As of today we are officially enrolled in the Italian national healthcare system known as Servizio Sanitario Nazionale (SSN). Here in Marche the SSN system goes by the acronym of ASUR. Joining the system presented another batch of bureaucratic issues for us to weave through and, as has become the norm, it involved multiple visits to the ufficio in question.
The heath system is paid for by taxes levied against employers; if you are not employed, it is by a fee you pay. If you are employed you just take a copy of your work contract and some identification documents and you are all set with coverage for you and your family. If you are a student you pay a fee of less than 200 Euro. For those of us who don’t fall into those two categories and have spouses (or children) it gets confusing.
When we applied for our residenza (which is still pending more paperwork) they gave us a receipt in my name and said we could use it to apply at the ASUR office along with a form declaring dependants, “dichiarazioni sostitutive di certificazioni”. The majority of the information available on the internet deals with employees and students, leaving those not in those categories guessing. Everyone seemed to agree that you need the receipt for the residenza, your permesso di soggiorno, your codice fiscal (tax id) and pay a fee. No one mentioned the dichiarazioni sostitutive di certificazioni. The fee is 387.34 Euro, but the question is do you pay this once as a family or does each person in the family pay the fee? For that question we found a lot of conflicting information.
Two weeks ago Valerie and I went to the ASUR office which is just up the hill from our apartment, taking our documents. We thought we were all set to sign-up. Not so fast, the man at the window had to go ask someone else what we were supposed to pay and came back with two forms we needed to take to the bank and pay the 387.34 Euro for each of us – over $1000 for the two of us for the rest of 2007. Since we had conflicting reports if both had to pay or I could sign-up and list Valerie as a dependant, I finally decided to try and pay one fee and roll the dice.
Thursday I went to the bank and paid the fee and then trudged back up to the office and waited in line. Eventually when it was my turn, using my broken Italian I was able to provide the clerk with my receipt for residenza, codice fiscale, passport, permesso di saggiorno, receipt for the 387.34 Euro and the completed dichiarazioni form which stated Valerie as my dependent. The clerk had copies made of everything, asked what doctor I would want as my primary care provider, and then told me to come back the next day. Apparently she was in a hurry for another caffé as she put up her chuiso sign as I walked away.
Today I went back up the hill and there was a different clerk at the required window; again in my broken Italian I explained that the other clerk told me to come back today, he asked my name and cringed when I said “Schneider” as he tried to pronounce it. He retreated to the back office and came back with the copies of my documents and then had to input everything as I stood and watched. When finished, he printed a short receipt which he had me sign and gave to me and, if I understood correctly, said I should expect an official card in the mail in about ten days.
So after three trips to the same office and a trip to the bank, I have my receipt showing our enrollment in the Italian national healthcare system. Hopefully this is not something we will need to take advantage of any time soon.