If you’re planning to take up residence in Italy, your family is entitled to subsidised or free medical treatment under the Servizio Sanitario Nazionale. However, many residents have a private health insurance policy (assicurazione sulla salute), which pays the portion of medical bills that isn’t paid by social security. If you aren’t entitled to public health benefits, you should have private health insurance, which is mandatory for non-EU residents when applying for a visa or residence permit.
You should avoid a company that reserves the right to cancel (recesso or facoltà di rescessione)a policy unilaterally when you have a serious illness or when you reach a certain age (shown as età massima assicurabile in policies), as it will prove difficult or impossible to find alternative cover. You should also steer clear of a one-year contract, which a company can refuse to renew. Nowadays, policies often have a period (e.g. five years) during which the insurance company cannot exclude you from cover (rinuncia alla diritto di recessione), even if you have a serious illness costing the insurance company a lot of money.
When taking out a policy, you must usually choose a maximum limit (massimale) on claims, unless it’s already fixed. Ensure that it isn’t too low and that it includes all members of your family. Obviously, the higher your cover, the higher are your premiums. Companies usually have a ‘nuclear’ family policy (polizza per nucleo familiare) offering substantial discounts. Most policies include optional cover for loss of earnings (polizza di indennità giornaliera) if you’re unable to work for a period after an illness or accident, which is worth considering, particularly if you’re self-employed.
When comparing policies, carefully check the extent of cover and exactly what’s included and excluded from a policy (often indicated only in the very small print), in addition to premiums and excess charges. In some countries, premium increases are limited by law, although this may apply only to residents of the country where the company is registered and not to overseas policyholders. Although there may be significant differences in premiums, generally you get what you pay for and can tailor your premiums to your requirements. The most important questions to ask are whether the policy provides the necessary cover and whether it’s good value. If you’re in good heath and able to pay for your own out-patient treatment, such as visits to your family doctor and prescriptions, the best value policy may be one covering only specialist and hospital treatment. To compare policies, it’s best to visit an insurance broker offering policies from a number of companies.
If you already have private health insurance in another country, you may be able to extend it to include Italy. If your stay in Italy is limited, you may be covered by a reciprocal agreement between your home country and Italy. If you already have a private health insurance policy, you may find you can save a substantial amount by switching to another company without losing any benefits (you may even gain some). If you’re planning to change your health insurance company, you should ensure that important benefits aren’t lost, e.g. existing medical conditions won’t usually be covered by a new insurer. When changing employers or leaving Italy, you should ensure that you have continuous health insurance. If your family is covered by a company health scheme, your insurance probably ceases after your last official day of employment. When changing health insurance companies, it’s wise to inform your old company if you have any outstanding bills for which they’re liable.
Most health polices offered by Italian insurance companies are supplementary policies for Italians who are covered by the national health service, and aren’t intended for foreigners who aren’t covered and are seeking a comprehensive health policy. Most Italian health insurance policies either don’t pay family doctors’ fees or pay for medicines other than those provided in a hospital or have an excess (deductible), e.g. around €80 for each ‘illness’, which may exceed the cost of treatment. Most, however, pay for 100 per cent of specialists’ fees and hospital treatment in the best Italian hospitals. Private policies vary considerably in price but generally cost from €1,300 to €2,000 per year for a family of four, although they’re higher for the elderly. Many companies, retirement groups and other organisations offer lower group rates.
The largest insurers in Italy include the National Insurance Institute (Instituto Nazionale delle Assicurazioni/INA), formerly state owned but now privatised, Europa Assistance, Filo Diretto, Pronto Assistance and Sanicard. Shop around and compare policies, which vary considerably – from good to terrible! Also bear in mind that (as in many countries) Italian insurance companies are reluctant to pay claims. (One of the reasons they don’t insist on a medical examination is so that they can refuse to pay a claim because you omitted to tell them you had a heavy cold three years previously.) When completing the questionnaire (questionario sanitario) be sure to list all previous illnesses, hospitalisation, current ailments and treatment.
There are a number of foreign health insurance companies with agents or offices in Italy, including Baltica (Denmark), BUPA International, Exeter Friendly Society, PPP International, Columbus Healthcare and International Health Insurance (Denmark). These companies offer special policies for expatriates and usually include repatriation to your home country and international cover. If you aren’t covered by Italian social security and need comprehensive private health insurance to obtain a resident permice, you must ensure that your health policy will be accepted by the authorities. The main advantages of a foreign health insurance policy are that treatment is unrestricted and you can choose any doctor, specialist, clinic or hospital in Italy, and usually abroad also. Policies may include permanent total disability cover of around €150,000 for those in full-time employment, and usually include repatriation and limited world-wide cover, including North America. A policy may also pay for repatriation of your body for burial in your home country.
Some companies offer policies for different areas, e.g. Europe, world-wide excluding North America, and world-wide including North America. A policy may offer full cover anywhere within Europe and limited cover in North America and certain other countries (e.g. Japan). An international policy allows you to choose to have non-urgent medical treatment in another country. Most companies offer different levels of cover; for example, PPP International offers Basic, Standard, Comprehensive and Prestige cover.
A medical isn’t usually required for most health policies, although ‘pre-existing’ health problems are excluded for a period, e.g. one or two years. Usually there’s an excess, e.g. around €80 per claim, although it may be possible to choose an increased voluntary excess of up to €800 and receive a discount (e.g. 10 or 20 per cent). An excess may be per visit (i.e. to a doctor or specialist), or per claim or illness. Obviously a ‘per claim’ policy is better, as the excess then includes a visit to a family doctor, medicines from a chemist’s, a consultation with a specialist and hospitalisation, if they’re all associated with the same illness. Cover for dental treatment, spectacles and contact lenses may be available as an option, although there may be a hefty excess, which usually means that you’re better off paying bills yourself. A basic policy doesn’t usually include maternity benefits and may offer no benefits or restricted benefits for out-patient treatment (which means that you must pay for visits to a family doctor); it may also exclude out-patient medicines, dressings, surgical/dental appliances, spectacles, contact lenses and hearing aids. There may also be an annual limit for ambulance costs.
Children (e.g. up to 16) may be included on a parent’s policy and children up to a certain age (e.g. 26) may receive a 50 per cent premium reduction. Premiums are usually related to age, although some companies (such as the Exeter Hospital Aid Society) don’t relate premiums to age provided you join before a certain age, e.g. 60 or 65. It’s impossible to obtain insurance with some companies if you’re above a certain age, e.g. 75.
There’s always an annual limit on total annual medical costs (which should be at least €400,000 to €800,000) and some companies also limit costs for specific treatment or costs such as specialist’s fees, operations and hospital accommodation. Some foreign health insurance policies may not provide sufficient cover to satisfy Italian regulations, and you should check the minimum cover necessary with an Italian consulate in your country of residence.
Claims are usually settled in major currencies and large claims are usually settled directly (indennità diretto) by insurance companies, although your choice of hospital may be limited. Always check whether a company pays large medical bills directly. If you’re required to pay bills and claim reimbursement, it may take you several months to receive your money (some companies are slow to pay). It isn’t usually necessary to have bills translated into English or another language, although you should check a company’s policy. Most companies provide 24-hour emergency telephone assistance.
The cost of international heath insurance varies considerably according to your age and the extent of cover. Premiums can sometimes be paid monthly, quarterly or annually (credit card payment may be accepted), although some companies insist on payment annually in advance. Annual premiums vary from around €1,000 to over €4,000 for the most comprehensive cover.
This excerpt has been republished with permission from Survival Books. Some of the information may apply to EU citizens only. If you would like to get the inside track on moving to Italy, pick up your copy of this great book by clicking here.