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

I experienced the new procedure for a client of mine at the national healthcare registration office (SSN) in Campobasso, Molise region.

I must admit it wasn’t easy because at the office nobody knew the exact, updated procedure or the new law as all the information passed to the local office is a short, inadequate and often inaccurate “circolare” (newsletter) from circolare del ministero della salute.

My situation was registering a family of expats who are moving to Italy with an elective residence visa (and relevant permit).

Apparently, we were stuck in a deadly vicious circle: the Questura (Italian local police office) would not release the elective residence permit without the health registration (SSN), but the health office would not let the user register without showing the issued permit!

At least, that’s what they told me repeatedly when I called the director of the office for information.

I pointed out that this was a vicious circle for anyone applying for the elective residence visa (and permit), but they insisted that their answer was correct because it was based on the latest Circolare (a sort of official newsletter) from the Italian Ministry of Health, which explicitly requires the Permesso di soggiorno in order to be able to register with the SSN.

Another important point they tried to make was the formal registration as an Italian resident. In their opinion, this was a basic requirement.

I noted that my clients were Elective Residence Visa applicants, and as such they were not required, nor were they willing, to register as Italian residents with the Italian authorities, also because of the tax implications that such a choice would entail. Again, they insisted on their choice.

This was an impasse for my clients. Just these two requirements would potentially derail their entire Elective Residence Visa project.

I would later find out that the information given by the local health office was not correct.

After proper investigation of the Italian law (I am Italian lawyer, luckily ) I found an old State regulation from 2012 which goes under the very friendly name: Accordo, ai sensi dell’articolo 4 del decreto legislativo 28 agosto

1997, n. 281, tra il Governo, le Regioni e le Province autonome di

Trento e Bolzano sul documento recante: «Indicazioni per la corretta

applicazione della normativa per l’assistenza sanitaria alla

popolazione straniera da parte delle Regioni e Province autonome».

(Rep. Atti n. 255/CSR). (13A00918.

This regulation is regarded , among the experts in the field, as the de facto, most comprehensive summary of legislation rules, issued by the State regarding registration of foreigners under the national Healthcare system (SSN). You will find the full text in Italian of the regulation on my website, if you are brave enough to read it  and a not-so-good automated translation in English done by Google (if you are even more brave).

So this regulation precisely lists (page 124 of the original document – you can read it on the link I provided below) the requirements for applying for registration of the National Healthcare system (SSN) and they are:

Copy of Permesso di Soggiorno or receipt of application in first

instance or renewal of the Pds

(Self-certification of reason for stay)

Identification document

Fiscal Code (Self-certification)

Residence (Self-certification) or statement of actual abode

Receipt of payment of SSN registration fee as indicated by Ministerial Decree, 8.10.1986 (after the new law it is a sum between € 2000 -2700 )

Thus, this document defeated the guidance provided by the regional health office, which could not reply anything but learn the correct requirements and process my application.

After clarifying the point, they were very kind and available.

As for the fee applied, we paid the relevant sum € 2000 through a F24 form at a local post office.

Payment can be done by credit card and cash.

The office issued a temporary registration to the SSN valid for three months, which would be renewed after producing copy of the permesso di soggiorno , once issued.

One important note regarding the address of actual abode.

You must make sure that it is registered together with your codice fiscale information, meaning that you filled out the form with your Italian address when you registered for codice fiscale.

That is especially important for those who obtained their codice fiscale through the Italian consulate, as they do no necessarily ask for an Italian address of abode to be linked with the codice fiscale application.

If the Italian address is not present in your codice fiscale record, the SSN office will find out immediately and will not process your application, so better to doublecheck in advance.

ACCORDO Stato Regioni sull’iscrizione al SSN per stranieri, del 20 dicembre 2012 

Below is the text, searchable, of the original in Italian. A machine translation done with google translate follows.

PERMANENT CONFERENCE FOR RELATIONS BETWEEN THE STATE, THE REGIONS AND THE AUTONOMOUS PROVINCES OF TRENTO AND BOLZANO

AGREEMENT 20 December 2012

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