Access exemptions and benefits
HOW TO GET THE BENEFITS YOU ARE ENTITLED TO
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WHAT IS THE "TICKET" AND HOW DO YOU PAY FOR IT
WHAT IS THE "TICKET"
The copayment is the contribution that the citizen pays for some health services he uses, in sharing with public spending. The cost varies from a few euros up to a maximum of 36.15 euros per prescription (each prescription can contain up to eight prescriptions from the same specialist branch). In some regions there is a higher limit (from 38 to 46 euros).
WHEN TO PAY THE "TICKET"
Ticket payment is expected for:
• specialist visits, instrumental diagnostic tests (such as CT scans, magnetic resonance imaging, ultrasound) and laboratory tests (blood tests, urine, faeces, swabs) included in the essential levels of assistance provided by the National Health Service;
• non-urgent services classified with a white code received in the emergency room and not followed by hospitalization (except for children under 14 and for those enjoying an exemption);
• spa treatments.
There is no ticket payment for:
• oncological screening for early diagnosis of cervical, breast and colorectal cancer;
• diagnostic tests required by law or arranged locally in the event of an epidemic;
• services of the general practitioner and pediatrician of free choice;
• treatments provided during a hospital stay;
• home care treatments;
• emergency codes other than the “white” one;
• foods for particular diets (for people with celiac disease, congenital metabolic diseases, cystic fibrosis, renal failure and severe dysphagia);
• medical devices for diabetes (needles, test strips, finger prick pens, blood sugar meters, etc.);
• prostheses, braces and aids intended for people with disabilities;
• vaccinations (offered free of charge by the NHS to children, adolescents, adults and the elderly);
• HIV test;
• counseling services (except in some regions for some specialist outpatient activities);
• services of clinics for sexually transmitted diseases.
The National Health System requires for citizens to participate to the cost of the health services they receive, by paying for the so called "ticket".
To this end, the national government has established lists of exemptions for citizens to obtain the total or partial coverage of the costs for the payment of the "ticket" for specific chronic conditions (list of chronic and rare diseases, pregnancies, invalidity), prevention activities (screening tests for specific tumors, HIV testing), or categories of individuals identified on the basis of the potential association between personal, social and economic conditions.
Some Regions have extended the exemptions provided at national level to include additional health conditions or other categories of citizens, or have changed the income thresholds.
WHO HAS THE RIGHT TO AN EXEMPTION?
The right to the exemption from payment of the "ticket" for visits, instrumental and laboratory exams is acknowledged for reasons due to limitations of income, invalidity, or care for chronic or rare disease, as well as for pregnancy
CLICK ON REGIONAL WEBSITES DEDICATED TO EXEMPTIONS
EXEMPTION DUE TO LOW INCOME, HOW TO OBTAIN IT AND ITS DURATION
INCOME EXEMPTION
There are four exemption codes associated with certain social and income situations which allow you to benefit from all the outpatient services guaranteed by the NHS without paying the ticket. The Regions can apply additional exemptions compared to the national ones (for example for residents on redundancy or on mobility with a specific ISEE). For more information consult the regional website page dedicated to tickets and exemptions.
- Code E01:applied to children under 6 years of age and to people over 65 who belong to a family unit* with a total annual gross income of up to 36,151.98 euros.
- Codice E02:assigned to unemployed people, and *dependent family members, with a gross annual family income of less than 8,263.31 euros, or increased to 11,362.05 in the presence of a dependent spouse, plus an additional 516.46 euros for each child load.
- Code E03: recognized to INPS social allowance holders and dependent family members.
- Code E04:reserved for holders of a minimum pension, over 60 years of age, and dependent family members, with a gross annual family income of less than 8,263.31 euros, or increased to 11,362.05 in the presence of a dependent spouse, plus a further 516 .46 euros for each dependent child.
*By family unit we mean the one relevant for tax purposes, made up of the interested party and his dependent family members. The family income is given by the sum of the individual overall incomes produced by the members of the household (art.1, decree of 22 January 1993).
*Here the definition of fiscally dependent family member.
HOW TO VERIFY THE INCOME EXEMPTION?
The Health card system (the platform for the computerized management of data and healthcare expenses of all NHS patients) makes available the list of people who have been granted the right to exemption for income reasons. The assignment takes place automatically on the basis of the information provided by the Revenue Agency and is recorded in the National Register of Insured Persons (included in the Health Card System). By connecting to the health card system, the doctor can check whether the patient is entitled to the exemption and, if so, enter the relevant code on the prescription.
The right to ticket exemption can also be verified by logging in to your account electronic health record.
HOW LONG DOES IT LAST?
The exemption is annual (expires on 31 March of the following year) and is automatically renewed if the legal conditions persist.
IF YOU ARE NOT INCLUDED IN THE EXEMPT LIST, BUT YOU BELIEVE YOU MEET THE REQUIREMENTS FOR EXEMPTION, WHAT SHOULD YOU DO?
Potential beneficiaries who fall within the limits set for the exemption but are not included in the list of exempt persons directly by the Ministry of Economy are those who are not obliged to submit a tax return (identified among the categories of subjects indicated in this list of the Revenue Agency, such as those who receive a minimum pension or a social allowance) and those who in the year preceding the tax return know that they have had a lower family income and are included in one of the exempt typologies.
These categories must present a self-certification with a request for exemption for income reasons:
- at the ASL office (the self-certification form can be downloaded from the website of your Region or ASL);
- online via the electronic health record;
- online tramite il Health card system in the Regions that have activated the service (Valle d'Aosta, Puglia, Sardinia, Sicily, Umbria, Molise, Veneto, Marche, Abruzzo, Calabria and the province of Bolzano).
The exemption is valid for one year and the self-certification of income (subject to verification by the Revenue Agency) must be renewed every year if you believe you are in a position to enjoy this right.
If the requirements necessary to obtain the exemption are no longer met, the ASL must be promptly notified. In case of untruthful declarations, criminal sanctions are foreseen. The revocation can also be done via electronic health record.
EXEMPTION DUE TO CHRONIC OR RARE DISEASE AND HOW TO OBTAIN IT
People suffering from a chronic or rare pathology are entitled to exemption from the ticket for specific services related to the treatment of the respective disease and the prevention of its worsening and complications. The exemption for visits and tests aimed at diagnosis is provided only when a rare disease is suspected (considering the burdensomeness and complexity of the diagnostic process).
To find out which diseases qualify for exemption, consult:
In the first list they are identified at the moment 67 exemption codes for chronic diseases and related co-payment-free services. In the second more than 460 exemption codes for rare diseases. In this case the list of exempt services is not detailed because the needs of patients are very varied. It is up to the treating doctor to establish for which visits and tests related to the rare disease the patient is entitled to exemption.
HOW TO GET THE EXEMPTION FOR CHRONIC ILLNESS
It is necessary to request exemption from the local health authority of residence by presenting the illness certificate issued by the specialist who works in a public or private structure accredited with the National Health Service. Alternatively, a copy of the medical record (drawn up by a public or accredited hospital) or the disability report (issued by a medical commission of the ASL, INAIL or military hospital) can be delivered.
The ASL, based on the documentation received, issues a certificate which reports the code of the exempt chronic pathology. The exemption code comes registered by the Local Health Authority in the Registry of Patients and made automatically available also on the electronic health record.
There duration of the exemption it can be unlimited or have an expiry date based on the type of pathology and the possibilities for improvement. To check the validity period, consult the annex to the ministerial decree of 23 November 2012
HOW TO GET THE EXEMPTION FOR RARE DISEASE
The right to exemption must be requested from the relevant local health authority by presenting the rare disease certificate, which must be released by one of the Centers of the National Rare Diseases Network. The exemption, taking into account that the majority of rare diseases are of genetic origin, is also guaranteed for genetic investigations on family members to diagnose the possible genetic basis of the patient's disease.
A disease is defined as rare when the number of people affected does not exceed 5 cases per 10 thousand inhabitants. For the purposes of the exemption, the particular clinical severity and degree of disability caused by the disease are also taken into account.
EXEMPTION FOR INVALIDITY AND HOW TO OBTAIN IT
EXEMPTION FOR INVALIDITY
A physical or mental disability (which leads to the partial or total loss of the person's ability to carry out normal daily or work activities) gives the right to exemption from the copay for all or some specialist outpatient services provided by the National Health Service.
HOW DO YOU GET IT?
The request for exemption must be made to your local health authority by presenting the certificate certifying the state of disability.
The degree of civil invalidity, (which reflects the level of impairment of working abilities in individuals of working age or of daily life tasks in minors and those over 65) is examined and ascertained by a medical commission of the ASL. To obtain recognition of civil disability you must send the application to INPS via the appropriate form online service. Whiledisability caused by accident at work or occupational disease is certified by an Inail medical commission. The one relating to public employees for service causes it is recognized by a special medical commission of the INPS (which can also ascertain cases of war disability, for which the commissions of military hospitals are mainly responsible).
EXEMPTION FOR PREGNANCY AND HOW TO USE IT
EXEMPTION FOR PREGNANCY
All the services for monitoring the pregnancy, at accredited public and private facilities, including clinics, they are completely free (regardless of income). You don't have to pay any tickets for the tickets either preconception tests, useful for ascertaining genetic defects and diseases in the couple that can be transmitted to the fetus.
HOW DOES THE EXEMPTION APPLY?
The general practitioner or NHS specialist will write the pregnancy exemption code on the prescription (code M followed by the number of the week of gestation), which allows you to receive the tests and visits scheduled during the birth process completely free of charge.
Different exemption codes are provided for in the case of threatened abortion and risky pathological conditions for the mother or fetus (code M50) and for preconception tests for women and men (code M00).
WHAT ARE THE EXEMPT BENEFITS?
To find out which benefits are guaranteed in exemption before conception and in the different stages of pregnancy, you can consult the database of the Ministry of Health.
Before conception:
- clinical tests for the woman and her partner who wish to have a child (indicated in theannex 10, section A, of the Prime Ministerial Decree of 12 January 2017) aimed at identifying the presence of any hereditary or infectious diseases (such as rubella and sexually transmitted diseases) and other risk factors for the health of the fetus.
During pregnancy:
- periodic obstetric-gynecological visits;
- specific tests for each trimester of gestation (indicated in theannex 10, section B, of the Prime Ministerial Decree of 12 January 2017);
- tests for invasive prenatal diagnosis if there is a risk of fetal pathology (indicated inannex 10, section C, of the Prime Ministerial Decree of 12 January 2017);
- birth support courses.
After pregnancy:
- assistance in the postpartum phase (for example obstetric support at home, where available, and psychological interview in case of discomfort for the woman).
Theapp “Healthy mom"of the Ministry of Health (downloadable on smartphones and tablets) accompanies the woman throughout the entire pregnancy process. It helps to know what checks and tests need to be done every quarter and to look for the nearest birth centers and clinics. It provides advice on the correct lifestyle to follow to protect the health of the mother and fetus and information on postpartum, breastfeeding, vaccinations and baby safety. The app allows you to upload ultrasounds and laboratory tests and note changes in weight over the weeks.
Download the app
"Healthy Mom"
"TICKET" FOR PHARMACEUTICAL PRESCRIPTION AND HOW TO OBTAIN IT
DRUG TICKETS: WHEN DO YOU PAY?
In most regions, a fixed share of participation in public spending (ticket) has been introduced to be paid by the citizen for class A drugs (i.e. those reimbursed by the National Health Service, dispensed on medical prescription and essential to ensure treatment for serious, acute and chronic diseases). The cost varies from 0.50 euros per pack to 2 euros, reaching in some cases 4/4.50 euros per pack, depending on regional rules. In some regions, 1 or 2 euros must be added to the ticket for each recipe.
For now they do not charge copays on drugs: Piedmont, Friuli-Venezia Giulia, Emilia-Romagna, Tuscany, Umbria, Marche, Basilicata, Sardinia and the Province of Trento.
WHO IS ENTITLED TO THE EXEMPTION?
The categories exempt from paying the drug copayment are defined differently from region to region.
It is therefore a good idea to contact your local health authority to find out the inclusion requirements. The exemption can apply to all class A drugs or be limited to approved drugs intended for the treatment of the chronic or rare pathology you suffer from.
Who benefits from aexemption from the co-pay for specialist outpatient services, for reasons of income, pathology or disability, may be entitled to total or partial exemption from the amount of the pharmaceutical ticket based on the criteria established by the Region.
For example, in Lombardy, residents with chronic or rare diseases who have an income of up to 46,600 thousand euros (increased depending on the composition of the family unit) are considered exempt for subsidized drugs related to the exempt pathology. Those with a higher income, however, are entitled to a 1 euro discount on the ticket (which is worth 2 euros for non-exempt people).
Consult the pages available on regional sites, dedicated to the exemption of the pharmaceutical ticket.
CLICK ON REGIONS/PA FOR REGIONAL PAGES DEDICATED TO DRUG TICKETS
HOW DO I GET THE DRUG EXEMPTION?
The right to exemption is recognized by the local health authority. Generally, at the same time as the issuance of theexemption from the ticket for specialist outpatient services, the ASL certifies the possible exemption from sharing the cost of medicines for reasons of income, pathology or disability based on the criteria established at regional level (if necessary, self-certification of income may be requested).
EQUIVALENT (OR GENERIC) DRUGS
EQUIVALENT (OR GENERIC) DRUGS
The copay is applied both for "branded" class A drugs and for equivalent class A drugs (also called "generic"), i.e. those not covered by patent, which are a copy of the original medicine and have a higher price. Bass.
If the patient must start treatment for a chronic disease for the first time or must be treated for a new episode of a non-chronic disease, the doctor is required to indicate on the prescription the name of the active ingredient contained in the medicine when there are several equivalent medicines on the market. In turn, the pharmacist is required to offer the citizen the drug with the most convenient price, i.e. the "generic" one. In the event that the citizen requests the original medicine or the doctor reports on the prescription, in addition to the active ingredient, the commercial name of a "brand" medicine, specifying that it cannot be replaced for the purposes of treatment, the difference in price between that “branded” and “generic” costs are paid by the citizen, even if they have an exemption (with the exception of victims of terrorism, war invalids and any other categories provided for by the Regions). Even when the doctor prescribes the original drug to continue a therapy already underway, the difference in price is paid by the citizen, even though he is exempt (with the exception, as mentioned above, of victims of terrorism, war invalids and other possible categories established by the Regions).
GROUP C DRUGS
GROUP C DRUGS
The cost of class C drugs (i.e. those not considered life-saving, which can be sold with or without a doctor's prescription) is normally borne entirely by citizens, including those who are exempt. Except for war invalids (holders of direct lifelong war pensions) and victims of terrorism.
REGIONAL EXEMPTIONS FOR CLASS C DRUGS
There is no national regulation that establishes the free use of class C drugs for rare disease patients. The Regions, however, may not charge the patient provided that these products are considered effective and indispensable for the treatment of the rare disease and are included in the individual therapeutic plan prepared by a unit of the national rare disease network. To find out how to request exemption from the cost of class C drugs, you must contact reference center for rare diseases in your region
