Judith's Article: Joining the NHS
by Judith in Umbria
This is my own experience in obtaining and maintaining health insurance in Italy as a non-working person.
I had to have health insurance before I was allowed a visa. I bought international health insurance through a Danish company online. It was payable in full up front. My doctor had to provide, in writing, information on pre-existing conditions, and none of them were covered. Drugs were not covered. There would be a co-pay, but since office visits are cheap here, that wasn't bad. The policy cost me, 4 years ago, a little less than $1800. My co-pays came to another 150 or so, and my prescriptions added up to a whopping additional $2400. At least if I were hospitalized or needed surgery my life wouldn't be ruined, but it was expensive and not very comprehensive.
As soon as I could, I went to the local sanitaria office. I needed my permesso di soggiorno, my residency (certificato di residenza), and my passport. Only one person in the office-- the manager-- does insurance for foreigners.
I was asked to declare my income. I don't have income, but savings. That qualified me for the minimum payment, which is just under euro 400. Your income is self-declared. No one I know has ever been asked for proof. It could happen, and then your tax return is what they want to see. The first time you have to name who will be your primary physician. Ask around and see who gets mentioned most often, and hope there is room for you in his/her clientele.
The insurance year runs from January 1 until December 31, and if you enter the program any time through the year, you pay for the entire year. I signed up for the insurance in November, and was encouraged to not do it and return in January, but the year's premium was only slightly higher than what I used to pay per month, and who knows when something disastrous will happen, so I paid it.
Every January, you must return to that office and do the whole thing over again, and you need your current permesso di soggiorno every time.
My friend does work and have income. Last year it was a pitiful sum, so she paid the minimum. This year she made more money, so she told the director she would need him to refigure her premium. He asked her how much more and she told him $6000 more. He laughed and said that wasn't worth reporting, and she paid the minimum. I think he lets everyone pay the minimum!
Anyway, once you have seen the proper person and figured your premium, you are given a scrap of paper that has the payable amount on it. You take it and the proper amount in cash to the post office and make a postal payment on the proper form. You then take the receipt you are given and return to the sanitaria office, where they will enter you into the system and produce a green folded card which you will show to anyone who asks for it when providing healthcare, prescriptions, visits, etc.
The premium is supposed to be 7% of your worldwide income. To date, no one I know has paid it.
Visits to your primary physician are free. Most, not all, prescriptions are free. Visits to specialists have a co-pay of about euro 16. Some tests have a modest co-pay. A friend who has broken a vertebra this week has to pay for the brace she needs, but everyone does, not just foreigners, and it is from euro200-300. Emergency care and tests are free to anyone.
When I arrived, I wrote in Italian all the major health episodes of my life. I made a list of all the prescriptions I take and why. I made some bloopers, but with a little discussion, the doctor and I worked it out. I could have brought all my records here and tried to translate them, but it hasn't proved necessary so far.
I have no complaints, since it is cheap, good and the same for everybody. I like my doctor, but I think I should probably be getting more blood tests than I do.
In 4 years he has only touched me once, and then got the neighboring doctor in when he palpated my neck!
There are no appointments, only 10 hours of office time a week, it takes a while to figure out which are the least busy days. Doctors make housecalls, but it needs to be an emergency, because if it is not, and you were actually well enough to come to the office, there will be a charge for the housecall.