ITALY / Health System & Social Security

Health System & Social Security

Social Security

Italy has an extensive social security (previdenza sociale) system covering the vast majority of the population. Social insurance provides benefits for unemployment, sickness and maternity, accidents at work and occupational diseases, as well as old-age, invalidity and survivor’s pensions, and family allowances. It does not include the national health service (Servizio Sanitario Nazionale/SSN), which is funded from general taxation.

The system is run by a number of state agencies, which have been brought together under the National Institute for Social Security (Istituto Nazionale della Previdenza Sociale/INPS). All resident employees and self-employed workers pay social security contributions (contributi previdenziali), with a few exceptions.

Employee’s contributions are deducted at source from their gross salary by their employer, who pays around two-thirds of pension contributions, while the remaining third is paid by the employee. There are different contribution rates for employees in industry, commerce and agriculture, and for workers (operai), office staff (impiegati) and managers (dirigenti), who also receive different benefits.

The self-employed (lavoratori autonomi) must register and make contributions either to a separate organisation (called cassa), which is a social security fund allied to their profession, or directly with the INPS.

Self-employed people who make contributions to their own cassa include architects, accountants, lawyers, engineers, surveyors, medical specialists and other freelance professionals, who each have different rates of contributions.

The self-employed who make contributions to INPS may be part-time employees (collaboratori), such as university students, freelance workers (indipendenti), including small businessmen, shopkeepers, traders, tenant farmers, sharecroppers and smallholders, or employees of relatively new industries (e.g. computer consultancies) who do not have their own cassa yet.

Contributions are automatically credited for periods of unemployment where an employee has paid contributions for unemployment benefit (indennità di disoccupazione), for periods of military service, maternity leave, and illness of not less than a week and no longer than 12 months.

Maternity and paternity leave allowance
Female employees are entitled to mandatory paid leave for a period of two months prior to the expected date of delivery and three months following the expected date of childbirth. In addition, female employees may also take an optional additional six months following the expiration of the mandatory leave. Female employees are afforded extensive protection from discrimination following their return to work and are entitled to return to the same position or similar position at the same level within the company. The employee is also entitled to receive any benefit or raise issued by the company while on leave and, upon return from leave, the employee may not be fired if not for exceptional circumstances concerning misconduct, the expiration of a fixed-term contract, or closure of the business.

Both male and female employees are entitled to paternity leave governed by the Legislative Decree n.151 of 2001. The parent-employee may take parental leave in the amount of 10 months for each child, during the first 8 years of the child’s life. Throughout mandatory leave, the employee is entitled to receive a daily allowance of 80% of the salary amount. During optional leave, the employee is entitled to receive 30% of his or her normal salary amount.


Public healthcare in Italy
The national health service in Italy, Servizio Sanitario Nazionale (SSN), provides residents with free or low-cost healthcare that includes access to general practitioners (GPs), treatment at public hospitals, subsidised medicines, lab services, ambulance services and certain specialist care.

Patients who make social security contributions may have to make copayments, but most of a medical bill is paid by the government.

The SSN is a socialised system, however regional governments are in charge of managing it on a provincial level, meaning that there are differences between regions. Usually hospitals in northern and central Italy offer a higher standard than those in the south.

How to apply for Italian health insurance
Foreigners who are EU nationals can take advantage of reciprocal health agreements which makes access to public healthcare in Italy easy.

Non-EU expats will, however, need to formally register for the SSN. Expats who have their residence status finalised and have an Italian identity card (carta d’identità) can then apply for an Italian health insurance card (tessera sanitaria).

In order to get a health card an expat should go to the nearest local health authority (Azienda Sanità Locale/ASL) and provide various documents: residence permit, official identification and proof of employment.

Expats who want to claim benefits for their families will require a family status certificate (certificato di stato di famiglia).

After registering, applicants have to choose a family doctor and a paediatrician for their children. They are then issued with their health card, which must be presented in order to receive care under the SSN.

Private healthcare in Italy
Although public healthcare in Italy is free, foreigners may choose to use private healthcare.
There are a number of excellent specialist facilities and university hospitals in the large urban centres.
This publication reflects the views only of the author, and the European Commission cannot be held responsible for any use which may be made of the information there