Treatment in Italy and in other European Union countries: what you need to know
European citizens covered by the health service in one country can receive treatment in all other EU countries in certain situations and under the conditions provided for by EU legislation.
The cost of the treatment will be covered by your home country’s health authorities. The costs of medical treatment in another EU country can be covered through:
- direct healthcare: your home country’s health service pays the health service of the country providing treatment directly
- indirect healthcare: you pay the cost of your care up front to the public, private or contracted private healthcare facilities or providers in the country providing treatment and you then claim the money back from your own local health authority.
The general principles laid down in the two legal instruments may be applied in specific ways in individual EU countries and may be supplemented by further national rules.
Direct healthcare: the Regulations
You can receive treatment in another EU country or in EFTA countries (Iceland, Liechtenstein, Norway and Switzerland) under the same conditions as healthcare beneficiaries from those countries, through the direct healthcare scheme (EU social security regulations Regulation (EC) No 883 of 29 April 2004 and Regulation (EC) No 987 of 16 September 2009).
Temporary stay
If you are staying temporarily in another Member State, depending on the nature of the services and the expected duration of your stay, you can obtain direct access to the necessary care by showing your European Health Insurance Card (EHIC) or replacement certificate.
Your public health service will directly cover the cost of the cross-border healthcare you receive from the public, private or contracted private healthcare facilities or providers (direct healthcare). You will not be reimbursed for any part-payment (patient contribution) services.
This scheme does not apply to services provided by non-contracted private healthcare providers or facilities (or ones not covered by conventions).
The EHIC or replacement certificate can only be used to cover the costs of essential medical care.
Workers and pensioners under Italian law
If you are a posted worker under Italian law, a pensioner with an Italian contributory pension or a student, you can receive healthcare directly in accordance with the levels provided for in the country where you are located. You need to ask your local health authority for form S1. For more information, see the interactive guide ‘If I travel to...’
Planned treatment
If you need planned medical treatment, i.e. prescribed in advance as part of a specific course of treatment, you must obtain prior authorisation from the competent institution.
For more information, see:
- Planned treatment in the European Union (if you are registered with the Italian SSN)
- Planned treatment in Italy (if you are registered with the national health service of another EU country).
Authorisation is subject to two conditions:
- The treatment is appropriate and intended to protect the patient’s health
- The treatment is available under your home country’s health service scheme but cannot be provided in your country within a medically acceptable timeframe, taking into account your state of health and the probable course of your illness.
Authorisation is granted through the S2 form, which must be submitted to the relevant public, private or contracted private healthcare facilities or providers in the country providing treatment.
Travel expenses may also be covered and, in some cases, the costs of an accompanying person.
Indirect healthcare: the Directive
You can receive healthcare in other EU countries, Iceland, Norway and Liechtenstein under the conditions described in Directive 2011/24/EU of 9 March 2011, transposed by Legislative Decree No 38 of 4 March 2014).
Specifically: you pay the costs of treatment abroad up front, subject to authorisation in specified cases, and then claim the money back from your national health service
You will be reimbursed for the cost that your home country’s healthcare service would have incurred if the treatment had been provided in your country, without exceeding the total cost of the treatment. However, Member States are at liberty to decide to reimburse the full cost of the cross-border treatment, even if this exceeds the costs they would have incurred if the healthcare had been provided in the home country.
The treatments that are reimbursable are those provided by your home country’s healthcare service, except for:
- long-term care (the purpose of which is to support people in need of assistance in carrying out routine, everyday tasks),
- allocation of and access to organs for the purpose of organ transplants,
- public vaccination programmes against infectious diseases.
For overriding reasons of general interest, Member States may restrict access to treatment in their country to incoming patients and limit the application of the rules on reimbursement to outgoing patients.
Member States may also introduce a prior authorisation system for cross-border healthcare that:
- involves a stay in hospital of at least one night requires the use of highly specialised and expensive medical infrastructure or equipment;
- involves treatments presenting a particular risk to the patient or to the population;
- is provided by public/private or contracted private healthcare facilities and providers which, in the specific case, could give rise to serious and specific concerns regarding the quality or safety of the care.
Italian and EU citizens registered with the Italian health service who wish to access indirect healthcare are required to apply for prior authorisation only for the services referred to in Ministerial Decree No 50 of 16 April 2018.
If you request authorisation for cross-border treatment under the indirect scheme (Directive) but meet the conditions for direct treatment (Regulations), you will be granted authorisation under the Regulations. Remember that you can still expressly request to be covered by the Directive.
Contact your National Contact Point
Relevant legislation
- Social security Regulation (EC) No 883 of 29 April 2004
Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems – Published in OJ L 166 of 30 April 2004. - Social security Regulation (EC) No 987 of 16 September 2009
Regulation (EC) No 987/2009 of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems – Published in OJ L 284 30 October 2009 - Directive 2011/24/EU of 9 March 2011
Directive 2011/24/EU of of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare – Published in OJ L 088 of 4 April 2011 - Legislative Decree No 38 of 4 March 2014
Implementation of Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare and Directive 2012/52/EU laying down measures to facilitate the recognition of medical prescriptions issued in another Member State.
