Exemptions from payment of the co-pay fee (ticket)
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As part of the Standard healthcare provision Essential levels of assistance (LEA) guaranteed by the National Health Service, the use of certain services by the citizen, is subject to payment of a small proportion of the fee (ticket) [1] while other services are provided at no cost to the insured at the time of use.
For health services that require the payment of a fee (ticket), the insured are recognized exemption from payment in relation to:
- particular income situations related to age of social condition;
- specific chronic or rare diseases;
- recognition of the state of disability.
This right is extended to third country citizens regularly registered with the SSN, in the same manner and under the same conditions as Italian citizens.
Indice
- 1 Health services that do not require payment of the fee (ticket)
- 1.1 Services included in programs of early diagnosis, collective prevention and protection of collective health
- 1.2 First-level services
- 1.3 Ordinary hospitalization
- 1.4 Services for the protection of maternity
- 1.5 Prevention of the spread of HIV infection
- 1.6 Promotion of donation of blood, organs and tissues
- 1.7 Protection of victims of complications caused by mandatory vaccinations, blood transfusions and blood products
- 1.8 Some vaccinations
- 2 Personal conditions for which there is exemption from payment of the fee (ticket)
- 3 Exemptions for chronic and rare diseases
- 4 Exemptions for disability or disabling status
- 5 Notes
Health services that do not require payment of the fee (ticket)
In order to encourage participation in prevention programs of proven effectiveness, ensure access to basic health care, ensure the appropriate use of hospital care and protect conditions of social interest, the following services are always excluded from payment of the fee (ticket), for all citizens, Italians and foreigners regularly registered and for holders of STP code:
Services included in programs of early diagnosis, collective prevention and protection of collective health
This category includes diagnostic imaging and laboratory services and other specialist services included in organized programs of early diagnosis and collective prevention in implementation of the national health plan, regional health plans or otherwise promoted or authorized with formal acts of the Region and services aimed at protecting collective health required by law or arranged locally in case of epidemic situations, as well as those aimed at start a work, resulting from legal obligations [2] In particular, the SSN guarantees free execution of tests for the early diagnosis of certain tumours:
- ammography every two years for women aged between 45 and 69; if the mammogram requires so, second-level services are also provided free of charge;
- cervical-vaginal cytology (PAP test), every three years for women aged between 25 and 65;
- colonoscopy every five years, for the population older than 45.
First-level services
The services that do not require the payment of the fee primarily include those provided by the general practitioner and paediatrician. In the hours not covered by the primary care physician, the continuous assistance service is available (former doctor on duty). First-level services, provided free of charge, direct, without appointment or medical prescription include even those offered by drug services (SerT), the Mental Health departments (DSM) and family planning clinics. As for basic assistance to holders of STP code, the Regions and Autonomous Provinces may provide for the assignment of the general practitioner and paediatrician or provide for other organizational assumptions.
Ordinary hospitalization
Treatments provided during ordinary hospitalization and services closely and directly related to the planned hospitalization, previously provided by the same structure, are excluded from payment of the fee (ticket) [3]. Urgent treatment provided at the Emergency Department of a hospital are also free. Regarding the latter category, it is important to emphasize that the exemption only applies for services for which the urgency is formally recognized during the Triage: at the time of acceptance, if in the ER the patient is assigned a white code, that indicates the non-severity of the clinical situation, then a ticket must be paid.
Services for the protection of maternity
Services provided to couples who wish to have a baby and pregnant women are exempt [4] as well as specialized services related to the voluntary interruption of pregnancy. In particular, the following services are guaranteed:
- obstetrics and gynaecology medical visits;
- some pre-conception analyses, in order to exclude the presence of factors that might negatively affect the pregnancy. If the couple's clinical or family history shows conditions of risk for the unborn child, all the necessary and appropriate services to ensure any genetic defects, prescribed by a medical specialist, can be provided with exemption (free);
- diagnostic tests to control physiological pregnancy. In the case of threat of abortion, all the necessary specialist services for the monitoring of the evolution of pregnancy are included;
- necessary and appropriate services for prenatal diagnosis during pregnancy, prescribed by the specialist, in case of specific conditions of risk to the fetus;
- necessary and appropriate services, usually prescribed by a specialist, for the treatment of pre-existing illnesses or that arose during pregnancy that involve a risk for the woman and fetus.
Prevention of the spread of HIV infection
Prevention of the spread of HIV infection is excluded from payment of the fee, limited to test the state of infection, in favour of persons belonging to risk groups, with risky behaviour or incidentally exposed to risk of infection.
Promotion of donation of blood, organs and tissues
Only services related to donation are excluded from payment of the fee.
Protection of victims of complications caused by mandatory vaccinations, blood transfusions and blood products
This includes services aimed at the protection of victims of irreversible complications due to mandatory vaccinations, blood transfusions and blood products, limited to the services indicated by law 25 February 1992 no. 210.
Some vaccinations
The SSN provides the following vaccinations free of charge:
- andatory vaccinations in childhood and subsequent recalls (diphtheria, antipoliomielitica, tetanus, hepatitis B virus);
- ecommended vaccinations in childhood and subsequent recalls (against pertussis, infections from haemophilus influenzae b-Hib, measles-mumps-rubella);
- PV vaccination for girls during the 12th year of life;
- neumococcal and meningococcal C vaccination for all newborns;
- influenza vaccination for people over 65;
- varicella vaccination for all newborns, as of 2015. [5]
Personal conditions for which there is exemption from payment of the fee (ticket)
Citizens contribute to health care fees through general taxation in proportion to their income and by paying a fee called “ticket” for some services included in the Standard healthcare provision Essential levels of assistance (LEA) . As well as representing a form of health care financing, the “ticket” is also to limit the use of unnecessary health services. Currently “ticket” concern:
- specialized services (visits, imaging tests and laboratory analyses);
- non-urgent emergency care;
- thermal spa treatments;
- pharmaceutical services (depending on the Regions).
- Citizens are entitled to exemption from the “ticket” on the basis of:
- particular income situations related to age of social condition;
- specific chronic or rare diseases;
- recognition of the state of disability
Exemptions for low income
The following are entitled to exemption for income: Italian and foreign citizens registered with the National Health Service under specific income categories related to age or social status. The following table shows the conditions of eligibility for exemption for income and the corresponding exemption code associated with each of them. Please note that each Regions may provide different or additional provisions to those provided at national level.
| Exemption condition | Code to be indicated on the medical prescription |
|---|---|
| citizens under the age of six and over the age of sixty-five belonging to a household with total income not exceeding € 36.151,98 | E01 |
| unemployed and dependent family members belonging to a household with total income less € 8.263,31, increased to € 11.362,05 in the presence of spouse and additional € 516,46 for each dependent child | E02 |
| non-contributory pensioners and dependent family members | E03 |
| Beneficiaries of minimum pensions over the age of sixty and dependent family members, belonging to a household with total income less than € 8.263,31, increased to € 11.362,05 in the presence of spouse and additional € 516,46 for each dependent child | E04 |
To obtain recognition of the exemption people who are eligible must submit a self-certification to the Local Health Authority of residence. The certificate of exemption for income has annual expiration. For foreign citizens who do not comply with the rules on entry and residence and holders of STP code, if without sufficient resources to pay for the “ticket”, it is possible to apply the exemption code X01. This code is indicated by the doctor on the medical prescription following a declaration of indigence by the insured, and applies only for the single service prescribed. The X01 code may only be used when the foreign citizen is not entitled to the exemption from the ticket for other reasons (pregnancy, illness, etc.):
| Exemption condition | Codice da riportare sull’medical prescription |
|---|---|
| Irregularly staying foreigners with STP code | X01 |
Exemptions for chronic and rare diseases
As regards exemption for chronic and rare diseases, citizens must make a request to the relevant ASL office by presenting a medical certificate issued by a medical specialist who work in a public hospital or a public outpatient unit, stating the presence of diseases for entitling to exemption [6] [7] In response to the request, ASL shall issue a certificate indicating the definition of the disease, the identification code and the list of services exempt. The exemption from payment of the “ticket” for disease reason is provided for all tests and medicines related to the disease. If the conditions apply, this type of exemption can also be recognized to foreign citizens who do not comply with the rules on entry and residence holders of STP Code [8] .
Exemptions for disability or disabling status
Exemptions for disability or disabling status are recognized following the assessment of the state and the degree of invalidity made by the medical commission of the competent ASL. Such exemption may apply, as appropriate, to all diagnostic imaging, laboratory and specialist services or only those related to the disabling condition.
Notes
- ↑ Decreto legislativo 29 aprile 1998 , n. 124 Last access 03/06/2015
- ↑ Decreto legislativo 29 aprile 1998 , n. 124. Art. 1 comma 4, lett. a) e b)Last access 03/06/2015
- ↑ Articolo 1, comma 18, della legge 23 dicembre 1996, n. 662 Last access 03/06/2015
- ↑ [The complete list of these services is contained in "Decreto Ministeriale 10 settembre 1998"Last access 03/06/2015.]
- ↑ Ministry of Health Vaccinazioni offerte dal Servizio Sanitario Nazionale Last access 03/06/2015
- ↑ "Decreto Ministeriale n.329/1999 ".
- ↑ Decreto Ministeriale n.279/2001"
- ↑ Allegato 12 al Decreto del Ministro dell’Economia e delle finanza 17 marzo 2008 Last access 03/06/2015
