Who is affected:

1. Permanent residents (over 5 years of residence) who do not already have an insription into the SSN with no expiry date
2. Who are EU citizens and
3. Are not in receipt of a state pension
4. That are covered by ASUR13 (Ascoli Piceno) & ASUR 12 (San Benedetto del Tronto)

I have heard rumours that those under Fermo ASUR are also affected but have no evidence of this.

What SHOULD you be entitled to:

An "Attestazione di residenza permanente per i cittadini dell'unione Europea" (which is granted by your comune upon request after 5 years of residence (and the expiry of your "permesso di soggiorno" if you had one) entitles you to a permanent inscription into the SSN (Italian NHS) without the need to renew or produce any other documents - just like an Italian.

What is actually happening:

ASUR 13 & 12 are only granting 12 months inscription, renewable every 12 months upon production of either an Italian tax return or certificate from the "Camera di Commercio" showing your registration. If you don't have these documents then you will be refused health cover after your first 5 years' inscription expires, unless you pay the minimum contribution of around €400 per person per year. If you have become in receipt of a state pension during those 5 years, you will be asked for an S1 form (formerly an E121) in order to get your permanent cover. You will need to contact HMRC in the UK to get this form but you will be covered.

Please note your children are only given the same coverage as you regardless of whether they were born in Italy or not.

What can you do:

1. When you request your permanent inscription into the SSN on the basis of your "attestazione di residenza permanente" and are refused (as you will be) get the reason for refusal in writing there and then from the ASUR administrative office. If they try to fob you off or say they will send it on, call the carabinieri as it is your right to have a written refusal stating the reasons at the time of refusal. This is very important as the ASUR 13 & 12 are claiming no-one has been refused health cover. You will need the refusal in writing to be able to prove that you were refused, even if you eventually decide to pay up/produce a tax return etc.

2. Write to your Euro MP.

3. Join our press campaign to get as much press coverage for this issue as possible to hopefully shame them into acting in accordance with the law.

Areas of confusion or popular misperceptions:

My EHIC (used to be E111) card covers my healthcare in Europe - No it doesn't. It only covers emergency care IF you are on holiday or during stays of less than 3 months.

My Tessera Sanitaria (blue healthcard) is still in date even though I am past the 5 years - This is not the same as the expiry of your SSN inscription. When you first subscribed you will have been given a white slip of paper and it is this expiry date that counts. If you continue to use health services (including the GP) past the expiry date on the piece of paper you run the risk of being sent a bill for them in the future.

My Tessera Santitaria is my entitlement to health cover in Italy - no it isn't. It is merely the Italian equivalent of the EHIC card (old E111).

I already have my certificate of residency so I don't need this "attestazione di residenza permanente" - Not true. Some comune's have told people this but it is a lack of understanding on their part. All EU citizens who have been living here for more than 5 years are entitled to the "attestazione" and if you don't have it you will not get health cover so it is a very important document. You normal residency document will not suffice.

So what? I'm working. It doesn't matter if I have to renew it every year - Your decision of course but it does matter. What if you can't work for some reason (ill health for example) and so there is no tax return/Camera di Commercio to be produced? You will not be able to renew your health cover for you and potentially your family. Do you really want to risk that?