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.
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 permit, 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.
This article is an extract from Living and Working in Italy from Survival Books.