# Healthcare insurance first 5 years for non-Eu



## boomerexpat

Hello all,

I am an American currently living in Mexico.

Is there an Italian company/organization you recommend for healthcare insurance during the first 5 years before one is eligible for the national insurance. I checked with BUPA and have a hard time with the idea of paying over 500 a month into their coffers. I'm 60.

Anything more reasonable than that?


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## BBCWatcher

I assume you're asking about coverage in Italy and about moving to Italy with an elective residency visa. If either or both assumptions are incorrect, please advise.

Why can't you buy into ASL right after you arrive? Get a Schengen visa-compliant policy to secure your ER visa, then pay for ASL after you arrive (ideally in January since it's a calendar year charge).


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## boomerexpat

BBC Watcher. I appreciate the prompt reply and specific info. 

This is for medical in Italy. I'm researching into retiring to Italy and, assuming it works out as well as I anticipate it will, would like to get on the path for permanent residency. I'm just starting to sift through the details. Originally I wasn't going to do this for a few years but am thinking of moving the process up to early next year.

so please forgive the very basic questions. 

ASL - I thought I had to be there 5 years to get into the system? Incorrect? I can do it right away?

Schengen visa compliant policy - is this the same as travel insurance?

Do you know of a good site to go and get basic information on the residency process for non-EU citizens, specifically retirees wanting to be on the path for permanent residence? Most of that I read is geared to the EU and vaguer for non-EU.


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## Bevdeforges

As far as expat insurance goes (this is what you'll need - not travel insurance, which would repatriate you to your home country in the event of serious accident or illness), you may want to take a look at the AARO coverage. AARO’s Health Care Program for Expatriate America

AARO is an American expat organization and they offer their members a sort of group coverage, with the medical coverage geared toward the visa requirements of most European countries. There is a rates sheet among the various documents you can download about the program. AARO membership can also be useful during your first several years living overseas, as they keep you advised of tax and other developments back in the US. 
Cheers,
Bev


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## BBCWatcher

boomerexpat said:


> ASL - I thought I had to be there 5 years to get into the system? Incorrect? I can do it right away?


Once you're a resident you can join ASL. As an elective resident you'll fall into what's called the "voluntary registration" category, which means you would pay a premium. But yes, you can join. I think it'd be impossible to find a better deal, especially at age 60+. The premium seems to vary a bit (and according to your income), but it's always reasonable at least by American standards.

This guide, published by the Italian Health Ministry, is quite good in explaining how it all works.



> Schengen visa compliant policy - is this the same as travel insurance?


It could be. It could even be your existing policy if you can get a suitable document from the carrier.

To tick that box you need to submit a letter or other suitable evidence of coverage from the insurance company. The Schengen requirements are that your insurance cover your intended period of stay (at least 90 days in your case), be valid throughout the Schengen Area, provide a minimum of 30,000 euro of coverage, cover all (emergency) medical expenses including repatriation of remains and medical evacuation, include direct settlement with medical providers (can be a preferred network), and have a contact point in the Schengen Area.

That's not a high hurdle, really.



> Do you know of a good site to go and get basic information on the residency process for non-EU citizens, specifically retirees wanting to be on the path for permanent residence? Most of that I read is geared to the EU and vaguer for non-EU.


It's very country-specific since each country has its own rules. Some allow foreign retirees, and some don't.

For Italy you can try Expatsinitaly.com, as an example.


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## BBCWatcher

Expect to pay about 388 euro to enroll in SSN/ASL.

That's per calendar year per person. If you enroll in November you're covered through the end of December, and the price is the same. So...try to enroll in January. But even if you enroll after January, it's still a bargain.

I've read reports of some local ASL authorities charging different rates, but 387.34 euro seems to be the norm.

On edit: Sorry, 387.34 euro is the minimum. The variability is because some local ASLs read the fine print more carefully. The premium for "voluntary registration" is supposed to be based on your income and is calculated as 7.5% of your income up to 20,000 euro then 4% for the next 30,000 euro (up to 50,000). So the maximum is 2,700 euro per year, and the minimum is 387.34 euro per year. Still a bargain, even if your local agency reads the fine print in the regulations. (Not all do, apparently.) If they want to charge you 387.34, then I would be happy about that.


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## boomerexpat

Thank you everyone for the insights


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## Mrtcpip

Hi everyone,

This is a good thread for me, I have a few questions please. 

Will the Italian Consulate require that a person have a health insurance policy to receive an Elective Residency? 

Or is health insurance a requirement of the permesso di soggiorno? 

If when purchasing a policy, what are the requirements? (I searched but could not find anything)

Will a travel policy for 3 months be adequate while we secure insurance once we arrive in Italy? (assuming Health care insurance is a requirement to receive the Elective Residency)


Thanks in advance!


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## BBCWatcher

Yes, you'll need health insurance to obtain an ER visa -- the consulate will demand that. It's up to the consulate what they'll accept, but generally it must be coverage that meets minimum Schengen standards. That isn't too much. In some cases a letter from your existing medical insurance provider stating they cover care in Italy is sufficient.

Once you're in Italy of course you have to get a PdS and continue proving coverage. You can optionally buy into the Italian public medical system (ASL), and that'll cost about 387 to 2700 euro strictly per calendar year. (So the best time to sign up is in January.) The exact amount depends on your income, although some localities have been known to skip the income calculation and just charge the minimum. If that happens, consider yourself lucky. Even at the income-adjusted price, it's probably the best deal you'll find.


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## BelloBello

BBCWatcher said:


> Yes, you'll need health insurance to obtain an ER visa -- the consulate will demand that. It's up to the consulate what they'll accept, but generally it must be coverage that meets minimum Schengen standards. That isn't too much. In some cases a letter from your existing medical insurance provider stating they cover care in Italy is sufficient.
> 
> Once you're in Italy of course you have to get a PdS and continue proving coverage. You can optionally buy into the Italian public medical system (ASL), and that'll cost about 387 to 2700 euro strictly per calendar year. (So the best time to sign up is in January.) The exact amount depends on your income, although some localities have been known to skip the income calculation and just charge the minimum. If that happens, consider yourself lucky. Even at the income-adjusted price, it's probably the best deal you'll find.


HI BBC,
I"ll be close to 65 when I make the move, will I qualify..with an ER, for ASL?
I'LL be 64 this year and in great health, at least I think I am.
Thanks.


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## BBCWatcher

Sure. The Italian public health system accepts applicants of any age as long as they're eligible to enroll. There is no age rating, and there are no preexisting condition exclusions, though there's a rough simulation of an "open enrollment" period because of the strict calendar year premium basis. If you sign up in, say, November you pay for the full calendar year even though you get less than two months of coverage. So if you're near the end of the calendar year you might try to get "bridge" coverage that ends in, say, mid-January -- maybe that's your existing policy -- and then sign up in early January.

ERs are "voluntary" participants which means they're eligible to enroll but must pay to do so, versus (as one example) Italian citizens who enroll for free.


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## BelloBello

BBCWatcher said:


> Sure. The Italian public health system accepts applicants of any age as long as they're eligible to enroll. There is no age rating, and there are no preexisting condition exclusions, though there's a rough simulation of an "open enrollment" period because of the strict calendar year premium basis. If you sign up in, say, November you pay for the full calendar year even though you get less than two months of coverage. So if you're near the end of the calendar year you might try to get "bridge" coverage that ends in, say, mid-January -- maybe that's your existing policy -- and then sign up in early January.
> 
> ERs are "voluntary" participants which means they're eligible to enroll but must pay to do so, versus (as one example) Italian citizens who enroll for free.


Wonderful! I thought as non-eu I wouldn't be able to. Another thing ticked off.
Thank you.


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## Larry and Arlene

*ExPat Health Care*

Greetings- We are American ExPats who have settled in Ascoli Piceno, Le Marche'. We have been here 9 months. We are decidedly senior citizens and entered on Elective Residenza Visas. To echo the BBC Watcher, once you have gotten your PdS and then gone to your local Anagrafe to get Residence Registration, you will, in due course, get your certificate of Residency which then permits you to go to the local oFFice of the Sanitaria to apply for the National Health Plan. This is administered on a Regional level. We were required to select the equivalent of a primary care physician at that time. Ditto again on the January enrollment and the amount we paid was the minimum as stated.

Two quick notes- SUITABLE ADDRESS- To get the visa they want to know where you are going to settle. If you haven't decided that, we suggest a scouting trip to make a decision on where in Italy, the size and characteristics of the community and importantly, make some contacts on the ground.

FRIENDS-OF-FRIENDS No matter how often you hear it it is true. Having a local to run interference for you and give advice is a Godsend. We breezed through processes because we had wonderful people holding our hands.

TIMING- There will be many variables. Elective Residenza Visa through the Italian Consulate in Los Angeles. They were very pleasant to deal with but we followed to the letter advice contained elsewhere on this blog; carefully do your homework, follow their requirements to the letter and be very, very thorough. Make it as easy for them as possible. In our case, visa in less than 3 weeks. PdS, took 4 months and I'm told that was quick. We got the residence process started but it took several goes because they needed an Apostile and certified Italian translation of our marriage registration. We were told by someone that wouldn't be necessary but it was. Health Insurance issued on the spot with the laminated card followed a week later.

Another tip: get your Codice Fiscale from the Consulate as you get your visa. Saves headaches as you will need it almost immediately when you arrive.

Hope this helps. Keep in touch if we can assist further. And we LOVE IT HERE!


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## boomerexpat

*prescriptions*

Larry and Arlene or anyone else, does the health insurance cover preexisting conditions and their related prescriptions?

I have glaucoma and need to take the eyedrops for it.

Also, I'm trying to find out on another post the details on taxes to US social security and 401K accounts in Italy. From what I can grasp, I'm getting some mixed views on that. I know what my tax situation will be with the US but not clear what implications for Italian taxes. Have heard that 401Ks are taxable and not taxable and that social security seems to be taxable???


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## Mrtcpip

Great post, ditto on the advice to get your residence secured before meeting with the Consulate. The first time we simply had a letter from the prospective landlord for three months with the ability to extend. This proved inadequate, and we had to return to Italy for the "scouting" trip as you mentioned. We also had to have our new lease registered by the real estate agent. I believe it was with the questura, but not certain. 

Q. Did you get an Apostile of your marriage certificate? We have a copy, I guess that is not adequate?

Thanks!


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## Larry and Arlene

*Apostile*

If you already have the Apostile, hopefully attached to the document that was certified, you should be fine. But the next step is getting a Certified Translation of the document done IN ITALY. The Apostile simply says the person signing your marriage certificate record was authorized to do so. It does not certify content, the document signing official did that.

There is a standardized process for translation certification in Italy. The person doing the translation should have some standing and then the translator certifies before an official of the court (Provincial Tribunale in most cases) that the translation is accurate.

When we presented that package to the Anagrafe, they thumbed through making sure the Apostile was there as well as the local court certification of accuracy with its (as always) tax stamp. The weren't concerned about content - it was check off the boxes time.


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## Mrtcpip

How did you get an apostile for your marriage certificate? When I ordered a copy from vitalchek.com there was no option for an apostile. It cost me $68 to boot..

Thanks for the help!


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## Larry and Arlene

*Apostile-*

We elected to obtain all the documents ourselves rather than using a service. A  Certificate of Marriage Record is normally obtained from the Clerk of the County Court in which the marriage took place. We elected to get extra copies, just in case, while we were at it, and we did that in person.
Apostile Our situation was California but we expect the situation will be essentially the same in all the U.S. jurisdictions. The terminology for the issuing office may vary but the end result should be the same. The Office of the Secretary of State of the State in which the County Clerk of the Court issued the Certification of Marriage Record is where you go. First, check on-line for the Secretary of State's website and look for 'Apostile.' It would normally be under document certification or some such. Determine the requirements to be met on the website for submitting a document. The fees were quite reasonable. A note of caution: we had to do it from here so because of time crunch, we FedEx'd the package together with a FedEx Account number on a return label with envelope. The glitch in the case of California was they would accept only PRE-PAID returns and would not use our FedEx account nor will the accept a credit card. The Apostile was turned around in a couple of days but it took four weeks to get it to us in Italy via snail mail- ARGH!!.
If you are still in the States, that should simplify matters.


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## Mrtcpip

Thanks for the info, I checked and the process is essentially the same for New York as far as I can tell. Do you know if any of these documents were needed for the ER meeting at the consulate? We have our meeting coming up and the last time they did t mention them as required. Thanks for the help !


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## Larry and Arlene

From comments we have seen on this Blog, it appears there is some variation in how different Consulates interpret the rules. In our case, we had a Certified Copy of Marriage Record with us when we were interviewed. We did not have the Apostile. Unfortunately, as we indicated earlier, we had to do that from Italy - not the best approach.

A suggestion we are passing along we got from others- Make extra copies of everything you are required to submit. If they feel they need more copies, you already have them for them. The easier you make their job, the likely they are to be favorably disposed.

If there is any way you could get the Apostile before the interview with the Consulate, that probably wouldn't hurt. But is seems with most all things Italian, predictability and consistency are not that high on the list.

But if it helps, we frequently remark the only negative that comes to mind about becoming ExPats in Italy is --'What if we hadn't done it?' This has been one of the smarter moves we have made. So some bureaucratic headaches turned out to be a relatively small price to pay.


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## pudd 2

Larry and Arlene said:


> From comments we have seen on this Blog, it appears there is some variation in how different Consulates interpret the rules. In our case, we had a Certified Copy of Marriage Record with us when we were interviewed. We did not have the Apostile. Unfortunately, as we indicated earlier, we had to do that from Italy - not the best approach.
> 
> A suggestion we are passing along we got from others- Make extra copies of everything you are required to submit. If they feel they need more copies, you already have them for them. The easier you make their job, the likely they are to be favorably disposed.
> 
> If there is any way you could get the Apostile before the interview with the Consulate, that probably wouldn't hurt. But is seems with most all things Italian, predictability and consistency are not that high on the list.
> 
> But if it helps, we frequently remark the only negative that comes to mind about becoming ExPats in Italy is --'What if we hadn't done it?' This has been one of the smarter moves we have made. So some bureaucratic headaches turned out to be a relatively small price to pay.


yes your are right a small price to pay , and as the Italians say without the buratwats 
Italy would be paradiso , and no human being should live in heaven


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