# Permesso di Soggiorno Renewal Frustration



## Mozella

After renewing my PdiS several times, I finally thought I had the process down pat........ WRONG!.

My ER Visa based PdiS expires in the summer, every other year. My ASL health insurance expires at the end of December every year. When I pay for my health insurance in January, in years when my PdiS has 6 months to run like this year, they usually set the expiration in August to match that of my PdiS even though I've paid for a full years health insurance. Once I renew my PdiS, I take the new card to the ASL and they give me a new health card lasting until 31 December at no additional charge. This past January I was able to convince them that they should give me a health insurance card covering the whole year, thus saving me an extra trip to the ASL office. However, I think I only got a break because the sister of my friend has been promoted to window clerk and we know each other.

Today my wife and I went to the Questura for the fingerprint portion of our PdiS renewal. It's always a PITA with hours long waiting in tiny over-heated rooms crowded with all sorts of confused people, many with babies, and many with incorrect paperwork. Today was no exception except that it was extra hot.

Expecting to breeze through once our names were called, as we had in years past, I was surprised when the clerk asked me to show proof of health insurance coverage lasting for the full two years. This had never happened before. 

I explained that I could only buy ASL insurance one year at a time. He argued that I must then also buy private insurance. This triggered an extended discussion as the clerk went around questioning every other clerk in the office. After making the rounds of his colleagues, and then returned to me to explain that one option was to renew my PdiS every 6 months. I explained I'd rather take an ice pick to the eyeball. We went back and forth as I explained the absurd Catch 22 I was in, even though I didn't invoke the actual book title. I offered to show him proof that I bought ASL insurance every year, but I would have to go back to my house to get the proof. I also offered to sign an auto-certification document swearing that I would continue my unbroken ASL coverage in the future. Since I'm old and fat (and by that point on the verge of a cerebral hemorrhage), I raised my voice and said, "Do I look like a guy who would fail to have health insurance"? Finally I resorted to actual begging asking him to take pity on a law abiding foreigner who was trying his best to obey the law. I don't know if that did it, or if they just got tired of me. After one last consultation with the lady who appeared to be the office manager, he returned to me, he said OK and walked away. I caught the eye of the office boss, I said, "a posto? tutto OK?", and finally she smiled and nodded.

I HOPE this means my wife and I will both get a notice in a couple of months to pick up the 2 year PdiS we paid for. Even when we first got our visa, we were only required to show health care for 90 days after our arrival because they assumed we would sign up with ASL in that time. My health insurance has never been questioned by the Questura before. This new requirement really throws a monkey wrench in our PdiS renewal procedure. The idea of buying double insurance makes no sense, at least to me. The obvious answer is for the ASL folks let us buy insurance lasting until our PdiS expires, but I am quite sure I would never live to see that change. There is no downside for ASL and they get to keep any unused premium payment if I were to die or (more likely) commit suicide after being overwhelmed by Italian bureaucracy. 

Has anyone else had a similar problem with a PdiS renewal?


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## BBCWatcher

How far away are you from an EC Long-Term Residence Permit (a form of CdS in Italy)?


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## Mozella

BBCWatcher said:


> How far away are you from an EC Long-Term Residence Permit (a form of CdS in Italy)?


I "think" I qualify in September. Every time I've seen the duration of stay written, it says 5 years. However, the latest instruction book accompanying my PdiS renewal this year says 6 years. Is that a regulation change or just a typo; hard to tell.

Anyhow, my next step is to take the Italian Language test. Problem is I'm older than dirt and although I was pretty good at languages when I was younger (I can still remember quite a bit of the Farsi I learned 40 years ago), at my advanced age a good percentage of the Italian I learn goes in one ear and out the other. I'm studying and practicing every day, I get along fine in every day conversation, but I still get lost when the conversation gets too complicated or too fast. 

Part of the problem is that not only do most people in my town (and all of my friends) speak the Piemonte dialect, Italian is their second language too. They can speak Italian, but many of them don't speak it very well. For example, I was bragging to 4 of my Italian friends about building a nice door step outside my front door. I didn't know the word "gradino", so I described the project and asked them what it was called. NONE of them knew the word. I had to look it up. When I visit the local bar in the afternoons and gather with a with my pals for a chat over a glass or two of wine, my friends speak Italian to me, but when they turn to say something to the person sitting next to them, it's invariably in dialetto, so I'm missing out on most of the conversation and that makes it harder to learn Italian. 

Anyhow, I'm going to give the test a try and if I can get past that, or get my doctor to certify that I'm too crazy to learn Italian, I'll continue with the Long Term Permit process. That will eliminate the need to renew my PdiS every two years.

Does anyone on this forum have personal experience with the Italian Language Test?


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## PauloPievese

Presuming that "ASL health insurance" is "Azienda Sanitaria Locale", how do you get this and how much does it cost? Is it adequate? If I can get a Permesso di Soggiorno do I automatically qualify for ASL?


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## Mozella

RetireInRome said:


> Presuming that "ASL health insurance" is "Azienda Sanitaria Locale", how do you get this and how much does it cost? Is it adequate? If I can get a Permesso di Soggiorno do I automatically qualify for ASL?


Yes, "ASL" is the Italian national health care system. It's not really "health insurance", it's government run socialized medicine. The cost (for foreigners) depends on your income and, to a smaller extent, where you live. I seem to remember that my wife and paid a little less than 400 Euros per year (each person) last January in Piemonte, which is the minimum if you don't have any income. It's not prorated and expires on Dec 31st, so you have to buy it on Jan 1 each year to maximize the value.

It's hard to say if it's adequate or not. I guess that depends on what you're used to. It's nowhere even close to as good as the health insurance I had in the U.S. but that was paid by my employer and I have no idea of the real costs except to guess that replacing it on the open market would be expensive. The Italian system offers better bang-for-the-buck since it's so cheap, but the care is not up to U.S. standards. There are the typical long lines, extended waiting times for appointments (sometimes VERY long), and all the other headaches and frustrations you would expect from a government run system. Our hospital would make a perfect movie set for a movie based in the 1950's. 

Neither of us have asked for any treatment which would be considered "serious". We both have bad knees but we limp along with the pain because we're afraid to get treatment from ASL based on the fact that our Italian friends with bad knees don't do very well. There's a reason you see so many Italians with walking canes.

But I don't think it's as bad as the English system, if that means anything. On the other hand, I'm not dead yet, the people who work for ASL are very warm and friendly, and did I say it was cheap?

The PdiS won't qualify you. After you get your PdiS you must next register for residency with the local commune where you live. There are a few documents you must fill out, they send someone out to inspect your abode, and in a week or a month you get a document proving you are a genuine resident. That proof is what you need to sign up with ASL because although it's national health care, it's administered locally. They will assign a doctor from your home town. I had a choice, so it might be a good idea to ask which doctor is the best in your town and request him/her when you sign up. 

The attribute which is most important is someone who shows up on time and doesn't take too many vacations. At least where I live, the doctor functions as a highly educated computer operator. My doctor is a great guy, but he has never touched me except to shake hands. He writes prescriptions for medicine and appointments at the nearby hospital or local clinic and, as far as I can tell, that's it. Then, we talk about football, auto racing, politics, taxes, and food for a few minutes.


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## PauloPievese

This answer is so good, so authentic, so fact-filled that it ought to be "sticky".


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## Mozella

RetireInRome said:


> This answer is so good, so authentic, so fact-filled that it ought to be "sticky".


Careful., this the Internet and "fact filled" is not guaranteed. I did my best to give my honest opinion and my personal experience. But others may have a completely different point of view along with different personal experiences. So don't consider my post as "gospel", but take it as just one data point in your quest for the truth.

Now if you want the real truth, then watch 



enlightening video. These pearls of wisdom have guided me for 34 years.


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## BBCWatcher

Your ASL card (tessera sanitaria) includes an embedded EHIC (European Health Insurance Card) that provides some medical coverage throughout most of Europe and even occasionally in some other places, like 6 months of coverage in Australia (would you believe). Is that medical insurance? Most people would say so, yes.

The WHO ranked Italy's healthcare system #2 in the world overall behind only France's. Granted, that was 14 years ago, though Italy still has pretty much the same system. The word "overall" is very important. Given huge amounts of money (or the insurance coverage equivalent) you can usually enjoy wonderful medical care in every or nearly every developed country, including Italy. But most people don't have such huge amounts of money and don't always have the best private insurance.


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## PauloPievese

One keeps hoping that the U.S. Affordable Care Act will ultimately result in reciprocity similar to that of Australia's as noted.

I'm down with the trusting the Internet thing but I've been doing this since the 80's (yes, like before the World Wide Web) so have a certain amount of both experience and incredulity. 

My experience of the Italian healthcare system is as a tourist who, having gotten some sort of food poisoning, walked into the 15th century hospital in Venice, was seen immediately, and paid about ten bucks. This may however be because Venice is effectively Disneyland with no real raison d'etre other than tourism and therefore gotta make the tourists feel safe and well.


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## DeeS

I found this post while searching for ASL information, and it was very entertaining. Thank you for the giggles. 

My perspective from a medical point of view is that Americans expect the best care possible, the newest drugs, the highest tech procedures, and don't want to pay for any of it. We complain when we have to pay part of the ridiculously high premiums, which are high because of (see sentence one of this paragraph). When we have to wait in the ER for an hour or two for our cough that we have had for 6 days, or we have a small cut which would have healed if we had just waited, or we get angry because the man with the chest pain is taken before us because we have waited for 45 minutes w/o being seen, it shows our unrealistic view of American health care. I worked in medicine for 40 years, primarily emergency medicine, but also in clinics. It is only getting worse.

The Italian "health plan", although cumbersome, does work in the majority of cases. Yes, we have to wait for care, sometimes for months, but it does get done. And for basically free. The main difference is patience. I have sat in an ER with a friend for 6 hours while she was evaluated for passing out. This started on an ER gurney, but she did most of the waiting in the waiting room in between visits to various doctors and tests. Others were waiting there, too. A woman with a sprained ankle waited for the same period of time, finally limped to the desk and asked for an ice pack, but she was patient. They all were patient. No hysterics, no screaming. Calm acceptance of the fact that that was how is was. 

I kept thinking "how different from the ER waiting room in the US". Better, maybe not, but certainly calmer. 

Just thoughts. 

Dee PS: I just applied for my renewal Permesso, and the INAC worker put in for a 2 years card. Maybe it wasn't the best idea. Now I am waiting for my appt with ASL... we will see what the Questura has to say.


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