Key points from the online meeting of 26.06.2024: the ASL and choosing a doctor, unemployment benefit, citizenship

ASL. Registration, choosing a doctor. Esenzioni ticket

What is the ASL?

ASL stands for Azienda Sanitaria Locale (local health authority), the body responsible for managing health services and implementing health policy in a given area of Italy. Each region has its own ASL, which provides medical services to the population.

Main functions of the ASL

1. Medical services: the ASL provides primary care services and specialist services such as doctor’s appointments, vaccinations and home care.
2. Emergency management: the ASL coordinates emergency medical services and provides assistance in crisis situations.
3. Prevention and health promotion: the ASL runs prevention programmes, health education and vaccination campaigns.
4. Public health monitoring: the ASL monitors the health of the population and manages infectious diseases.
5. Services for vulnerable groups: the ASL offers support and specialist services for at-risk groups such as pensioners, children and people with disabilities.

How to contact the ASL

Anyone can contact their ASL for information about the services available, to book appointments or to deal with health problems.

Registration with the SSN (Servizio Sanitario Nazionale, the National Health Service) is done at the ASL of the Comune where the person lives or has their registered residence (residenza).

If you hold a permesso di soggiorno (residence permit), you submit the following documents to the ASL

* an identity document (carta d’identità);

* codice fiscale (tax code);

* permesso di soggiorno;

If you are waiting for your permesso

* codice fiscale numerico provvisorio;

* ricevuta della domanda di regolarizzazione;

* passport

In this case you are not automatically given a tessera sanitaria (health card), only a certificato sostitutivo.

People who do not hold an EU residence permit can also receive the outpatient and hospital treatment they need. To do so, they must obtain an STP card from the ASL (Straniero temporaneamente presente).

This card is issued for 6 months and can be renewed.

As a general rule, you can obtain this card 90 days after your arrival in Italy by going to the ASL with your passport and filling in the relevant Autocertificazione di indigenza (self-declaration of lack of means).

In this case medical care and some medicines (fascia A) are provided free of charge. With this card you pay some tickets (healthcare co-payments), you are not entitled to the esenzione per reddito (income-based exemption), but you are entitled to the esenzione per patologia (exemption for a medical condition) if you provide a Certificato di patologia as proof of the illness.

Note that with this card you can only use public and municipal facilities (strutture pubbliche).

People who have come to Italy as tourists, that is, for no more than 90 days, are not registered with the SSN, because they must have travel insurance. So if they need medical care, they will receive it, but they will be billed for it.

Choosing a doctor (MEDICO DI BASE)

People who already hold a permesso, and those who are waiting for one, are assigned a family doctor (medico di base) by the ASL from the list of doctors who have places available. If you wish, you can change doctor by going back to the ASL, without having to give a reason.

For people with an STP card, a designated doctor sees patients at the ASL office itself, and you cannot choose them.

Appointments with the family doctor are by booking and free of charge. When needed, the medico di base refers the patient to specialists, orders the necessary tests or other examinations and writes prescriptions for medicines. To book a specialist, take the referral from your family doctor to the hospital’s CUP (booking centre) and book an available date. Then you pay the ticket. If the specialist orders further tests or examinations, go back to your family doctor, who will write the prescription or referral.

Esenzioni

People on low incomes or belonging to certain social groups are entitled to reduced charges for medical services (esenzioni ticket, exemptions from co-payments).

Esenzioni codes

E00: people aged 6 to 65 with chronic illnesses, disabling illnesses or rare diseases, if the family’s income in the previous year did not exceed €36,151.98. This code applies only to medicines connected with the illnesses listed above;

E01: children under 6 and people over 65, if the family’s income in the previous year was no more than €36,151.98;

E02: unemployed people and the members of their family who are fiscalmente a carico (tax dependants), if income in the previous year was up to €8,263.31. This amount rises to €11,362.05 with a dependent spouse, plus €516.46 for each child;

E03: people receiving a social pension and their dependants (fiscalmente a carico);

E04: people receiving a minimum pension and the members of their family who are fiscalmente a carico, if the family’s income in the previous year was below €8,263.31. This amount rises to €11,362.05 with a spouse, plus €516.46 for each child;

E07: non-EU citizens holding a permesso di soggiorno di asilo politico o motivi umanitari;

E20: people whose family income in the previous year did not exceed €16,000.00;

E21: families of 3 people whose income in the previous year did not exceed €19,000.00;

E22: families of 4 or 5 people whose income in the previous year did not exceed €23,000.00;

E23: families of more than 5 people whose income in the previous year did not exceed €25,000.00;

E24: people whose family income was between €36,151.98 and €52,000.00. This exemption code can only be used if the person has an esenzione per malattia rara/per patologia.

E94: full or partial exemption from charges for medicines for families with a total annual income of up to €18,000. The amount increases by €1,000 for each dependent child.

E95: full or partial exemption from charges for medicines for people over 65, if the annual family income does not exceed €36,151.98;

E96: full or partial exemption from charges for medicines for people whose annual family income is up to €23,000. The amount increases by €1,000 for each dependent child.

X22: granted to people (refugees) who have come from Ukraine (valid until 31.12.2024), provided they have chosen a family doctor/paediatrician and only if the person is entirely without work. This code is provided for by Circolare N.0000863-15/01/2024-DGPROGS-MDS-P and Ordinanza n.895 del Capo della Protezione civile. It is granted by the ASL on a declaration that the person is not working. Temporary protection does not entitle a person to a TEAM (tessera europea assicurazione malattia, the European Health Insurance Card).

Unemployment benefit

Governed by Decreto legislativo 22 del 04.03.2015.

*NASpI (Nuova Assicurazione Sociale per l’Impiego)

It is available to people who worked under an employment contract and lost their job through no choice of their own (the exceptions being resignation per giusta causa (for just cause) and protected resignation during maternity (dimissioni protette per maternità)).

It does not apply to agricultural workers (agricoli), to holders of a Partita IVA (VAT number), or to non-EU nationals who worked in seasonal jobs. They are entitled to other kinds of benefit.

NASpI is paid by INPS (National Social Security Institute) monthly, for a period equal to half the time for which social security contributions were paid during the 4 years before the dismissal.

By law, to qualify for NASpI a person must have worked at least 13 weeks during the last 4 years and have had social security contributions (contributi) paid for that period.

In other words, someone who worked without a break for 4 years will receive payments for 2 years.

How to apply

You can use the services of a CAF or a patronato, or apply yourself on the INPS website.

The application is submitted online on the INPS platform no later than the 68th day after the dismissal.

Payments start from the 8th day after the dismissal if the application is submitted by the 8th day after the dismissal, or from the day after the application is submitted (if it is submitted after the 8th day).

The amount of unemployment benefit is calculated on the average monthly income over the last 4 years before the dismissal and comes to roughly 75% of that monthly income.

Calculation formula: contributions over the last 4 years / weeks of contributions × 4.33

If the result is less than €1,425.21, the benefit is 75% of that amount; if it is higher, 25% of the difference between the calculated amount and €1,425.21 is added on top.

Overall, however, payments cannot exceed €1,550.42 a month (as of 2024).

Payments stay the same for the first 5 months; from the 1st day of the 6th month they are reduced by 3% each month.

When applying, you must fill in the form declaring that you are available to take up the job offers proposed to you (Dichiarazione di immediata disponibilità al lavoro e alla partecipazione alle misure di politica attiva del lavoro), agreed with the Centro per l’impiego (job centre).

Documents required for the application:

1. The contract from your last job and your last busta paga (payslip)
2. Cessazione del rapporto di lavoro (termination of employment)
3. IBAN code, BIC/SWIFT code
4. Permesso di soggiorno
5. Carta d’identità
6. Codice fiscale

Please note that to receive the payments you must have a registered residence (residenza).

Italian citizenship

The criteria for granting Italian citizenship set out in Law No. 91/1992 ( legge n.91/1992) are of four types:

• By birth (cittadinanza jure sanguinis);
• By marriage to an Italian citizen (cittadinanza per matrimonio);
• By operation of law (cittadinanza per beneficio di legge);
• By naturalisation (Italian citizenship by residence, cittadinanza italiana per residenza).

Italian citizenship by birth (Cittadinanza italiana per nascita) (Under Article 1 of Law No. 91/1992 (l’art.1 della legge n.91/1992))

A citizen by descent is

1) a child whose father or mother is an Italian citizen (so-called iure sanguinis)

Italian citizenship by birth (cittadinanza iure sanguinis) passes from parents to child, regardless of the place of birth.

So the child of a father or mother who is an Italian citizen is an Italian citizen even if born abroad, provided that the birth certificate is entered in the civil status register (registro dello Stato Civile).

2) anyone born on the territory of the Italian Republic if both parents are unknown or stateless, or if the child does not take the parents’ citizenship under the law of the State they belong to (so-called iure soli);

3) a child of unknown parents found on the territory of the Republic is considered a citizen by birth unless possession of another citizenship is proven (so-called ius soli residuale)

(The law grants citizenship to a child of unknown parents who is found on the territory of the Republic);

4) Recognition or judicial declaration of parentage (riconoscimento o la dichiarazione giudiziale della filiazione) while the child is a minor determines the child’s citizenship in accordance with the law.

(The child becomes an Italian citizen after recognition or a judicial declaration of parentage, provided this happens before they come of age);

5) In addition, the minor children of a person who acquires or recovers Italian citizenship acquire citizenship iure sanguinis if they live with that parent, from the moment the parent obtains or recovers citizenship

(In short, if you hold Italian citizenship, your child automatically becomes an Italian citizen.

On coming of age, children may renounce Italian citizenship only if they hold another citizenship);

6) In the case of adoption of a minor.

Italian citizenship by marriage (cittadinanza italiana per matrimonio)

Italian citizenship by marriage is granted to a foreign national (or stateless person) married to an Italian citizen who meets the requirements laid down by law in Articles 5 and 6 of Law No. 91 of 5 February 1992 ( artt.5 e 6, legge 5 febbraio 1992 n.91.)

In this case the application can be submitted:

• if you live in Italy: after two years of marriage;

• if you live abroad: after three years of marriage.

During this period there must be no applications for divorce, annulment or termination of the civil effects of the marriage, no legal separation of the spouses, and no grounds that would endanger the security of the Italian Republic.

If the spouses have children, born to them or adopted, the time before an application can be made is halved (to 1 year).

A foreign national may apply whether their spouse acquired citizenship before the wedding or after the marriage. In the latter case the two years are counted from the moment the spouse became an Italian citizen.

Italian citizenship by residence (by naturalisation)

It can be applied for by foreign nationals who have lived legally in Italy for a certain period and meet certain requirements.

In particular, you need to prove

• Continuous legal residence in Italy

(You must have lived in the country regularly and without interruption and be registered at the anagrafe (registry office) for residenza anagrafica.)

You must be able to show a period of legal residence that depends on your origin. In particular:

• at least 4 years of continuous legal residence in Italy for EU citizens
• at least 5 years of continuous legal residence in Italy for stateless persons or refugees holding a Permesso per Asilo Politico
• at least 10 years of continuous legal residence in Italy for non-EU citizens, or those holding a permesso per Protezione Sussidiaria or another permesso.

(To prove your continuous legal residence, you must provide a historical residence certificate, “certificato di residenza” in Italian. You can request it from the Anagrafe office of the Comune where you live.)

• Sufficient income to support yourself

(The law requires you to show that you earned a minimum annual income over the last 3 years in order to obtain Italian citizenship lawfully.)

Your minimum annual income must be equal to or higher than €8,263.31 (as of 2023, and subject to change) if you are single. This amount rises to €11,362.05 if you have a dependent spouse, to which you must add €516.00 for each additional dependant (for example, your children or parents).

• A “clean” criminal record, to show that you are not a threat to the security of the Italian Republic

(A criminal record certificate from your country of origin, translated, apostilled and legalised.)

How to apply for Italian citizenship

Applications are submitted online only, on the portal of the Ministero dell’Interno (Ministry of the Interior).

The procedure and the documents required vary depending on the grounds on which you are applying for citizenship.

Renouncing Ukrainian citizenship

Renunciation of Ukrainian citizenship is permitted if the person has acquired the citizenship of another State or has received a document issued by the competent authorities of another State stating that the citizen of Ukraine will acquire its citizenship if they renounce Ukrainian citizenship. Renunciation of Ukrainian citizenship is not permitted if the person applying to renounce it has been notified in Ukraine that they are suspected of a criminal offence, or if there is a final and enforceable court conviction against them in Ukraine.

The overall time for considering an application to renounce Ukrainian citizenship must not exceed 1 year. This period does not include the time needed to send the documents by diplomatic or courier mail.

The date on which Ukrainian citizenship ends is the date of the corresponding Decree of the President of Ukraine. On receiving notice that Ukrainian citizenship has ended, the diplomatic mission abroad informs the applicant of the decision of the President of Ukraine within a week, withdraws their Ukrainian travel documents and issues a certificate of termination of Ukrainian citizenship.

Decisions of the President of Ukraine on citizenship matters must be carried out within 1 month. If a person whose citizenship has ended does not collect the certificate and does not return their Ukrainian travel documents to the mission within that time, the diplomatic mission abroad takes steps to have the passport declared invalid.

To renounce Ukrainian citizenship, a citizen of Ukraine who has moved abroad permanently, that is, whose Ukrainian international passport carries the mark “Permanent residence” from the competent Ukrainian authorities or the stamp “Accepted for permanent consular registration” from the Consulate General of Ukraine in Naples, submits the following documents:

• an application to renounce Ukrainian citizenship in four copies. The questions must be answered in Ukrainian only, fully and accurately;
• four photographs (35×45 mm);
• the original of your valid Ukrainian international passport and copies of the first page and of the page with the mark of departure for permanent residence in the Italian Republic or with the stamp of the Consulate General of Ukraine in Italy “Accepted for permanent consular registration”, in four copies;
• a document issued by the competent Italian authorities confirming the acquisition of Italian citizenship (the original Certificato di Cittadinanza), bearing an apostille (obtained at the Prefettura), together with an official translation bearing an apostille (obtained at the court), plus four copies of that document with its translation, as well as legalised copies of the documents proving Italian citizenship, together with an official translation bearing an apostille;
• the original birth certificate plus four copies. If the birth certificate was issued by the competent Italian authorities, it must be apostilled, with an official translation into Ukrainian (the translation must also be apostilled), plus four copies of that document with its translation.
• if the person renouncing Ukrainian citizenship was adopted, the original of the Ukrainian court’s adoption decision plus four copies must be added to the main list of documents.
• the receipt for payment of the consular fee.