Before going abroad for treatment, you should contact your competent institution (if you are registered with the Italian National Health Service, the ASL to which you belong) to find out the procedure you will need to follow to obtain coverage of the costs of your healthcare abroad and, in particular, if prior authorisation is required and how to request it; if the cost of treatment will be paid directly by your health system (the Italian NHS, if you are registered with it) or you will have to pay the costs upfront; which expenses are reimbursable and in what amount.
Prior authorisation is always required if you seek planned treatment abroad under Regulation (EC) No 883/2004 of 29 April 2004. In this case, in order to receive scheduled treatments covered by your health system from public or affiliated private facilities in another Member State, in the other EEA Countries (Norway, Iceland and Liechtenstein) or in Switzerland, you must obtain prior authorisation from your competent institution (if you are registered with the Italian National Health Service, from the ASL to which you belong). Prior authorisation is subject to two conditions: the treatment is appropriate and aimed at safeguarding the health of the person concerned; the treatment is among the sickness benefits covered by the national health service/health insurance provider of your home country but it cannot be given in your country within a time limit which is medically justifiable, taking into account your state of health and the probable course of your illness.
On the other hand, if you intend to travel to one of the EU Member States in accordance with Directive 2011/24/EU of 9 March 2011, and pay for your treatment upfront, prior authorisation may not be necessary. However, prior authorisation may be required in the following cases: the treatment you need is subject to planning requirements relating to the object of ensuring, in the territory of the Member State concerned, sufficient and permanent access to a balanced range of high-quality treatment or to the wish to control costs and avoid any waste of financial, technical and human resources, and also involves overnight hospital accommodation for at least one night or requires the use of highly specialised and cost-intensive medical infrastructure or medical equipment; is provided by a healthcare provider that, on a case-by-case basis, could give rise to serious and specific concerns relating to the quality or safety of the care.
For any follow-up treatments or check-ups that might be necessary after the authorised treatments, check whether you will need another authorisation (if you are covered by the Italian NHS, you will need to request another authorisation from your Local Health Authority (ASL)).
You should therefore check with your competent institution (if you are covered by the Italian NHS, the ASL to which you belong) or with your National Contact Point whether you need prior authorisation for the treatment you require and how to request it.
Prior authorisation must be requested from your competent institution (if you are registered with the Italian National Health Service, the ASL to which you belong), whether you rely on Regulation (EC) No 883/2004 of 29 April 2004 or Directive 2011/24/EU of 9 March 2011.
Under Regulation (EC) No 883/2004 of 29 April 2004 prior authorisation is required for any treatment which is among the benefits provided for by the legislation of your country of residence and which cannot be given in your country within a time limit which is medically justifiable, taking into account your state of health and the probable course of your illness.
Directive 2011/24/EU of 9 March 2011 provides that Member States may make reimbursement of costs of cross-border healthcare subject to prior authorisation for treatment which is made subject to planning requirements relating to the object of ensuring sufficient and permanent access to a balanced range of high-quality treatment in the Member State concerned or to the wish to control costs and avoid, as far as possible, any waste of financial, technical and human resources, and involves overnight hospital accommodation of the patient in question for at least one night or requires use of highly specialised and cost-intensive medical infrastructure or medical equipment; involves treatments presenting a particular risk for the patient or the population; is provided by a healthcare provider that, on a case-by-case basis, could give rise to serious and specific concerns relating to the quality or safety of the care.
Therefore please check with your competent institution (if you are registered with the Italian National Health Service, the ASL to which you belong) or with your National Contact Point if the treatment you need is subject to prior authorisation.
Under Regulation (EC) No 883/2004 of 29 April 2004 prior authorisation is required for any treatment which is among the benefits provided for by the legislation of your country of residence and which cannot be given in your country within a time limit which is medically justifiable, taking into account your state of health and the probable course of your illness. If you are denied authorisation pursuant to EC Regulation No 883/2004 of 29 April 2004 you may lodge an appeal with the civil court having territorial jurisdiction (Labour Court) pursuant to Articles 444 et seq. of the Italian Code of Civil Procedure.
Directive 2011/24/EU of 9 March 2011 provides that Member States may make reimbursement of costs of cross-border healthcare subject to prior authorisation for treatment which is made subject to planning requirements relating to the object of ensuring sufficient and permanent access to a balanced range of high-quality treatment in the Member State concerned or to the wish to control costs and avoid, as far as possible, any waste of financial, technical and human resources, and involves overnight hospital accommodation of the patient in question for at least one night or requires use of highly specialised and cost-intensive medical infrastructure or medical equipment; involves treatments presenting a particular risk for the patient or the population; is provided by a healthcare provider that, on a case-by-case basis, could give rise to serious and specific concerns relating to the quality or safety of the care.
If you have been denied authorisation or reimbursement, Article 10(8) of Legislative Decree 38/2014 introduces a fast-track administrative protection mechanism in addition to the traditional administrative or judicial actions before the Regional Administrative Court (TAR). Under this mechanism, within 15 days from the date of refusal, the patient may apply for review of the refusal to authorise or reimburse cross-border healthcare directly to the General Director of the Local Health Authority concerned. The Director must reply within 15 days from the review application.
However, the traditional remedies will also remain available, namely judicial appeal to the Regional Administrative Court within 60 days of the refusal decision, pursuant to Legislative Decree 104/2010, and administrative appeal within 30 days of notification of the refusal decision, or extraordinary appeal to the President of the Republic within 120 days of notification of the refusal, pursuant to Presidential Decree No 1199 of 1971.
If the request for prior authorisation and/or reimbursement is neither granted nor denied by the administration within the time of 30 days established by Article 10 of Legislative Decree 38/2014, the patient may submit the same request to the next responsible authority, which must be named by each administration pursuant to Article 2(9-bis) and (9-ter) of Law 241/1990. In this case, the procedure must be completed in half the time allowed for processing of the initial request. Under Article 20(4) of Law No 241/1990, as the matters in question concern the protection of health, the tacit acceptance procedure is not applicable.
As long as the authority fails to respond and, in any case, no later than one year after expiry of the deadline for completing the procedure, patients may also lodge a judicial complaint for failure to take administrative action, pursuant to Article 31 of Legislative Decree 104/2010 (Code of Administrative Procedure), by filing an appeal with the competent Regional Administrative Court.
Therefore please check with your competent institution (if you are registered with the Italian National Health Service, the ASL to which you belong) or with your National Contact Point if the treatment you need is subject to prior authorisation.
The prior authorisation for direct healthcare (EC Regulation No 883/2004 of 29 April 2004) may be refused by the ASL to which you belong if you do not meet the requirements for granting it, essentially when the treatment is not included among those provided by the legislation of your country, and when the same treatment can be given in Italy within a time limit which is medically justifiable, taking into account your state of health and the probable course of your illness.
Prior authorisation for indirect healthcare (EU Directive No 24 of 9 March 2011) may be refused if the treatment you require presents a particular risk for you or for public health, if the healthcare provider you chose gives rise to concerns relating to the quality or safety or care, or the same treatment is available in your country within a time limit which is medically justifiable.
You can find information about the healthcare provided in the European Union by visiting the website of the competent institutions of the country in which you intend to receive treatment or by contacting the National Contact Point of the State of treatment.
If you are registered with the National Health Service, if your claim is rejected you may file an administrative or judicial appeal, and you may also submit an application to the General Director of the Local Health Authority (ASL).
If you are insured with the health system of another EU country, please contact your competent institution or your National Contact Point for information regarding your rights.
You must file for reimbursement of the costs you incurred, with your competent institution (if you are registered with the Italian National Health Service, the ASL to which you belong), enclosing medical documentation and invoices/receipts (if you are registered with the Italian National Health Service, you must submit the original medical certification and invoices and/or receipts).
The competent institutions (if you are registered with the Italian National Health Service, the Regions and the Autonomous Provinces of Trento and Bolzano) may provide for the reimbursement of the costs of travel and stay for you and, possibly, an accompanying person, as well as additional costs related to one or more disabilities.
You should contact your competent institution (if you are registered with the Italian National Health Service, the ASL to which you belong) or your National Contact Point to find out if these costs are reimbursable and if prior authorisation is required. In any case, to obtain reimbursement you will need to produce appropriate proof of expenditure.
The costs you paid for the treatments in one of the EU Member States will be reimbursed if the healthcare you have received is covered by your health system and if you obtained prior authorisation, where required.
Therefore, please contact your competent institution (if you are registered with the Italian National Health Service, the ASL to which you belong) or your National Contact Point to obtain this information.
To find out which expenses are reimbursable and in what amount, you can contact your competent institution (if you are registered with the Italian National Health Service, the ASL to which you belong).
Regulation (EC) No 883 of 29 April 2004 is mainly based on direct healthcare: health services are provided, under the same conditions as for persons insured in the country of treatment, by public or NHS-affiliated private health facilities or professionals and are, as a rule, paid directly by your health system, except for any co-payment (e.g. the ‘ticket’ in Italy). In the event of scheduled treatment, such co-payments might be wholly or partially reimbursable.
Directive 2011/24/EU of 9 March 2011, is mainly based on indirect healthcare: the patient usually pays upfront for the treatment abroad, authorised in the cases provided for, and subsequently claims reimbursement from his/her national health system.
Last update: 23 october 2019
