Type of Medical Insurance Required for Foreign Residents

Antinello Image
06/25/2009 - 08:15

So here's the story:-We bought our house last year in August and are still trying to apply for residency for my wife. The hopeless jobsworth in our local commune has spent nearly a year telling us that we cannot apply for residency as we require 'medical insurance' but as the government haven't provided her with any guidelines on this new requirement, she doesn't know what the policy should cover...  She has contacted her 'prefecturor'? in Terni who is apparently also in the dark on this.Can anyone offer us any advice on this? Is there an insurer in Italy who have developed a policy designed specifically for foreigners residing in Italy?Antinello 



Many thanks Gala and Penny for the links sent. We have referrred our Comune to paragraph F, p.11 in the August 07 circular before. They are arguing that the government guidelines do not make clear exactly what the 'comprehensive' medical policy should cover.Does anyone have any experience of going though this process in the last year? What policy did you present to your comune and which company/insurer did you obtain in from?Any guidance on this would be appreciated.Antinello

Why are you having to take out a private medical insurance at all? You should only need one if you are not an EU citizen or did not pay National Insurance contributions in your own country. If you are an EU citizen and paid NI in your home country (or are in receipt of a state pension) you are entitled to free cover due to the contributions you have already paid at home. You just need to produce the relevant document (E121, E120, E126 etc.) proving this from your own country. The length of the cover depends on your situation.  If you tell us your nationality and whether you are retired and in receipt of a state pension, here working or are elective residents (with your own means of support) then I can point you to the correct bit of the documentation and the correct E number form.

If my memory serves me right it started in France.  Lots of people were taking early retirement, available in the UK I understand from the age of 50 for a private pension or from that age if one is being made redundant from a government department or similar organisation, and settling in France.  The French Government started charging them as they were not workers, tourists, students, people over the official retirement age, officially unemployed and looking for work, dependents of a national of the country they are living in etc.  The EU agreed some new Directive to ensure these categories of people do not become a burden on the country's health system they are in and are treated exactly the same throughout Europe.  The E106 can be used in certain circumstances and the Italian Ministry of Health circular is very restrictive about this.  Please refer to the circulars that Penny have reseached and made available.The question of comprehensiveness is one that should be asked of the insurers of the risk: I would suggest it means everything included for health care below the age of 65 and the premium would reflect the health status of the person.


Moving to an EEA country

The NHS is a residence-based healthcare system. Therefore, once you have moved permanently away from the UK you are no longer entitled to medical treatment under normal NHS rules.You must notify your former GP so that you and your family can be removed from the NHS register.You will also no longer be entitled to use your UK-issued European Health Insurance Card (EHIC) to access healthcare abroad.Back to top

Receiving a UK state pension or long-term incapacity benefit

If you're receiving a UK state pension or long-term incapacity benefit, you may be entitled to state healthcare paid for by the UK. You will need to apply for an E121, which you  need to present to the health authorities in your new country of residence. You will then be treated on the same basis as a resident of that country.It is advised to check what is covered before leaving the UK and make arrangements if necessary. Use the 'country-by-country guide' and select a country from the list for detailed information.For further advice, contact the Overseas Healthcare Team (Newcastle)International Pension Centre Tyneview Park Whitley Road Newcastle upon Tyne NE98 1BACustomers who are in receipt of a UK state pension can obtain an E121 by telephoning 0191 218 7777  (Monday to Friday 8am - 8pm).Customers who are in receipt of UK long-term incapacity benefit can obtain an E121 by telephoning the Working Age Group Incapacity Benefit team on 0191 21 87644 (Monday to Friday 8am - 5pm).The ESA team contact number is 0191 21 87037 (Monday to Friday 8am - 5pm).If at any time in the future, you want to come back to the UK for planned treatment you must consult your new authorities to find out the options available to you. However, you will be charged in the UK, unless you can provide an E112 issued by your country of residence.When visiting the UK on holiday you should obtain an EHIC issued by your country of residence.Back to top

In receipt of other UK benefits

If you get a UK benefit, such as short-term incapacity benefit or maternity allowance, your healthcare cover is subject to different rules; the period of your cover and application criteria may differ depending on your particular circumstances.For more information, contact the International Pension Centre (IPC) or the Department for Work and Pensions (DWP).Back to top

Healthcare provided under the E106

If you move to an EEA country to live but not work and don't receive a UK benefit, you may be eligible for up to two-and-a-half years of state healthcare, paid for by the UK.You will need to apply for an E106 with the the Overseas Healthcare Team (Newcastle) and prove that you have worked in the UK and paid National Insurance contributions up to three years before your departure.For further advice, contact the Overseas Healthcare Team (Newcastle)Overseas Healthcare Team (Newcastle) Room TC001 Tyneview Park Whitley Road Newcastle upon Tyne NE98 1BATel: 0191 218 1999 (Monday to Friday 8am-5pm)The E106 will entitle you to treatment on the same basis as a resident of the country you moving to. This may mean that you have to make a patient contribution to the cost of your care.When the cover on the E106 expires, you cannot get any further medical cover from the UK until you are in receipt of a UK state pension. It is up to the country’s authorities to decided whether you are eligible to join their healthcare scheme. You will also be entitled to a UK-issued EHIC, allowing you to visit other EEA countries besides the one your are a resident with. http://www.nhs.uk/NHSEngland/Healthcareabroad/Pages/Livingabroad.aspx 

SergeThanks for providing such a detailed response on this.In our case we are not entitled to any support from the UK Government/NHS and have no choice but to obtain private health cover in order to obtain residency in Italy. Many insurers in italy provide 'comprehensive' health cover policies, however, our problem is getting our local comune to accept that any of the policies available meet the requirement.It would be useful to hear of any specifc policies offered by insurers that have been accepted for residency application purposes.Antinello

 I took clients through the residency process a few weeks ago and the comune was happy to accept a RAS Allianz policy which cost 124 euros pa - it's teh chepaest that Ive found and fulfills the requirements for residency.  I posted about it on another thread - if you visit the RAS allianz website I believe you can also buy it online.  

Just as a follow up to this, we have managed to find an insurance agent in Rome that offers a policy specifcally designed for foreigners applying for residency in Comunes. It's a 'formula' they just developed. We have sent a draft policy to our comune and it has been approved in principle.Will post the specific policy/agent once this is formally accepted by the Comune.On another note the Comune have asked us to provide a 'letter of family status' from the UK Embassy in Rome. I contacted the Embassy in Rome and they have no idea what this is and said the only thing they can do is put a stamp on a photocopy of our marriage cert. It would then be up to us to get this translated.Does anyone have any experience of getting this particular document for residency purposes?Antinello

From your original post and this post it seems to me that your Commune do not know what they want, but know what they do not want!   That is not strange situation for government agencies.  Back to health insurance!  Italian insurance companies, I understand, will offer private health care insurance to supplement state benefits, this is not comprehensive medical insurance but if your Commune will accept it and you can afford to pay as you go (payment for the equivalent of state benefits) for your health care then this is the policy for you.  Comprehensive health care insurance  will cover all elective care including hospitalisation in private hospitals, tests, outpatient consultations etc.  They could cost in excess of €2000 per annum for an individual: the premium would of course depend on the age of individual, the level of cover required, his/hers health status and the country it is valid for.  Most insurance companies also provide family cover.  I mention the country because I know private health care is cheaper in Italy than in the UK (I presume you are a UK citizen).   As mentionned in my previous post if you are resident in Italy technically you are not entitled to free healthcare from NHS UK.  When you are in the UK (or if elect to be treated in the UK) and you require medical treatment your private health insurance may not cover you unless you make specific provision for it.  This article provides more guidance.http://www.justlanded.com/english/Italy/Italy-Guide/Health/Private-Healt...A range of companies provide private medical insurance, BUPA International, SAI (an Italian company), AXA, even the Italian Post Office (I understand sells a policy to students, they may have other products) etc. For what it is worth you may want go and see the local mayor during his public sessions and ask him to clarify the Commune's position.  Alternatively, as you know in all countries, it is not what you know or what you are entitled to that matters but who you know.  If you know a local influential person locally get him or her to accompany you to the Commune and talk to Anagrafe.  Most of the time this will do the trick.   As I said there are two issues: what the Commune will accept and what your insurance needs are will dictate the type of policy you buy. Hope this helps and good luck!  

In reply to by Serge

Many thanks again Serge. This is useful info.Our main problem is that we haven't developed the right connections locally yet and don't speak enough Italian to negotiate effectively with the Mayor/Anagrafe.I wonder if there are any agents/English speaking lawyers reading this and operating in the Terni area who would be prepared to offer their services to work this to a successful outcome? If so please send me a private message.Thanks allAntinello

 Serge is right, some time ago... I think it was around 2005... France started to complain about other EU nationals under retirement age (less than 65 years of age), who moved to their country, starting to use all the health care available and becoming a burden to their health system. Other EU countries did some research and found that they were in a similar situation. After that, they started to apply tougher policies for anyone who is under the age of 65, does not contribute to the Health system in the country where they reside and who are not invalid pensioners. What you must look at is the Italian directives as they are the ones who decide on this matter. 

Marrige certificates and birth certificates are being requested more and more by comunes for proof of status - they must be translated, but it doesnt have to be a traduzione giurata.  The birth certificate thing really annoys me because a British passport is proof of birth but they dont accept it as such.   

Thanks for this.We are having trouble getting a straight answer so not sure if this is what they are looking for. Here's a quote from the email we recently received from the Anagrafe:-'3) documentazione autentica idonea a dimostrare gli status (rapporto di filiazione, stato civile, ecc). PER TALE DOCUMENTAZIONE NON E' CONSENTITA L'AUTOCER-TIFICAZIONE'Antinello

Application (inc insurance) accepted by the commune - progress!I think the vigile urbano has to make a suprise visit within a certain number of days/weeks. Is this correct? If so does anyone know the timeframe?Is it still common practice to visit this municipal policman and suggest he/she pops round in the morning or should we camp down at home in case we miss him/her because (god forbid) we should pop out to the shops!Antinello 

Some years ago in Lombardia we were awaiting the visit of the vigili who, as ever, don't tell you when they are to call. They presume that since everyone without exception in Italy has lunch at home that if they call around 1;30 - 2;00 p.m. they will certainly find you at home. They need to physically see you in your property, thus verifying that you actually live there. Instead against all odds I was out, and Jean received the vigili (2 ladies) who proceeded to look around the living room and entranceway. Unfortunately at that time Jean's Italian language wasn't too great, and so she rang my mobile then passed me to the vigilessa. This bright spark asked me why she should believe that I lived there. I suggested she look near the door where she would see a pair of trainers size 46, and then check if she thought they were Jean's.... "Mumble mumble; va bene; "Buongiorno" ...Residence 'awarded' without problems.

Ive just been closeted with the head of the ASL here in Ragusa.  He tells me that an anagrafe should only accept Complete insurance from any applicant - so all my posts about cheap insurance could now not be valid, even though comunes accept it as valid.He also says that assicurazione volontaria is now available to EU members and not only extra communitari - at a cost of 386 euros pa.  (he received this news via Regione Sicilia, so it could be that it is only a Sicilian thing at the moment)  If true, its good news as far as EU members wanting to gain residence.  

Just wanted to report in on this previous topic.After just over a year my wife has finally been given resident status in our local Comune!For others out there scrambling around trying to obtain the 'correct' insurance we managed to find a policy entitled 'Polizza a Favore Di Cittadini Stranieri U.E. Soggiornanti in Italia' which was accepted by the Comune and only cost around 180 Euros. The agent we bought it through is Agenzia Generale at 34 Lungotevere Flaminio in Rome. Their telephone number is 06 3210214.Right, now we can buy a car...Antinello   


Healt insurance for residence must be all in Italian, and must state the writing, <valid for the Italian territory> - Health policies, valid for other countries, tourist ones where the term <valid for the Italian territory> is not clearly expressed are not considered valid from the current legislation - in case the health policy is issued in non-Italian language and has the diction <valid for the Italian territory>, the general policy rules, which normally exceed 100 pages, written in small characters, must be fully translated, apostillated and legalized. The community health card called TAM, replaces the health insurance required, only if the request for residence is made following a contract of work, in Italy, regularly registered.