Persons who are insured in one of the EU Member States who intend to seek treatment in Italy may avail themselves of the health facilities and professionals of the Italian National Health Service - NHS. See also The strengths of the Italian NHS.
If you want to come to Italy to be treated, you have two different ways to get coverage of costs from your health system, under the provisions of two sets of EU rules:
The Social Security Regulations: Direct healthcare with prior authorisation
Under these regulations, the health services provided by public or by NHS-affiliated health facilities or professionals are paid for directly by your health system (direct healthcare). Prior authorisation from your health insurance provider is always required. If it is granted, you will need to make no upfront payment, other than the co-payment (ticket) where applicable.
Directive on patients' rights to cross-border healthcare: Indirect healthcare
This system does not provide for direct payment by your competent institution, so you must pay for the treatment upfront and then claim reimbursement from the same competent institution that authorised you. For certain types of treatment (e.g. at least one night in hospital, etc.), prior authorisation may be required to receive reimbursement.
The two schemes (the Regulations and the Directive) may involve different procedures and cost coverage criteria. You should therefore obtain detailed information about both schemes, by contacting your competent institution or National Contact Point, also because EU rules may be applied in specific ways in the country in which you are insured and may be supplemented by specific national rules.
Whichever scheme you choose, you should always contact the health facility or professional you have chosen, for information on waiting times, treatment options and, if you choose indirect care, on how much you will have to pay for the treatment.
Please note that you cannot use the European Health Insurance Card - EHIC to obtain refunds for these types of treatments (scheduled treatments). This is because the EHIC can only be used for urgent and medically necessary treatment during a short stay abroad.
Under this scheme, governed by the Social Security Regulations, if you are insured in an EU Member State or in one of the other EEA countries (Iceland, Liechtenstein, Norway) or in Switzerland you can obtain coverage for the costs of planned treatment at public and NHS-affiliated private facilities in Italy, provided that the treatment you need cannot be given in your country within a time limit which is medically justifiable, or in a manner appropriate to your clinical case, taking into account your current state of health and probable course of your illness.
In general, the cost of healthcare is only covered if you are entitled to it under the legislation of the country in which you are insured.
If you meet these conditions, you must request prior authorisation from your competent institutions to obtain coverage of the costs of your treatment in Italy.
If your request is granted, your competent institutions will issue an S2 form with which you can obtain authorised treatment in Italy, the costs of which will be covered directly by your competent institution. You must submit the form to the Local Health Authority (ASL) responsible for the health facility in which you have chosen to be treated or, if you have chosen a hospital, directly to it.
As to cost coverage, under this scheme you will be treated under the same conditions applying to domestic patients, hence you may be charged a co-payment (ticket).
Check with your competent institution to see if you are entitled to coverage for other costs, such as travel and subsistence costs, and the costs of the person accompanying you where needed.
With regard to persons with disabilities, identified in Article 3(3) of Law No 104 of 5 February 1992, requiring neurological rehabilitation, the out-of-hospital living expenses incurred by the patient and any accompanying person - if the patient is a child or is not self-sufficient and the accompanying person has been authorised by the Regional Reference Centre (CRR) - in hotels or facilities connected with the highly specialised healthcare facility, are classified as equivalent to hospital stay, if inpatient stay was not envisaged for the entire referral authorised in accordance with Article 4 of Ministerial Decree of 3 November 1989, with issue of Form S2 for direct healthcare provision.
In the case of inpatient treatment, the costs of stay of the accompanying person may be covered, if the hospital abroad certifies the need for the presence of the accompanying person during the patient’s stay.
The contribution is paid by the Regions in varying amounts according to household income, in the manner set out in Article 2(1) of the State-Regions Agreement of 6 February 2003.
This scheme does not apply to the following types of treatment:
If you wish to obtain cost coverage for this type of treatment in Italy, you must follow the procedures for obtaining direct healthcare (under the Social Security Regulations) or other rules in force in your country.
Unlike the Regulations, the indirect healthcare scheme (Directive) enables you to receive treatment in EU countries under the same conditions as in the country in which you are insured. This means that:
As a rule, the costs of treatment are covered indirectly, so you will have to pay for the treatment upfront and then claim reimbursement from your competent institution.
In order to be reimbursed for certain types of treatment (e.g. at least one night in hospital, etc.), you may need prior authorisation from your competent institution.
Reimbursable treatment can also be provided by private facilities or professionals not affiliated with the Italian National Health Service - NHS.
For more information on your rights, authorisations and refunds and on the procedures to follow, contact your competent institution or the National Contact Point of the country in which you are insured.
Health facilities or professionals operating in Italy, whether public, NHS-affiliated or private, must charge non-NHS patients the same rates as Italian patients.
Ask your chosen healthcare provider how much you will have to pay for the treatment you need.
Please note that under the Italian public health system, health professionals can also provide private consultations outside normal working hours (Intramoenia). In this case the rates may be higher, but waiting lists much shorter. We recommend you check which type of rate applies when booking your consultation.
The reimbursement for indirect healthcare under the EU Directive is, as a rule, equal to the cost that your health system would have incurred for the health care you seek, without exceeding the actual cost of care received. The reimbursement for any difference with what you have spent, and for ancillary costs (travel, accompanying person where needed, etc.) is governed by the rules of your country.
Keep the medical documents and the invoices or receipts for the sums you paid: you will need them to claim reimbursement from the competent institution in your country.
For more information on your rights and on the procedures to follow, contact your competent institution or the National Contact Point of the country in which you are insured.
Last update 28 october 2019
