, year 2008, (http://ods.ars,marcheit) and there are 5 regions and 1 P.A.

to insure, albeit in a diversified way, the doctor of medicine and/or the paediatrician of your choice (research: ‘The protection of the Immigrant Health in Local Policies, 2010 by the Caritas Hospital in Rome, ( http://vvww.caritasroma. ittwp-content/uploads/2010/09/BY THE SALUTE.pdf)

 ——–  73 Resolution A7-0032/2011. The European Parliament calls on Member States Member States “to ensure that the most vulnerable groups, including the undocumented migrants, have the right and can de facto equal access to the health care system” (point

5), “to ensure that all pregnant women and children, Regardless of their status, they are entitled to protection as defined in their national legislation, and de facto receive it” (paragraph 22).

1.2.1 STP Code (Temporarily Present Foreigner) Health care for foreigners without residence permit is issued through the issuance of a card with individual regional code STP (Foreigner) Temporarily Present) that identifies the patient for all services that can be provided for prescriptive purposes and accounting. The STP code can be issued by local health authorities, companies Hospitals, University Hospitals and IRCCS.

The STP code is an identification code consisting of 16 characters:

– three characters consisting of the initials STP

– three characters consisting of the ISTAT code relating to the region

– three characters consisting of the ISTAT code relating to the ASL (Health Authority) that assigns the code

– seven characters for the sequential number assigned at the time of the release It is awarded at the time of the first disbursement of the benefits if the foreign national who makes use of the benefits is not in possession of it or may also be issued in order to facilitate access to care, in particular prevention programmes. The STP code is issued to the foreigner who does not have a permit to following a declaration of his/her personal data and of a declaration of indigence (see Annex) and is used to receive essential health services on an equal footing conditions with the Italian citizen with regard to the Participation in the cost (ticket).

Validity and duration of the STP code The STP code is valid throughout the national territory and Duration of 6 months74 . It is renewable in the event of the foreigner’s stay in the territory national. Documents Required for the Issuance of the STP Code The information required by the ASU health facility for the STP code issuance are:

– name, surname, gender, date of birth, nationality. If it is not possible to show an identity document, it is necessary to sufficient registration of the personal details provided by the patient75 . The data recorded by the ASL/health facility are confidential76 and may only be communicated upon official written request from part of the judicial authority. Using the STP Code The STP code should be used to:

– the prescription of health services on regional prescriptions (clinical-instrumental examinations, specialist visits),

– the prescription of drugs that can be dispensed, with the same conditions of participation in the expenditure with Italian citizens, by the affiliated pharmacies,

– the reporting, for the purposes of reimbursement, of benefits provided by the SSR’s accredited facilities. Participation in the expense (Ticket) Health services are provided free of charge77 for the applicants, without prejudice to the share of expenditure to equality with Italian citizens. The STP foreigner is exempt from the participation fee in the (ticket), in analogy with the Italian citizen, as far as concerne78 .79

– first-level health services, with direct access without reservation and binding; (such as those of general medicine, SERT, DSM, Family Counselling Centres);

– emergency services provided at the Emergency Department according to the exemption criteria already defined for citizens Italian;

– the benefits provided to protect pregnancy and maternita’;

– the preventive services that can be provided through the territorial articulations of the Department of Prevention ( national and regional vaccines, screening, HIV80 prevention);

– the benefits that may be provided under exemption, in accordance with the criteria and limits provided for by the legislation in force for Italian citizens, in particular presence of chronic diseases, rare diseases and disabling states (with consequent issuance of Certificate of Exemption);

– age/age (under 6 or over 65 years), under the same conditions with Italian citizens. For all other situations (level II performance, diagnosis and treatment, rehabilitation and preventive medicine, food special, specific safeguards…) The conditions set out in the for the Italian citizen. If the foreign national does not have a residence permit and possession of the STP code, did not have sufficient resources for the payment of the ticket, it is possible to apply, following a declaration (Annex), ii exemption code XI:11 which applies exclusively for the specific service performed81 .

Costs of care provided and reporting The costs of the essential health services provided82 , entities lacking sufficient economic resources, including quotas of any unpaid contribution to the expenditure, shall be the ASL (Local Health Authority) with territorial jurisdiction for the place where the services are provided83 which will therefore take care of request:

(1) to the Ministry of the Interior the reimbursement of the cost of the urgent or otherwise essential hospital services, due to illness and accidents, i.e. the urgent ones delivered by pronto relief and essential services, even if continuous, provided in inpatient regimen, including day hospitalization, or on an outpatient basis84 ;

2) to the Region the reimbursement of the cost of the referred to in paragraph 3 of Article 35 of the T.U., points a – f (p. 28). Reimbursement procedures to be forwarded to the Ministry of the Interior through the Prefecture must be carried out anonymously, through the STP code, with an indication of the diagnosis, the type of and the amount to be reimbursed85 . No Reporting Access to health facilities by the non-resident rule with the rules on stay must not involve any kind of reporting to the Authority86 ,87 It should also be noted that the Ministry of the Interior has clarified that “for the Carrying out activities concerning birth declarations and recognition of filiation (Birth Registry of the State

no documents relating to the stay must be shown, since these are declarations also made for the protection of minors, in the public interest of factual certainty”88   . 

 ——–  74 A longer period is hoped for, as ordered by the Region Veneto Region, which has indicated, for some time, as a period of validity of the STP code 12 months renewable.

 ——–  75 Ministry of Health Circ. no. 5 of 24 March 2000: In any case, the health facility must provide even in the absence of identity documents for the registration of the personal details provided by the patient, not only because the beneficiary of the services cannot, in principle, remain anonymous, but also for the purposes of the fulfilment of Article 4 of the 394199 Presidential Decree and the detection of Notifiable cases of infectious and communicable diseases mandatory.”

 ——–  76 Legislative Decree no. 196 of 30 June 2003 and subsequent amendments and Integrations

 ——–  77 That is, the total cost of the service or hospitalization.

 ——–  78 Ministry of Health Circ. no. 5 of 24 March 2000.

 ——–  79 In the Apulia Region, the STPs, having signed the Declaration of indigence are equivalent to Italian citizens who declare the minimum economic conditions for which it is provided for exemption for resident citizens. (DGR no. 1501, 1 August 2008: “Pharmaceutical cost sharing system. Modification to the DGR resolution no. 1198 of 6 August 2005 and subsequent amendments,” – published on BURP no. 127 of 14 August 2008)

 ——–  80 Ministerial Decree no. 1 February, 1991.

 ——–  81 Annex “Technical Specification of the SSN and SASN Recipe”, D.M. of 17 March 2008.

 ——–  82 Art. 35, paragraph 3 of the T.U., points a – f pag. 28

 ——–  83 Art. 43, paragraph 4 of Presidential Decree 394/99.

 ——–  84 Pursuant to the Prime Ministerial Decree of 29 November 2011 et seq. Performance are included in three main areas: collective health care in the living and working environment, including including infectious disease prophylaxis, vaccinations and early diagnosis, forensics;

district assistance including activities and health services and social and health care services spread throughout the territory (primary medicine, pharmaceutical, specialist and ambulatory diagnostics, services home care for the elderly and seriously ill, counselling centres, homes family and therapeutic communities);

Hospital Care: Emergency Room, Ordinary Hospitalization, Day hospital, care in long-term care facilities, rehabilitation.

 ——–  85 Article 43, paragraph 5 of Presidential Decree no. 394/1999.

 ——–  86 Pursuant to paragraph 5 of Art. 35 of the T. access to the health facilities by the foreigner who is not in compliance with the rules on the stay must not involve any kind of reporting public security authorities, except in cases where it is A REPORT IS MANDATORY IF THE CITIZEN IS ON AN EQUAL FOOTING Italian. Law 94/2009 not only did not amend this rule, but with the amends Article 6, paragraph 2 of the Consolidated Law on Banking and exceptionality of Article 35 of the T.U. itself: ‘With the exception of for measures concerning sports and recreational activities in temporary, for those relating to access to health services referred to in Article 35 and those relating to compulsory school performance, documents relating to the

referred to in Article 5(8), must be shown to the offices of the public administration for the purpose of issuing licences, authorisations, registrations and other interest of the foreigner, however named”.

 ——–  87 Min. Circ. of the Interior No. 12, prot, 780/A7 of 27 November  2009. 

 ——–  88 Min. Circ. of the Interior no. 19 of 7 August 2009.

2. Community citizens

2.1. Registration required

2.2. Health Insurance Contract and Voluntary Registration

2.3. EHICs and Attestations of Right, issued by Institutions Community

2.4. indigent residents, without EHIC, without certificate of right of residence, without requirements for registration with the SSR, – ENI Code – There are 27 member states of the European Union (EU) (as of 1 January 2007):  Austria (AT)  Belgium (BE) Bulgaria (BU)  Cyprus (CV) Danish (DK) Estonia (EE)  Finland (FI) Francia (FR)  Germany (DE) Greece (EL) Ireland (IE) United Kingdom (IT)

Latvia (LV) Lithuania (LT) Luxembourg (LU) Malta (MT)  Netherlands – Netherlands (NL) Polish (PL) Portugal (PT) United Kingdom (UK) Czech Republic (CZ) Slovak Republic (SK) Romania (RO)  Slovenia (SI)  Spain (ES) Sweden (SE) Edheria (HU) States belonging to the European Economic Area (EEA) and have adhered to the EU Regulations Norvegia (NW) Liechtenstein (LI)  Islanda (IS)  Citizens of Switzerland (CH) are treated in the same way as citizens of Switzerland.

of the European Union. Main regulatory references: • Regulation 1408/1971 (currently valid only for EEA countries, Switzerland and non-EU citizens) • EC Regulation 574/1972 (currently valid only for EEA countries, Switzerland and non-EU citizens) • Directive 2004/38/EC “EU citizens’ rights” their family members to move and reside freely in the of 29 April 2004 • Legislative Decree no. 30/2007 “Implementation of Directive 2004/38/EC on the right of citizens of the Union and their family members to and to reside freely in the territory of the Member States of 6 February 2007 • Guide to a better transposition and application of the Directive 2004/38/EC on the right of citizens of the Union and their family members to move and reside freely

within the territory of the Member States. European Commission no. 313 of 2 July 2009 • Regulation (EC) No 987/2009 laying down the implementation of Regulation (EC) No 883/2004 on the Coordination of social security systems of 16 September   2009  • Regulation (EC) No. 988/2009 amending Regulation (EC) No.   883/2004  • EU Regulation 1231/2010 extending EC Regulations No. 883/2004 and EC No 987/2009 to third-country nationals residing in legally in the territory of the Member States (with the exception of United Kingdom and Denmark89 )

 ——–  89 Regulation (EC) No 1231/2010, recitals (18) and (19) Ministerial Circulars and Notes • Circular of the Ministry of the Interior no. 19 of 6 April 2007 • Circular of the Ministry of the Interior no. 39 of 18 July 2007 • Circular of the Ministry of the Interior no. 45 of 8 August 2007 • Circular of the Ministry of the Interior no. 18 of 21 July 2009 • Note from the Ministry of Health DG RUER1/11/12712/1.3.b of 3 August 2007 • Note of the Ministry of Health DG RUERI/II/3152-P/1.3.b/1 of 19 February 2008 • Note from the Ministry of Health DG RUERI/11/15645-P of 24 July   2009  • Note from the Ministry of Health DG RUER1/11/005846-P/1.3.b/1 of 30 March 2010 • Note from the Ministry of Health DG RUERI/11/ 7656- P of 28

April 2010 • Note from the Ministry of Health DG RUER1/11/ 7672- P of 29 April 2010 • Note from the Ministry of Health DG RUER1/11/ 9004- P of 18 May 2010 • Note from the Ministry of Health DG RUERI/11/10437-P of 11 June   2010  • Note from the Ministry of Health DG RUER1/11/12647-P11.3.b/1 of 20 July 2010 • Circular Ministry of Health DG RUERINI/1.3.b-b/12881 of 22 July 2010 • Circular Ministry of Health DG RUERI/11/13254-P of 28 July 2010 • Circular Ministry of Health DG RUER1/11/18839-P of 12 October 2010 • Note from the Ministry of Health DG RUERIA/1/13ba/1192 of 13 January 2011 • Note of the Ministry of Health DG PROG S/ 3020 /1.3.b/1 of 7 February 2012 • Note from the Ministry of Health DG PROGS/ 7257 /1.3.b/1 of 19

March 2012 • Note from the Ministry of Health DG PROGS/ 7366 /1.3.b/1 of 20 March 2012 • Note from the Ministry of Health DG PROGS/ 852511.3. B/1 of 30 March 2012 • Note from the Ministry of Health DG PROGS/ 11841 /13.b/1 of 10 May 2012 • Note from the Ministry of Health DG PROGS/ 17416 /I.3.b/1 of 11 July 2012 • Note from the Ministry of Health DG PROGS/26053/1.3.b/1 of 19 October 2012 Following the enactment of Legislative Decree no. 30 of 6 February 2007, which transposes Directive 2004/38/EC on citizens’ rights of the Union and their family members to move and reside freely within the territory of the Member States, citizens of the European Union are no longer required to apply for any stay at the Police Headquarters.

EU citizens, who meet the requirements that determine the The right of residence for periods of more than three months is required to register in the population registry resident (or in specific cases to the population register temporary)90 .

 ——–  90 Law No 1228 of 24 December 1954 and Presidential Decree No 223 apply of 30 May 1989 (Population Registry Regulations) resident).

2.1. Registration required For stays of more than three months, the citizen will be enrolled, together with family members (even if they are not citizens of the Union), to the SSR, on an equal footing with Italian citizens residing in Italy, in the following cases91 :

(1) employed or self-employed persons in the State:

– registration with the SSR for an indefinite period if the employment relationship is for an indefinite period, whether it is subordinate or self-employed (form of Annual verification of the persistence of requirements for enrolment)92

– registration with the SSR for the duration of the employment relationship if the employment is for a fixed term of less than one year or renewable from year to year until the expiry of the contract, including including seasonal care; in particular, for workers only Registration can also be made for periods of time. less than 3 months.

(2) family members93 , including non-EU citizens94 , of workers subordinate or self-employed in the State:

– registration with the SSR for the same duration as the family member’s registration worker

3) Dependent family members of a registered Italian citizen: – registration to the SSR for an indefinite period

4) Residents in possession of a “residence certificate” “95 accrued after five years of residence in Italy and their family members who have individually acquired the right to permanent residence (the only exception is for minor children who are included in the same certificate as this right descends from the parent):

– registration with the SSR for an indefinite period of time and without the verification of Additional Requirements

5) unemployed (already employed or self-employed in the national territory96 and their family members) if:

(a) duly substantiated involuntary unemployment after having worked for more than a year in the national territory and registered at the Employment Centre and who have made the declaration attesting to the immediate Willingness to work97 :

– registration with the SSR for as long as you remain unemployed (form of annual verification of the persistence of the requirements for registration);

(b) duly proven involuntary unemployment during the first twelve months of residence in the national territory, registered with the Employment Centre and have made a declaration attesting to the immediate Willingness to work98 :

– registration with the SSR for one year from the date of unemployment;

6) follow a vocational training course. Except in the case of involuntary unemployment, the preservation of the quality of presupposes that there is a link between the professional activity previously carried out and the course of Follow-up training:

– registration with the SSR for the duration of the training course;

(7) holders of Community forms E106/S1, E109/S1 (ex E37),   E120/S1, E121/S1 (ex E 33), SED 07299 

– registration with the SSR for the duration of validity indicated in the form. The more detailed description is given in the part of the forms;

8) victims of trafficking or enslavement admitted to programs social protection100 ;

– registration with the SSR is formalised following submission of the documentation and is valid for the entire duration of the program assistance;

9) already employed or self-employed, temporarily incapacitated as a result of illness or accident

– maintains his/her enrolment for as long as the state of illness persists, or accident, regardless of the type of employment contract (employed or self-employed);

10) Enrolled in the mobility lists

– maintain the registration for as long as the mobility period lasts101 ; (11) detainees in adult and juvenile prisons, and internees in judicial psychiatric hospitals; in semi-freedom, subjected to alternative measures to punishment

– registration for as long as the penalties last102 ;

12) EU parents of Italian minors, in compliance with the Law 176 of 27 May 1991 “Ratification of the Convention on the Rights of the Child, done at New York on November 20, 1989”:

– with registration renewed every year.

13) minors in the care of institutions or families In the presence of the above requirements that entitle you to registration SSR, EU citizens can formalise the registration regardless of residence in Italy or in Member State.

 ——–  91 Circ. Min. della Salute Prot. DGRUERI/11/12712/1.3.b of 3 August 2007.

 ——–  92 Some Regions have indicated that they will be registered with a for the first five years or implement forms of verification of the Persistence of enrollment requirements.

 ——–  93 Art. 2 of Legislative Decree no. 30/2007: ‘family member’ means:

(1) your spouse;

(2) the partner who has contracted with the Union citizen a registered partnership on the basis of the law of a Member State Member State, where the legislation of the host Member State equate a registered partnership with marriage and in compliance with the conditions laid down in the relevant legislation of the Member State host

(3) direct descendants under 21 years of age or dependents, and those of the spouse or partner;

(4) the dependent direct relatives in the ascending line and those of the spouse referred to in

(b).

 ——–  94 Art. 10 of Legislative Decree no. 30/2007: non-EU family members of citizens of the Union request the competent Police Headquarters to territory of residence the Residence Card of a family member of a citizen of the Union (which becomes permanent after 5 years). Please note that non-EU citizens may be allowed to EC residence for long-term residents” (pds CESLP), previously referred to as a “residence card” pursuant to Article 9 of the TU and art. 16, paragraph 2 of Presidential Decree no. 394/1999, (as amended from the entry into force of Legislative Decree no. 3 of 8 January 2007) which is a residence permit for an indefinite period and gives the right to registration with the SSN for an indefinite period.

 ——–  95 Art. 14 of Legislative Decree no. 30/2007: “Union citizens who have resided legally and continuously for five years in the national territory has the right to permanent residence not subject to the conditions laid down in Articles 7, 11, 12 and 13.”  .  Article 17 of Legislative Decree No. 30/2007: “To the family members of the citizen not nationals of a Member State of the European Union, who have acquired the right of residence the Police Headquarters issues a permanent residence card for family members of European citizens.”

See also Article 15 of Legislative Decree No. 30/2007: exceptions to the provisions relating to the right of permanent residence which may be be acquired/vested before the rolling period of five years of stay, under the conditions described herein.

 ——–  96 By Art. 7, paragraph 3 of Legislative Decree no. 30/2007 conditions under which a Union citizen, who is already a worker, subordinate or self-employed in the national territory, retains its own status of “employed or self-employed in the state” and consequently, the right to register with the SSR.

 ——–  97 Art. 2, paragraph 1 of Legislative Decree no. 181 of 21 April 2000, as well as replaced by Article 3 of Legislative Decree No. 297 of 19 December 2002.

 ——–  98 referred to in Article 2, paragraph 1, of Legislative Decree no. 181 of 21 April 2000, as replaced by Article 3 of Legislative Decree 19 no. 297 of December 19, 2002.

 ——–  99 For a description of the forms, see section 2.3.2

 ——–  100 Art. 6, paragraph 4 of Law no. 17 of 26 February 2007: The provisions of this Article shall apply in so far as compatible countries, including to citizens of EU Member States who are in a situation of gravity and actuality of danger”.

 ——–  101 Art. 15, paragraph 3 of Legislative Decree no. 30/2007

 ——–  102 Art. 1 of Legislative Decree no. 230 of 22 June 1999, “Reorganization of the Penitentiary Medicine in accordance with Article 5 of Law 30 November 1998, no. 419”, paragraphs 5 and 6: “The following are registered with the foreigners, limited to the period in which are detained or interned in penitentiary institutions. These subjects have equal treatment and full equality of rights with respect to the to free citizens, regardless of the regular permit of stay in Italy. Prisoners and internees are excluded from the Cost-sharing system for health services provided by the National Health Service”.

For the services provided to prisoners and internees, Regardless of nationality, the Code of Reference applies. F01 exemption.

2.2. Health Insurance Contract and Voluntary Registration Health insurance is aimed at particular groups of citizens of the Union who have their residence or residence in Italy, and are not covered by the State of Origin in accordance with EU safety regulations that they do not show certificates of entitlement (Models E 106/S1, E 120/S1, E 121/S1, E 109/S1, SED 072, TEAM), or are not entitled to compulsory registration.

EU citizens have the right to reside in the national territory for periods of more than three months, including   qualoral103 :  • has resources for themselves and their families sufficient economic resources104 , so as not to become a burden on the of the State’s social assistance during the period of residence and a health insurance contract, (in implementation of the current legislation105 and with the characteristics of private or public sector covering all risks in the inland;

• is enrolled in a recognized public or private institution to follow as your main activity a course of study or vocational training and disposes, for himself and for his of sufficient economic resources, so as not to become a burden on the State’s social assistance system during its period of stay, to be attested by a declaration or with other appropriate documentation and an insurance contract private or public health covering all risks in the inland.

These citizens must be registered in the municipal registry (registration as residents or, in cases where maintain their residence in another EU country, in the file of the temporary population). The health insurance contract does not entitle you to registration with the SRG. The private insurance contract must be Meet the following requirements106 :

– be valid in Italy,

– cover all risks in the host Member State107 ;

– have a duration of one year with an indication of the commencement and expiration

– indicate the family members, if any, covered and the degree of kinship,

– indicate the procedures and formalities to be followed for the request of the refund. In addition, the need for the interested party to submit An Italian translation of the insurance policy. As an alternative to the health insurance contract, citizens of the Union who have their registered residence, may health coverage through public health insurance (in Italy voluntary registration)108 .

For EU citizens enrolled in a course of study, for the purposes of voluntary enrolment is independent of the requirements of the residence, the declaration of domicile being sufficient. Voluntary registration can be made with the payment of the of the amounts provided for in the Ministerial Decree of 8 October 1986.

 ——–  103 Article 7, paragraph 1, letters b) and c) of Legislative Decree no. 30/2007.

 ——–  104 The availability of sufficient economic resources may be self-certified by the interested party (alt. 46 and 47 of Presidential Decree 445/2000) and For their quantification, the parameter the amount of the minimum social allowance (consisting of Euros 5,317.65 per year – quota for the year 2009) considered sufficient for the residence of the applicant and a family member, doubled in the case of one or two additional family members, tripled six family members living together are four or more than four, also taking into account any income from cohabiting family members.

“Sufficient” resources can be periodic, accumulated, provided by third parties (Ministry of the Interior Circular, no. 18 of 21 July 2009).

 ——–  105 Ministerial Decree of 8 October 1986.

 ——–  106 Circular of the Ministry of Health DG RUERI/II/12712/1.3.b of 3 August 2007.

 ——–  107 EC Directive no. 38/2004, Article 7, paragraph 1, letters b) and c).

 ——–  108 Guide to a better transposition and application of the Directive 2004/38/EC on the right of citizens of the Union and of their family members to move and reside freely within the Member States. European Commission No. 13 of 2 July 2009 and Ministry of the Interior Circular no. 18 of 21 July 2009.

2.3. EHICs and Attestations of Right, issued by Institutions Community Forms (Community Forms) EU Regulation No. 631/2004 has significantly modified the existing Community legislation, providing for the introduction of progressive from 1 June 2004 of the EHIC (European Football Card) Health Insurance) which replaces the corresponding models issued for the benefit of benefits in the event of a temporary stay in another Member State from the place of residence.

Citizens of the European Union assisted by another Member State109 , in a “temporary stay” in Italy is guaranteed access to health services that are necessary through the EHIC. It should be noted that: 1 citizens of the Union shall have the right to reside in the Italian territory for a period not exceeding three months without any condition or formality, except the possession of a document valid for expatriation according to the legislation of the State of which they are national”110   . 

The European Commission has also established111 that the Member State must allow the Union citizen not to move their residence even for stays of more than three months, “such as students or posted workers or citizens who do not intend to move permanently to Italy as maintain their centre of interests in the State of provenance” . In both of the above cases of temporary stay112 (less or less more than three months), EU citizens will be able to use the TEAM113 ,114 issued by your country to receive all treatment considered medically necessary in relation to the duration of the temporary stay and in a state of health, In this case, you will not be registered with the SRG.

The EHIC has replaced the Community models: E 111 (temporary) stay for tourism); E 128 (temporary stay for study and for posted workers); E 110 (road transport) international); E 119 (temporary stay for the purpose of looking for a job; only for the section on health services). The EHIC allows a citizen “assisted” by a Member State115 , temporarily located in another Member State, to access the directly to the health services of that country, to the same conditions of the beneficiaries of that State and to receive all the medically necessary services, taking into account the nature of benefits and length of stay116 ,117 (yes deals with the so-called ‘alignment of rights’ principles, ‘direct access to care providers’ and the ‘principle of

non-discrimination”). Women have the right to check-ups during pregnancy, childbirth if unplanned (urgent, premature). For the birth event the E 112/S2 model is to be requested. The interruption of Pregnancy is guaranteed only if medically necessary118 Health benefits (included in the essential levels of assistance pursuant to the Prime Ministerial Decree of 29 November 2001 and subsequent amendments and additions, and consequent provisions are provided in Italy on the basis of certificates of rights granted to the assisted in relation to the reason for the stay (temporary stay, transfer for treatment to Italy, transfer of residence to Italy of workers or pensioners or members of their families, accident at work or occupational disease,

etc.). The services provided by General Practitioners or Paediatricians of Free Choice are paid with the system of occasional visits by the ASL and not by the interested parties on whom they do not No burden is imposed119 ,120 . If the services of the Continuity Medicine are present Assistance and Tourism Medicine, the patient is required to payment of the contribution to the expense, where applicable, with the possibility of to request reimbursement from their competent institution at the return to their home country.

The EHIC or any provisional replacement certificate and some Formulari (E106/S1, E109/S1, E112/ S2, E120/S1, E121/S1, E123/DA1, SED 5072) are normally issued by the competent institution of the Union citizen’s country of origin before the departure for Italy, so that they can already be used upon arrival in Italy, or in any case, in case of need of assistance Health. If the Union citizen is in Italy without a certificate and, therefore, in the impossibility of proving the right to receive health care at the expense of the foreign institution in which he/she is registered, the patient is Holder of the debit invoice for the services rendered. until the presentation of a provisional replacement certificate of the

EHIC that guarantees the economic coverage of the services yields in the periods in which the event occurred. Such an invoice can only be reconsidered after the insurance coverage has been for the necessary periods is received from the foreign institution competent. Certificates can be requested from the foreign institution declared by the EU citizen also by the ASL (if the length of the patient’s stay allows it)121 .

The competent foreign institutions certify the right to benefit from Italy of the health services specifically provided for by the TEAM and each Formulate and assume the burden of the services healthcare provided in Italy. The forms have different purposes as summarised below. I title dei Form E1061S2, E109/S2, E120/S1, E121/S1, SED S072 are entitled to registration with the SSR and the GP/PLS.

On the EHIC and on each Formula, the following is indicated in the appropriate box: the code of the issuing State and the expiry date by to which the benefits may be provided. The prescription of medical and specialist examinations and the provision of medicines for EU citizens temporarily residing in Italy owners of the EHIC, take place through the new recipe filled in both on the front where, next to the data personal data and tax code, the abbreviation EU is reported, both on the back, set up to collect the data of the foreign institution competent.

 ——–  109 Such is a person who is in possession of a certificate of entitlement, in so far as being a citizen, in accordance with EU safety regulations does not give rights, unlike what happens in the case of of the Free Movement Directive, the beneficiaries of which are the Citizens.

 ——–  110 Art. 6 of Legislative Decree no. 30 of 6 February 2007.

 ——–  111 Communication from the Commission to the European Parliament and the Council – COM 2009, 313 of 2 July 2009 “Guide to better transposition and application of Directive 2004/38/EC on the Right of EU citizens and their family members to move and reside freely within the territory of the States members”.

 ——–  112 In the case of temporary residence of more than three months, “the register the persons concerned in the temporary population, in accordance with the provisions of art. 8 of L. n.1228/1964 (registry law) and art. 32 of Presidential Decree n. 223/1989 (registry regulations).

 ——–  113 Or Provisional replacement certificate.

 ——–  114 The costs of health care services will be to be paid for by the competent foreign institutions.

 ——–  115 A person in possession of a certificate of entitlement is a person who is in possession of a certificate of entitlement, Being a citizen does not give you rights under the regulations social security systems, unlike in the the case of the Free Movement Directive, whose beneficiaries they are the citizens.

 ——–  116 EU Regulation no. 631/2004.

 ——–  117 It does not entitle you to register with the SSR or to choose your GP.

 ——–  118 In this case, if the interested party is provided with an appropriate certificate issued by your own country, the service is free of charge (except for any ticket)”. Circ. Min, Health DG RUERI/11/1271211.3.b of 3 August 2007.

 ——–  119 The provision as a whole excludes from the possibility of payment all health services, although necessary, but which constitute the the very purpose of the trip to Italy: to take advantage of these services the need for prior authorisation by the of the competent foreign institution notified to the ASL by means of presentation of the Mod. EI 12/S2. In principle, the assessment of the need for “from a medical point of view, taking into account the nature of the and duration of stay” is carried out in science and conscience from the caregiver. The services provided must be be included in the essential levels of care. A principle guide may be to consider unnecessary and therefore not all health services that can normally be postponed can be provided

without the slightest risk to the insured until they return home planned temporary stay in Italy for reasons not sanitary.

 ——–  120 Art. 56 of the National Collective Agreement of 15 December 2005

– Text supplemented by I’A.C.N. of 29 July 2009 and Art, 57 of the National Collective Agreement of 23 March 2005 – Text integrated with the A.C.N. of 29 July 2009.

 ——–  121 For the request of forms from the foreign institution, the ASL will use the mod. E107 or S071 to request E106, E109, E120, E121/S1 o S009 to request E112/S2 or SO44 to apply for the EHIC or the replacement certificate. If the duration of the stay is not to obtain the forms, the services will have to be paid for directly from the patient who can request reimbursement to the return to his country. If applicable, the ticket must be paid even in the presence of a certificate and remains at the patient’s expense.

2.3.2. Attestations of law issued by Community institutions (Community forms) The Forms, normally issued by the competent institution of the country of origin of the Union citizen before departure for Italy, they are used for ‘Registration with the SSR of certain categories of Union citizens residing in a country (Italy or other European country) other than the competent one. E 106/S1 or SED S072: certificate of entitlement to Benefits in kind for sickness and maternity of residents in country other than the competent country, posted workers and family members residing with them, cross-border commuters, students, family members of Unemployed.

Duration of the registration equal to the duration of validity of the mod. E1   06/S1.  Enrolment is made by choice of the general practitioner. The “information document”122 must be issued; should not be issued the EHIC, in the other forms, but the TS asterisked (without value   TEAM).  El 09/S1 or SED 5072: certificate for the registration of family members ( employed or self-employed) residing in another State by the competent one.

Duration of the registration equal to the duration of validity of the mod. E1   09/S1.  Enrolment takes place with the choice of the general practitioner and with the issuance of the health card on equal terms with the Italian citizens residing there. The “information document” must be issued123 ; should not be issued the EHIC, in the other forms, but the TS asterisked (without value   TEAM). 

E 112/S2 or SED S010: certificate of planned treatment in a Member State other than the competent State. The services are provided on the basis of medical indications. There is no registration with the SSR or the choice of a medical doctor general. The “information document”124 must be issued; they don’t go issued the EHIC, in the other forms, but the TS asterisked (without TEAM value).

The mod. El 12/S2 only covers the treatment for which he has been made the transfer. Other Treatments That Could Be Rendered necessary during the temporary stay not related to the pathology in question must be delivered through the EHIC. E 120/51 or SED S072: certificate of entitlement to health benefits for pension or annuity applicants, and for their family members residing in a Member State other than that of the competent.

Duration of the registration equal to the duration of validity of the mod.   E120/S1.  Enrolment is made by choice of the general practitioner. The “information document”125 must be issued; should not be issued the EHIC, in the other forms, but the TS asterisked (without value   TEAM).  E 121/S1 or SED S072: certificate for the registration of holders of pension or members of their families residing in a Member State other than the competent one.

Membership duration: unlimited. Enrolment is made by choice of the general practitioner. The “information document” must be issued126 ; should not be issued the EHIC, in the other forms, but the TS asterisked (without value   TEAM).  The doctor chosen by the holders of the above-mentioned models must not fill in the prescription for “outpatient visit” or “Home visit. E 123/DA1: Certificate of entitlement to benefits health care resulting from accidents at work and illnesses of employed or self-employed persons in the Union resident or residing in Italy for work purposes or to receive treatment of occupational diseases. It is not provided registration with the SSR and the “information document” must be issued, and

It cannot be extended to dependent family members. General notes for the Community’s Residence/Actual residence An EU citizen shall be registered in the of the ASL in whose territory he/she resides or has or, in the absence of such a request, in the territory in which declares that he/she has his/her actual residence/domicile. Self-certification With regard to self-certification, art. 3, paragraph 1 of the decree of President of the Republic no. 445 of 28 December 2000 equates the citizens of the European Union to Italian citizens. Therefore requirements such as residence, family status, composition of the family unit, quality of living dependent, birth of child, Unemployment status, marital status, possession and code number

tax number, VAT number and any data in the archive of the tax registry, etc., can be self-certified127 . It should be remembered that Public Administrations can no longer request, nor accept, documents or certificates from its users containing information already in the possession of a public office (a following the entry into force, as of 1 January 2012, of the Amendments to the rules on certificates and declarations contained in the Consolidated Law Presidential Decree 445/2000 introduced by

Art. 15, paragraph 1 of Law no. 183 of 12.11.2011). Fiscal Code In all cases of registration with the SSR both of “EU citizens” that of “convention holders” or “foreign nationals” it is necessary to acquire the Italian Tax Code number. The central and peripheral offices of the Revenue Agency issue, upon request, the Tax Code to all citizens and to all citizens of the European Union, Space and European Economic and Swiss Economic Association on presentation of a document of valid and comprehensible recognition.

Dependents It should be noted that with regard to the identification of those who are dependent, reference is made to the regulatory provisions128 regulate tax deductions for family expenses (Provv. Revenue Agency, prot. No 12293/2010): “All members of the family are considered to be dependent family members for tax purposes of households who did not have an income in 2009 total amount of more than 2,840.51, gross of charges Deductible.

They may be considered dependents, even if they do not cohabiting with the taxpayer or residing abroad: the spouse who is not legally and effectively separated;

children (including recognised, adopted, fostered natural children, or affiliates) regardless of whether certain age limits and whether or not they are engaged in studies or Free internship. The following others may also be considered dependents family members, provided that they live with the taxpayer or that receive maintenance payments from the same person who are not entitled to measures of the Judicial Authority: the spouse legally and effectively separated: the descendants of the children; Parents (including birth and adoptive parents); Genres and daughters-in-law; father-in-law and mother-in-law; brothers and sisters (also unilateral); grandfathers and grandmothers (including natural ones)”

 ——–  122 Note Ministry of Health DGPROGS/26053/1 3 b/1

 ——–  123 Note of the Ministry of Health DGRUERI/9310/1.3.b of 18 November 2004

 ——–  124 Note of the Ministry of Health DGRUERI/9310/1.3.b of 18 November 2004

 ——–  125 Note of the Ministry of Health DGRUERI19310/1.3.b of 18 November 2004

 ——–  126 Note of the Ministry of Health DGRUERI/9310/1.3.b of 18 November 2004

 ——–  127 Art. 46 of Presidential Decree no. 445 of 28 December 2000 ” with declarations, also contextual to the application, signed by the interested party and produced in place of the normal Certifications the following statuses, personal qualities and facts: Date and place of birth; residence; citizenship; Enjoyment of rights civil and political; Single, married, widowed, or free; family status; existence in life; birth of the child, death of a spouse, ascendant or descendant; Registration in registers, in lists kept by public administrations; Membership in professional associations; qualifications, exams taken; qualification professional qualification, specialization title, qualification, training, refresher and qualification

technique; income or economic situation, including for the purposes of granting of benefits of any kind provided for by law Special; fulfilment of specific contribution obligations with an indication of the amount paid; possession and number of the tax code, VAT number and any data present in the archives of the tax registry; unemployment status;

status of pensioner and pension category; QUALITY OF student; as legal representative of natural persons or legal guardians, guardians, curators and the like; Registration at associations or social formations of any kind; All situations relating to the fulfilment of military obligations, including including those attested in the matriculation sheet of the State of service; that they have no criminal convictions and that they are not recipient of measures relating to the application of preventive measures, civil decisions and entered in the criminal record in accordance with the current legislation; Say you are not aware that you are being subjected to criminal proceedings; quality of living dependent; All data at

direct knowledge of the data subject contained in the registers of the marital status; that they are not in a state of liquidation or bankruptcy and not to have filed an application for an arrangement with creditors.

 ——–  128 Art. 23 of Presidential Decree no. 600/73 and art. 12 and 13 of Presidential Decree 917/86 and subsequent amendments and additions; Provv. Revenue Agency,  prot. N. 12293/2010 

2.4. Indigent residents, without EHIC, without attestation of right of residence, without requirements for registration with the SSR Citizens of the European Union, not residing in the territory that do not meet the requirements for compulsory registration to the NHS and are not assisted by the States of origin (i.e. who do not have certificates of entitlement Models E 106/S1, E 120/S1, E 121/S1, E 109/S1 and SED 072, TEAM), are required to pay the benefit provided to them.

If you are unable to pay the benefit because you are destitute, then they will have to self-certify to the ASL that they do not meet the requirements and self-declare their condition of poverty (as attached) In this case, these citizens will be issued with a card129 through which the following benefits will be ensured130 ,131 : • urgent outpatient and hospital care or in any case essential, even if continuous132 , due to illness and accident, • preventive medicine programmes are extended to safeguard of individual and collective health In particular, the following are guaranteed:

(a) the social protection of pregnancy and maternity, on an equal footing processing with Italian citizens, pursuant to 29 405 of July 1975, No 194 of 22 May 1978, and of the Decree of Minister of Health 6 March 1995, published in the Official Gazette Official Decision No. 87 of 13 April 1995, on an equal footing with Italian citizens133 ;

(b) the protection of the health of the child in compliance with the Convention on the Rights of the Child of 20 November 1989, ratified and made enforceable pursuant to Law 27 May 1991, n.   176; 

c) vaccinations in accordance with the regulations and as part of interventions collective prevention campaigns authorised by the regions; d) international prophylaxis interventions;

(e) the prophylaxis, diagnosis and treatment of infectious diseases, and possible remediation of the relevant outbreaks;

(f) treatment, prevention and rehabilitation of drug addiction. Prescription and registration of benefits in respect of of the above-mentioned EU citizens are carried out with the the use of a regional code which, according to what is already the case, in 13 Regions and Public Administrations, it can be called ENI (European Non-European Subscribed)134 , also for the purposes of the traceability of Requirements.

The card can be issued on the occasion of the first provision of services or, in order to facilitate access to treatment, at the request of the interested party, as a result of: – exhibition of identity document in accordance with European legislation,

– declaration of domicile in the regional territory (for more than three months),

– declaration that he/she is not registered in the residents’ registry,

– declaration of not being in the conditions of registration for the SSR, that it has not taken out any insurance contract health care, to be without a certificate of entitlement issued by the country of origin,

– signing of the declaration of indigence. The card is valid for six months in the regional territory of emission and is renewable. The card can be used for:

– the prescription on regional blackmail of health services (clinical-instrumental examinations, specialist visits),

– the prescription of drugs that can be dispensed, with the same conditions of participation in the expenditure with Italian citizens, by the affiliated pharmacies,

– the reporting, for the purposes of reimbursement, of benefits provided by the SSR135 facilities. Participation in the expense (Ticket) The benefits must be provided on equal terms with the Italian citizens with regard to the eventual cost sharing.

 ——–  129 Services are provided and recorded through the Code Regional in the following Regions and P.A.: Balzano (CTA code), Lombardy (code CSCS), Tuscany (code STP), Friuli Venezia Giulia, Piedmont, Liguria, Veneto, Emilia-Romagna, Marche, Lazio, Abruzzo, Molise, Campania, Puglia, Sicily, Sardinia (ENI Code). Umbria and P.A. Trento have given indications for the disbursement of treatments that cannot be postponed but without ENI code.

 ——–  130 With reference to the inviolable rights of the Constitution that establishes “the protection of health as fundamental to the the right of the individual and the interest of the community and guarantees free care for the most deprived” and the “principle of not discrimination’ within the meaning of Article 10 of the Treaty on Functioning of the EU

 ——–  131 Min. Circ. of Health DGRUERI/11/3152-P/1.3.13/1 of 19 February 2008: “We are of the opinion that 13.Lgs 30/2007 should be harmonised with the rules of principle of the Italian legal system (Article 32 of the Italian Constitution), from the principles of which derive the solidarity and universal character of the health service National”

 ——–  132 Assistance for essential and continuing services is disbursed according to the procedures identified by the Regions and Public Administrations.

 ——–  133 Circ. Min. Health DGRUERI/11/31521P/I.3.b/1 of 19 February 2008 “Health services related to the protection of maternity, Voluntary interruption of pregnancy, with the same conditions with assisted women registered with the NHS, in application of the laws 405 of 29 July 1975, No 194 of 22 May 1978, and Decree 10 September 1998”.

 ——–  134 The ENI code is an identification code consisting of 16 Characters:

– three characters consisting of the initials ENI

– three characters consisting of the ISTAT code relating to the region

– three characters consisting of the ISTAT code relating to the ASL (Health Authority) that assigns the code – seven characters for If sequential number assigned at the time of issue

 ——–  135 Circ. Min. della Salute Prot. DG RUERI/II/12712/1.3.b of 3 August 2007; Circ. Min. of Health DG RUERI/11/3152-P/1.3.b/1 of February 19, 2008: “Of all these services shall be kept, by the Local Health Authorities, separate accounts, which show that the identity of the Community citizen and the benefits received, which will be taken into account for the recovery and negotiation of the vis-à-vis the competent States in the Community or diplomatic forum”

3. Summary of procedures (Synoptic tables) Foreigners not belonging to the European Union Registration required Part of the measure in graphic format Voluntary enrolment Part of the measure in graphic format Entrance and stay for medical treatment Part of the measure in graphic format Without a residence permit STP (Foreigners Temporarily Present) Part of the measure in graphic format Citizens of the European Union Registration required Part of the measure in graphic format Enrollment or Membership Maintenance at the expense of the competent foreign institution Part of the measure in graphic format Voluntary registration with the SRG Part of the measure in graphic format ENI Code Indigent EU residents, without EHIC, without certificate of

right of residence, without requirements for registration with the SSR Part of the measure in graphic format

4. Attachments

4.1 Forms FOREIGN NATIONALS WHO ARE NOT IN COMPLIANCE WITH THE RULES REGARDING ENTRY AND STAY Part of the measure in graphic format INDIGENT COMMUNITY RESIDENTS, WITHOUT TEAM, WITHOUT ATTESTATION OF ENTITLEMENT TO STAY, NO ENTRY REQUIREMENTS                                AL SSR  Part of the measure in graphic format DECLARATION OF INDIGENCE Part of the measure in graphic format

4.2 List of reference standards List of reference standards The references are given below (in chronological order) national and European regulations mentioned in the text General References Italian Constitution, art. 32, 1948 Law no. 405, 29 July 1975: Establishment of Family Counselling Centres L 194, 22 May 1978, and the Ministerial Decree of 10 September 1978 1998:  Norms for the social protection of maternity and interruption Voluntary Pregnancy Dublin Convention, 16 June 1990 Convention on the Determination of the State Responsible for Examination of an asylum application lodged in one of the Member States of the European Communities Law no. 176 of 27 May 1991: Ratification and implementation of the Convention on the Rights of the Child

Done at New York, 20 November 1989 Constitutional Law No. 3, October 18, 2001: Amendments to Title V of Part Two of the Constitution Prime Ministerial Decree of 29 November 2001: Definition of essential levels of care Non-EU foreigners Law no. 1228 of 24 December 1954: Organisation of the resident population registry L No 304 of 18 May 1973: Ratification and implementation of the European Agreement on Placement at the adopted in Strasbourg on 24 November 1969  Law No. 184 of 4 May 1983: Regulation of the adoption and custody of children D.M. Sanita’ of 8 October 1986: Determination of the assistance contribution for 1986 health insurance for foreign citizens, pursuant to art. 5 of the Decree-Law No 663 of 30 December 1979, converted into Law 29

February 1980, No 33 Presidential Decree no. 309 of 9 October 1990: Consolidated text of the laws on the regulation of narcotic drugs and psychotropic substances, prevention, treatment and rehabilitation of psychotropic substances. states of drug addiction Legislative Decree no. 502 of 30 December 1992: Reorganization of the health regulations, in accordance with Article 1 Law no. 421 of 23 October 1992 D. Lgs. 517/93:  Amendments to Legislative Decree No. 502 of 30 December 1992, reorganisation of the health regulations, in accordance with the art. 1 of Law no. 421 of 23 October 1992 Legislative Decree no. 286 of 25 July 1998: Consolidated text of the provisions concerning the discipline Immigration and rules on the status of foreigners

Presidential Decree no. 394 of 31 August 1999: Regulation laying down rules for the implementation of the Consolidated Law on Immigration Provisions on immigration rules and on the status of the foreign national, in accordance with Article 1(6), Legislative Decree no. 286 of 25 July 1998 Legislative Decree no. 230 of 22 June 1999: Organisation of prison medicine in accordance with Article 5 of the Law no. 419 of 30 November 1998 Ministry of Health Circular No. 5 of March 24, 2000: Indications for the application of Legislative Decree 25 July 1998, n.

286 “Consolidated text of the provisions concerning the of immigration and rules on the status of foreigners” – Health care provisions Telex Min. S DPS-X-40-286/98 of 3 April 2000 Judgment of the Constitutional Court no. 376 of 27 July 2000: “Constitutional illegitimacy of art. 17, paragraph 2, letter d) Law no. 40 of 6 March 1998 (Immigration regulations and on the condition of the foreigner), now replaced by art. 19, paragraph 2(d) of the DIGS. 286 of 25 July 1998 (Consolidated Law on the Provisions on immigration rules and on the status of the foreign national), in so far as it does not extend the prohibition of expulsion to the husband of the woman living with the woman in a state of pregnancy or within six months of the birth of the child”

Presidential Decree no. 445 of 28 December 2000: Legislative provisions on administrative documentation Legislative Decree no. 196 of 30 June 2003: Code regarding the protection of personal data EC Regulations No. 1408 of 1971, No. 574 of 1972, pending the implementation of EC Regulation No. 883 of 29 April 2004, European Parliament and of the Council on the coordination of Social security systems Ministry of Health Circular DGRUERI VI/AG412591 of 4 June 2004  Presidential Decree no. 681 of 31 July 1980: Health care in Italy for men and women religious of the clergy who work abroad and who receive a remuneration equivalent to employment income pursuant to Law 222/85 and Presidential Decree no. 33 of 17.2.87

Legislative Decree no. 3 of 8 January 2007: Implementation of Directive 2003/109/EC on the status of third-country nationals who are long-term residents Legislative Decree no. 30 of 6 February 2007: Implementation of Directive 2004/38/EC on the right of citizens of the Union and their family members to move and freely reside in the territory of the Member States” Ministry of the Interior and Ministry of Family Directive of 21 February 2007: Abolition of the application for a residence permit for the minor alien adopted or fostered for the purpose of adoption.

Ministry of Health Circular DGRUERINIA.3.b.a15719/13 of 17 April 2007: Clarifications on health care for citizens following the recent Directives issued by the Ministry of the Interior Ministry of Health Circular, DGRUERIA/1/11494/1.3.b.a./P of 19 July 2007: Enrolment in the National Health Service of students who do not belonging to the European Union Ministry of Health Note DGRUERI/II/12712/1.3.b of 3 August 2007: Right of residence for EU citizens, Directive 3872004 and Legislative Decree no. 30 of 3 February 2007 Intergovernmental Agreement between the Government of Italy and the Government of Belarus on the conditions for the rehabilitation of Belarusian children in Italia (artt. 2 e 4), anno 2007 

Legislative Decree no. 251 of 19 November 2007: Implementation of Directive 2004/83/EC on minimum standards on the attribution to third-country nationals or stateless persons of the qualification of the refugee or person otherwise in need of international protection, as well as minimum standards on the content of the Recognized protection Ministry of Health Circular DGRUERiNI/1.3.b.a120114/P of 19 November 2007: Registration with the National Health Service of non-EU citizens EU citizens awaiting the issuance of a residence permit for family reasons and new regulations introduced by Legislative Decree 10 August 2007, n. 154 D.M. of 17 March 2008: Revision of the Ministerial Decree of 18 May 2004, implementing the

paragraph 2 of Article 50 of Law No. 326 of 2003 (Project health card), concerning the model of medical prescription book a National Health Service (Annex: Disciplinary NHS and SASN prescription technician) Ministry of Health DGRUERIN1/.3.b a/4537/P of 24 February 2009: New provisions on family reunification under the Article 29 of the Consolidated Law on Immigration, as amended by Legislative Decree No. i60 of 3 October 2008. Health Insurance for reunification of a parent over sixty-five years of age Ministry of Health Circular DGRUERINI/Bba/8489/P of 16 April 2009:  Health care in Italy for holders of residence permits who carry out regular work Ministry of Health Circular DGRUERINI/.3.b.a/9682 of 4 May

2009:  New provisions on family reunification under the Article 29 of the Consolidated Law on Immigration, as amended by Legislative Decree no. 160 of 3 October 2008 Law no. 94 of 15 July 2009: Provisions on public security Ministry of the Interior Circular No. 19 of 7 August 2009: Law no. 94 of 15 July 2009, containing “Provisions on public safety.” Indications on the subject of registry and status civilian Ministry of the Interior Circular, prot. No. 0004820 of 27 August 2009:  Law no. 94 of 15 July 2009 on “Provisions on Public Safety Ministry of the Interior Circular No. 12, prot. 7801A7 of 27 November 2009:  Health care for foreigners who are not registered with the Service National Health Notice Prohibition of reporting foreigners who are not in the

rules with the rules of the stay. Subsistence European Parliament Resolution A7-0032/2011 of February 2011 on reducing health inequalities in the EU Prime Ministerial Decree of 5 April 2011 issued pursuant to Article 20, paragraph 1 of the T.U.  Humanitarian temporary protection measures EU foreigners European Community Regulations Regulation 1408/1971 (currently valid only for Member States)

EEA, Switzerland and non-EU citizens) Regulation (EC) 574/1972 (currently valid only for Member States) EEA, Switzerland and non-EU citizens) Regulation (EC) No 631/2004 amending Regulation (EEC) No 631/2004 Council Regulation (EEC) No 1408/71 on the application of the social security for workers, the self-employed and their family members moving within the Community and the Council Regulation (EEC) No 574/72 laying down the detailed rules for the implementing Regulation (EEC) No 1408/71, as regards the alignment of rights and simplification of procedures Directive 2004/38/EC “The rights of citizens of the Union and their family members to move and subjugate freely in the territory of the Member States’ of 29 April 2004

Legislative Decree no. 30/2007 “Implementation of Directive 2004/38/EC on the the right of Union citizens and their family members to move and to reside freely in the territory of the Member States” of 6 February 2007 Guide to better transposition and enforcement of the Directive 2004/38/EC on the law of citizens of the Union and their family members to move and reside freely within the territory of the Member States. European Commission No. 313 of 2 July 2009 Regulation (EC) No 987/2009 laying down the procedures for application of Regulation (EC) No 883/2004 on the coordination of social security systems of 16 September 2009 Regulation (EC) No 988/2009 amending Regulation (EC) No 883/2004 EU Regulation 1231/2010 extending EC Regulations No. 883/2004 and

EC No. 987/2009 to third-country nationals who are legally resident in the territory of the Member States (excluding the United Kingdom and Denmark Laws, Decrees, Ministerial Circulars Law no. 1228 of 24 December 1954: Ordering of the registry of the resident population. Ministerial Decree of 8 October 1986: Determination of the assistance contribution for 1986 health insurance for foreign citizens, pursuant to art. 5 of the Decree-Law No 663 of 30 December 1979, converted into Law 29 February 1980, No 33 Presidential Decree no. 223 of 30 May 1989: Approval of the new population registry regulation resident Legislative Decree no. 230 of 22 June 1999: Organisation of prison medicine in accordance with Article 5 of the

Law no. 419 of 30 November 1998 Legislative Decree no. 181 of 21 April 2000: Provisions to facilitate the matching of supply and demand for pursuant to Article 45(1)(a) of the Law no. 144 of 17 May 1999 Legislative Decree no. 297 of 19 December 2002: Amending and correcting provisions of Legislative Decree 21 April 2000, no. 181, laying down rules to facilitate the meeting between labour supply and demand, in implementation of Article 45(1), letter a) of Law no. 144 of 17 May 1999 Presidential Decree no. 334 of 18 October 2004: Regulation amending and supplementing the decree of President of the Republic no. 394 of 31 August 1999 on immigration Ministry of Health Circular DGRUERI/9310/1.3.b of 18 November

2004:  New NHS prescription and how to fill in the bill Foreign institutions of the services provided in Italy under the of international health mobility Legislative Decree no. 30 of 6 February 2007: Implementation of Directive 2004/38/EC on the right of citizens of the Union and their family members to move and residence freely in the territory of the Member States Law no. 17 of 26 February 2007: Conversion into law, with amendments, of Decree-Law 28 300 of December 2006, extending the deadlines provided for by Laws. Legislative delegation provisions Ministry of the Interior Circular No. 19 of 6 April 2007: Legislative Decree No. 30 of 6 February 2007 on “Implementation of the Directive 2004/38/EC of the European Parliament and of the Council of

29 April 2004 on the law of citizens of the Union and their family members to move and reside freely in the territory of the Member States, amending Regulation (EEC) Regulation (EEC) No 1612/68 and repeals Directives 64/221/EEC, 68/360/EEC and 72/194/EEC. 73/194/CI, 75/34/CI, 75/35 (Che), 90/364/CI, 90/365/CI A 93/96/CI Ministry of the Interior Circular No. 39 of 18 July 2007: Legislative Decree no. 30 of 6 February 2007. Right to freedom movement and residence of citizens of the Union and their Family Note Ministry of Health prot. DGRUERI/11/12712/I 3.b of 3 August 2007:  Right of residence for EU citizens – Directive 38/2004 and D.lgs 3/02/2007 n. 30  Ministry of the Interior Circular No. 45 of 8 August 2007:

Legislative Decree No. 30/2007. Right of free movement and residence of citizens of the European Union Note Ministry of Health DGRUER1/11/3152-P/1.3.b/1 of 19 February 2008:  Clarifications concerning health care for citizens Community citizens residing in Italy Ministry of the Interior Circular, no. 18 of 21 July 2009: Directive 2004/38/EC on the rights of citizens of the Union and their family members to move and reside freely within the territory of the Member States. Publication of European Commission guidelines. Clarification of coverage required for the purposes of residence of the Union citizen, and The concept of “resources sufficient for residence”

Note from the Ministry of Health OGRUERI/I1/15645-P of 24 July 2009: Guidelines of the European Commission on the application of the Directive 2004/38 -. Hedging Information Note health care for foreign patients with a European Health Insurance Card Health insurance (EHIC) National Collective Agreement of 15 December 2005 – Integrated text with I’A.C.N. of 29 July 2009: Regulation of relations with doctors general medicine pursuant to Article 8 of Legislative Decree no. 502 of 1992 and Subsequent amendments and additions Provision of the Revenue Agency, prot No. 12293 of 1 February 2010:  Approval of the “Unico 2010-PE” model declaration with the Instructions for this Note from the Ministry of Health DGRUERI/II/005846-P/1.3.b/1 of 30 March

2010:  New Community Social Security Regulations – Card Issuance European Health Insurance for Pensioners (and their family members) and family members of workers Note from the Ministry of Health DGRUERI/11/ 7656- P of 28 April 2010: Information note on the new forms and the commencement of their utilization Note from the Ministry of Health DGRUERI/II/ 7672- P of 29 April 2010: New Community Social Security Regulations, EC Reg. 883/04 (Basic Regulation), Reg. EC 987/09 (Implementing Regulation), General principles and main innovations Note from the Ministry of Health DGRUERI/11/9004- P of 18 May 2010: New Community Social Security Regulations – Compilation Provisional replacement certificate for pensioners (and their family members)

and family members of workers who reside in a country other than the of the head of the family. Note from the Ministry of Health OGRUER1/11/10437-P of 11 June 2010: New decisions and recommendations of the Administrative Commission to be Apply from 1 May 2010 Ministry of Health Note DGRUERI/II/12647-P/1.3.b/1 of 20 July 2010:  Portable Documents & SEDs Ministry of Health Circular DGRUERWI/1.3.b-b/12881 of 22 July 2010:  New EU Social Security Regulations 883/2004 and 987/2009

– Health care for pensioners with two or more pensions residents of another Member State Ministry of Health Circular DGRUERI/11/13254/ 1.3.b/1 of 28 July 2010: Indirect assistance – Pricing: changes introduced by art. 35 lett. B del Reg. 987/09 (ex art. 34 del Reg. CEE 574/72)  Circolare Ministero  della  Salute  DGRUERI/11/18839/1.3.b/1  del  12 ottobre 2010:  Nuova procedura per l’emissione del modello E106 (S1) per lavoratori  Note from the Ministry of Health DGRUERINI/13ball 192 of 13 January 2011: Regulation (EU) No 1231/2010 of the European Parliament and of the Council of 24 November 2010 extending Regulation (EC) No 883/2004 and if Regulation (EC) No 987/2009 to third-country nationals to whom they are

regulations are not already applicable solely because of the NATIONALITY Note from the Ministry of Health DGPROG S/ 3020 /1.3.b11 of 7 February 2012:  EU Regulations 883/2004 and 98712009: portable documents and SEDS Note from the Ministry of Health DGPROGS/ 7257 /1.3.b/1 of 19 March 2012: EU Regulations 883/2004 and 987/2009: application to Switzerland Note from the Ministry of Health DGPROGS/ 7366 /1.3.b/1 of 20 March 2012: EU Regulations 883/2004 and 987/2009: Italy’s transition from double accounting regime to the single one at cost Note from the Ministry of Health DGPROGS/ 852511.3.b/1 of 30 March 2012:  Portable document issuance S1 (E106) for public workers Note from the Ministry of Health DGPROGS/ 11841 /I.3.b/1 of 10 May

2012:  EU Regulations 883/2004 and 987/2009: application to EEA States Note from the Ministry of Health DGPROGS/ 17416 /1.3111 of 11 July 2012:  Al and S1 for workers – clarifications. 11.07.2012 Note from the Ministry of Health DGPROGS/28053/13.b/1 of 19 October 2012  EU Regulations 883/2004 and 987/2009: Italy’s transition from double accounting regime to the single one at cost. Clarification of compilation NHS recipe