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Post by Angela Fuller Wed Apr 22, 2015 4:57 am


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This would be costly to a few... Bb2329932f8a5d83a0c6de2ad928d9c23612df1303079547a8cdcf8fc454eb55
Photo: Richard Pohle/AFP
Brits in Italy could face health 'black hole'
Published: 21 Apr 2015 09:00 GMT+02:00
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British people living in other European countries could find themselves forced to take out private health insurance, due to a clampdown on expats using the country’s National Health Service.

Many British people in other EU countries return to the UK for routine doctors’ visits, and many fail to register with a local doctor in their new country, particularly in the early stages following a move abroad. In some countries, bureaucracy means registering with local health authorities can take years.
But under new rules that come into force this month, people who make use of the NHS in the UK will be asked to declare that they are ‘ordinarily resident’ in the country. Those who live elsewhere in the EU, Norway or Switzerland, and who want planned treatment could find themselves forced to pay up-front. 
Even expats seeking emergency treatment during short visits home could also face steep charges if they don’t have their paperwork from their new country in order, as the NHS seeks to claw back £500 million a year ($746 million, €695 million) in lost revenue.
Claire*, from London, has lived in Italy for two years, but still isn’t registered with an Italian doctor. When she needed a smear test recently, she opted to have it with her old doctor in London.
“I wanted to speak to an English doctor who I could speak with, felt comfortable with and I knew. And I knew it would be swift.”
“I haven’t registered with an Italian doctor yet as I haven’t got a residence permit in Italy yet, due to the kinds of bureaucratic delays that are typical in Italy. Without residency, I can’t register with the health service.”
Long-standing European arrangements state that EU citizens should seek healthcare in the country they live in, regardless of their citizenship. They can seek healthcare in other EU countries, but this must generally be authorised and billed back to their country of residence.
But in a change to UK rules, expats who want treatment in the UK have to show a European Health Insurance Card (EHIC) issued by their new country. Until this month, former UK residents were automatically entitled to use the NHS for free if they fell ill during a visit. In practice, many expats use the NHS for planned treatment too. But now this right is being removed.
The charges faced by patients without an EHIC card or proper insurance can be significant. Intensive care beds are charged at a rate of £1,800 a day (€2,495) plus the cost of procedures and drugs. Even hospital outpatient visits can be costly, at £248 per visit (€348).
The Royal Berkshire NHS Trust, one of 59 NHS Hospital Trusts in England, says on its website that patients who leave a debt could find their details registered with the UK Border Agency, meaning they could be stopped next time they try to enter or leave the country.
In an email to The Local, the UK Department of Health confirmed that there is no ‘grace period' following a move during which they can use the NHS - the moment they have left the country they lose their right to NHS treatment.
The new declaration could make it harder for expats to bypass the system, and new rules could leave expats with no option but to go private.
Joe Coaker of ALC Healthcare, a private insurer focused on expats, says Claire’s situation is not unusual.
“We often hear from expatriates who question the need for international health insurance as they imagine they can return to the UK and fall back on the NHS or the State healthcare in whichever country they come from,” he said.
There was better news for British retirees in Europe. Anyone living in the EU and receiving a British state pension will be entitled to free healthcare in the UK, as long as they hold a valid S1 form, which is obtained from British authorities before moving abroad. The move comes after the British government decided last year that it would stop paying the healthcare costs of UK pensioners who lived in other EU countries, leaving many facing big bills.
*Not her real name 
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Angela Fuller
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Post by stevegwmonkseaton Wed Apr 22, 2015 8:46 am

Yeh, but it's mainly rubbish being recycled by the government. For years now the NHS has supposed to be asking you if you are resident in the UK and have not done so! Now the government intend to try and force them to do this.... Well these two "ragmags" revel in such things.
Express LINK
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All I see as changed is the government trying to enforce with the trusts the requirement, by asking to see your passport...  Smile Note according to the Express it only covers hospitals not GPs. To me it's just another step in the long term plans to privatise the NHS i.e. doing the jobs required to make it look more attractive to private companies pirat

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Post by Admin Wed Apr 22, 2015 8:55 am

Well, I think it's a good thing. It's no different to what happens here where you have to show your health card when you pay for treatment.
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Post by stevegwmonkseaton Wed Apr 22, 2015 10:09 am

Admin wrote:Well, I think it's a good thing. It's no different to what happens here where you have to show your health card when you pay for treatment.

What happens here is nothing to set your stall by.... Shocked

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Post by Admin Wed Apr 22, 2015 10:29 am

Yes but why should UK tax payers fund people who don't live there to use the NHS? If you live in Italy you have to contribute here. That is just morally right.
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Post by Flip Wed Apr 22, 2015 11:36 am

Spot on Penny, if the UK system was more like we have here, I don't think it would be in such DooDoo as it is now. The Brits have always had a phobia of carrying ID of any sort, so to monitor the situation how are they supposed to check; demanding a passport is a non starter as what happens if you are admitted via A&E do you have to first get your documents before they treat you? No don't think so. It's just the usual pre-election sabre rattling that Politicians do to drum up support. Personally I think if you hadn't thought that the NHS was going to be Privatised under a Tory Gov, then you've been doing a passable impression of an Ostrich.
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Post by stevegwmonkseaton Wed Apr 22, 2015 12:05 pm

Ah tax payers... Yes I pay UK tax, so I'm entitled ... Just give them your tax number then or is it NI number ... passport number. Oh and yes that's what the government intend, go to A&E and you need your passport - I think not, just as is the case here...

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Post by Admin Wed Apr 22, 2015 12:31 pm

Exactly. Not sure what you mean here but whenever I have been to the hospital in Italy (including emergencies) I have had to give my tessera to them and they see my details on their computer.
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Post by stevegwmonkseaton Wed Apr 22, 2015 12:40 pm

We have been 3-4 times to the hospital here in Italy, asked for our cards (which we don't have), but still been treated (and very well too).

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Post by Flip Wed Apr 22, 2015 5:50 pm

Steve as long as you stay in the UK to have your 'Medical Procedures' that's fine by us Italian Taxpayers, just don't expect to be treated any differently as I would not expect to be treated any differently in the UK. I have a Tessera Sanitaria here and if I need treatment (God forbid) in the UK I would show them that. It seems that here in Italy we are kinder to ''Expats'' than the UK would have us think.
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Post by ghiro Wed Apr 22, 2015 6:40 pm

I had to take my mother-in-law (aged 82) as an emergency to A&E at the Chelsea & Westminster in London recently.

On arrival they asked her for her details at reception.  Initially they tried unsuccessfully to find her on their computer (she lives in Wiltshire).  The fact they couldn't find her seemed to trouble them.

Eventually we established that they had spelt her first (Christian) name incorrectly and up she popped on their database.  All was well!  Smile  

But what if they hadn't managed to find her?  Would they have denied her treatment or, perhaps, charged her?  The 'medical' NHS computer system is a disaster but the 'admin' system seems quite robust.
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Post by stevegwmonkseaton Wed Apr 22, 2015 9:11 pm

Flip wrote:Steve as long as you stay in the UK to have your 'Medical Procedures' that's fine by us Italian Taxpayers, just don't expect to be treated any differently as I would not expect to be treated any differently in the UK. I have a Tessera Sanitaria here and if I need treatment (God forbid) in the UK I would show them that. It seems that here in Italy we are kinder to ''Expats'' than the UK would have us think.

Flip I pay Italian tax almost every day I'm here, they call it IVA... Smile

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Post by modicasa Thu Apr 23, 2015 5:13 am

I dont think indirect taxation counts, as you pay it wherever you are - and remember - its on what they laughingly call 'luxuries'.  Cool

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Post by stevegwmonkseaton Thu Apr 23, 2015 7:44 am

modicasa wrote:I dont think indirect taxation counts, as you pay it wherever you are - and remember - its on what they laughingly call 'luxuries'.  Cool

It's a lot more here, but a lot of it (food) we see as a luxury compared to the UK...

Back on the topic of healthcare, this same subject/article was posted on the same day on Abruzzolutely and someone on there has said they have been told the rules on Italian care have changed and you now have to be resident 5 years before you can get your health card, anyone else heard this Question

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Post by Angela Fuller Thu Apr 23, 2015 8:12 am

Steve, Admin did say in another post that you are not covered as a resident by the Italian system until you have premanent residency (which is after 5 yrs), does that answer your question ?
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Post by stevegwmonkseaton Thu Apr 23, 2015 9:09 am

Thanks Angela, I've since dug up this LINK, which seems to confirm it, well for Rome at least... It's now just curiosity as to whether or not this changed recently as a number of people we know in the last few years have gained their TEAM card immediately after getting residency.....

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Post by Admin Thu Apr 23, 2015 9:51 am

It is correct that you don't get cover until you have permanent residency (5 years). That has been the case since I arrived in 2004. However, if you are contributing in Italian income taxes and INPS you can be covered immediately you gain residency.

The difference is the UK used to cover the first 5 years, then they covered the first 2 and now they cover none of it.
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Post by Angela Fuller Thu Apr 23, 2015 9:57 am

Admin: A question:  Do you have to apply for permanent residency or is it automatic ?  I think maybe you need to apply?  and ques 2: If your OH has permanent residency and you are included on the S1 form, what does this entitle you to ?
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Post by Admin Thu Apr 23, 2015 10:33 am

Yes, you have to apply. Don't forget either as I know someone whose residency was cancelled after 5 years as he didn't apply for permanent residency!

The S1 form only means that the UK will pay for the holder's healthcare. It has nothing to do with residency, other than meaning you don't need to take private cover to apply for residency in the first place.

One of the requirements of residency is that you can support yourself. If your husband is a pensioner (I can't remember in your case) then he can make a declaration saying you are his responsibility financially and so long as his pension is sufficient for both of you (the amount changes every year but is around €10-11,000) each year then you are fine. I think you may well be given permanent residency as you are effectively 'joining' him. However, in your case it doesn't matter as you are on the S1 and, assuming it doesn't have an expiry date, the UK will pay for your healthcare.
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Post by Angela Fuller Thu Apr 23, 2015 1:43 pm

thx Admin, that has made it all clear....now off to the comune...AGAIN !
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Post by Angela Fuller Fri Apr 24, 2015 4:57 am

Admin, OH is a resident and has UK government pension, I have been added to the S1 form which is, apparently in the post.  Neither of us work here. Is it necessary for husband to apply for permanent residency and if so what are the, ( if any ) benefits. He was unaware that it was compulsory to apply for it after 5 yrs and thought it was just something you could do if you wanted to vote in local elections.
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Post by Admin Fri Apr 24, 2015 8:18 am

It's got nothing to do with voting in local elections which you can do as a resident anyway. For most people, the advantage is that they get healthcare like an Italian. Obviously for a pensioner that is a little different. As to whether it is compulsory I honestly don't know.

I do know that someone who lived in Montefortino got his residency cancelled becuase after 5 years he did not take his permanent residency. Whether this was correct/legal or not I don't know.

Your permanent residency certificate has no expiry date. I don't know what you get nowadays when you ask for residency and whether that document has an expiry - I did it all too long ago and the laws have changed.
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Post by The Original Relaxed Fri Apr 24, 2015 9:18 pm

Admin wrote:Yes, you have to apply. Don't forget either as I know someone whose residency was cancelled after 5 years as he didn't apply for permanent residency!

On this specific point (residency having been cancelled) I encountered this recently. The extracommunitari concerned was not recorded in the 2011 Italian census as resident (present on the day in question) at the address which was his 'residence' as recorded on his (entirely legitimate) Carta d'identita.Maybe just your average xenophobia, but this little detail may have escaped the notice of  'pretend' residents (whether EC or extracommunitari).


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Post by stevegwmonkseaton Sat Apr 25, 2015 6:49 am

The Original Relaxed wrote:
Admin wrote:Yes, you have to apply. Don't forget either as I know someone whose residency was cancelled after 5 years as he didn't apply for permanent residency!
On this specific point (residency having been cancelled) I encountered this recently. The extracommunitari concerned was not recorded in the 2011 Italian census as resident (present on the day in question) at the address which was his 'residence' as recorded on his (entirely legitimate) Carta d'identita.Maybe just your average xenophobia, but this little detail may have escaped the notice of  'pretend' residents (whether EC or extracommunitari).



[/quote]

Just out of curiosity what is a 'pretend resident'? Also what happens to them if they have lost their residency?

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Post by Lisa C. Sun Apr 26, 2015 6:28 pm

Sorry if this may have been addressed before but I also have a question about health insurance.  My husband and I are US citizens and got our Italian citizenship about 4 years ago through Jus Sanguinis.  We are currently US residents but are looking to move to Italy full-time in about 3 years, when we retire.  As Italian citizens, will we be able to get permanent resident status right away and thus qualify for the Italian health insurance?
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