Trouble proving residency rights leaves Brits in Italy paying €2k health charge
Amid a lack of clarity about who has to pay Italy's increased healthcare fees, citizens' rights campaigner Clarissa Killwick says British nationals are wrongly being charged despite having permanent residency rights.
UK nationals living in Italy are stuck in limbo: being permanent residents but unable to prove it.
A permanent resident has at least five years' residency, whereas with less than five years you are an ordinary resident.
Why does this matter? Under the Withdrawal Agreement (WA), a permanent resident can be absent from Italy for up to five years in one go whereas for ordinary residents it is generally a maximum of six months per year. Consider someone who needs to return to the UK temporarily to care for elderly or sick family members, for example.
Secondly – and this clearly would affect more people - there are important implications regarding healthcare. And having continuous healthcare cover in some form is required for maintaining legal residency.
Broadly, under the Withdrawal Agreement, WA beneficiaries must receive equal treatment to EU citizens in their host countries. EU citizens in Italy with an “attestazione soggiorno permanente” qualify for free registration for state healthcare, (as do ordinary residents who are employed/self-employed, amongst others such as S1 holders.)
For those who don’t qualify for free registration, the options are private healthcare insurance or voluntary contributions to the state system.
From 2024, minimum voluntary contributions have jumped from just under €390 to €2,000 per year per person - an increase of around 500 percent. That’s without going into detail into how students are affected.
READ ALSO: Do Italy’s British residents have to pay the €2,000 healthcare fee?
As yet there are no unequivocal guidelines as to who exactly is in scope of these new rules – just non-EU citizens, or non-EU and EU, therefore WA beneficiaries too?
There could also be a legal argument concerning the principle of proportionality given the size of the increase.
In the meantime, some UK nationals are already being charged €2,000 by their local health authorities. This is particularly harsh for those who are permanent residents, as they should not be paying at all.
Why can’t they evidence their status? Some town halls are refusing to issue WA beneficiaries the attestazione di soggiorno permanente, the same as they do for EU citizens. This is in spite of an Italian government circular stating it should be provided. (Circolare n. 2/2021 Oggetto: Brexit - Attuazione dell’Accordo sul recesso del Regno Unito e dell’Irlanda del Nord dall’Unione Europea.)
The best evidence of residency status for WA beneficiaries is the WA biometric residency card from provincial immigration offices but a significant number are refusing to issue a permanent card, (carta di soggiorno permanente Articolo 50 TUE), until five-year ordinary residency ones expire. This is in breach of the Withdrawal Agreement under article 18.4.
Even when immigration offices are willing, there can be very long delays. Communications can be difficult or, in the case of the Perugia questura, for example, non-existent.
READ ALSO: What you need to know about Italy's €2,000 healthcare fee
In another region, one of our members has managed to get the permanent card but her health authority will not accept it for free registration. We have communicated, via the embassy, that the guidelines need to be very explicit about WA beneficiaries so there is no room for doubt or misinterpretation.
There is limited support for British citizens in Italy experiencing problems related to the Withdrawal Agreement as resources have been cut back. Some manage to get help, otherwise the standard advice from Consular Services to those in difficulty is to find a lawyer.
The particular issue of being unable to prove permanent residency is not new - we’ve been raising it for around two years with the embassy in Rome who, in turn, engage with the Italian government. We also discussed it directly with the European Commission last May.
But the huge increase in minimum voluntary healthcare contributions puts the seriousness of this failure into sharp focus.
One member and her husband have been paying unnecessarily for some time, at the old rate, and will have to pay the new fee if they don't get any joy soon. They have been here nearly seven years. All their efforts so far to evidence their permanent residency - including appealing to the embassy for help - have proved fruitless.
And it is very stressful for those who have not quite reached permanent residency, with no certainty of how they will be able to prove it.
In one such case, a woman in our group who will struggle to meet the new cost has type 1 diabetes, amongst other health issues, but without insulin quite simply she would die. She says she is stuck because she doesn’t have the money to return to the UK either.
As always, the vulnerable and those on low incomes will suffer the most.
Clarissa Killwick.
Since 2016, Clarissa has been a citizens' rights campaigner and advocate with the pan-European group, Brexpats - Hear Our Voice. She is co-founder and co-admin of the FB group in Italy, Beyond Brexit - UK citizens in Italy.
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UK nationals living in Italy are stuck in limbo: being permanent residents but unable to prove it.
A permanent resident has at least five years' residency, whereas with less than five years you are an ordinary resident.
Why does this matter? Under the Withdrawal Agreement (WA), a permanent resident can be absent from Italy for up to five years in one go whereas for ordinary residents it is generally a maximum of six months per year. Consider someone who needs to return to the UK temporarily to care for elderly or sick family members, for example.
Secondly – and this clearly would affect more people - there are important implications regarding healthcare. And having continuous healthcare cover in some form is required for maintaining legal residency.
Broadly, under the Withdrawal Agreement, WA beneficiaries must receive equal treatment to EU citizens in their host countries. EU citizens in Italy with an “attestazione soggiorno permanente” qualify for free registration for state healthcare, (as do ordinary residents who are employed/self-employed, amongst others such as S1 holders.)
For those who don’t qualify for free registration, the options are private healthcare insurance or voluntary contributions to the state system.
From 2024, minimum voluntary contributions have jumped from just under €390 to €2,000 per year per person - an increase of around 500 percent. That’s without going into detail into how students are affected.
READ ALSO: Do Italy’s British residents have to pay the €2,000 healthcare fee?
As yet there are no unequivocal guidelines as to who exactly is in scope of these new rules – just non-EU citizens, or non-EU and EU, therefore WA beneficiaries too?
There could also be a legal argument concerning the principle of proportionality given the size of the increase.
In the meantime, some UK nationals are already being charged €2,000 by their local health authorities. This is particularly harsh for those who are permanent residents, as they should not be paying at all.
Why can’t they evidence their status? Some town halls are refusing to issue WA beneficiaries the attestazione di soggiorno permanente, the same as they do for EU citizens. This is in spite of an Italian government circular stating it should be provided. (Circolare n. 2/2021 Oggetto: Brexit - Attuazione dell’Accordo sul recesso del Regno Unito e dell’Irlanda del Nord dall’Unione Europea.)
The best evidence of residency status for WA beneficiaries is the WA biometric residency card from provincial immigration offices but a significant number are refusing to issue a permanent card, (carta di soggiorno permanente Articolo 50 TUE), until five-year ordinary residency ones expire. This is in breach of the Withdrawal Agreement under article 18.4.
Even when immigration offices are willing, there can be very long delays. Communications can be difficult or, in the case of the Perugia questura, for example, non-existent.
READ ALSO: What you need to know about Italy's €2,000 healthcare fee
In another region, one of our members has managed to get the permanent card but her health authority will not accept it for free registration. We have communicated, via the embassy, that the guidelines need to be very explicit about WA beneficiaries so there is no room for doubt or misinterpretation.
There is limited support for British citizens in Italy experiencing problems related to the Withdrawal Agreement as resources have been cut back. Some manage to get help, otherwise the standard advice from Consular Services to those in difficulty is to find a lawyer.
The particular issue of being unable to prove permanent residency is not new - we’ve been raising it for around two years with the embassy in Rome who, in turn, engage with the Italian government. We also discussed it directly with the European Commission last May.
But the huge increase in minimum voluntary healthcare contributions puts the seriousness of this failure into sharp focus.
One member and her husband have been paying unnecessarily for some time, at the old rate, and will have to pay the new fee if they don't get any joy soon. They have been here nearly seven years. All their efforts so far to evidence their permanent residency - including appealing to the embassy for help - have proved fruitless.
And it is very stressful for those who have not quite reached permanent residency, with no certainty of how they will be able to prove it.
In one such case, a woman in our group who will struggle to meet the new cost has type 1 diabetes, amongst other health issues, but without insulin quite simply she would die. She says she is stuck because she doesn’t have the money to return to the UK either.
As always, the vulnerable and those on low incomes will suffer the most.
Clarissa Killwick.
Since 2016, Clarissa has been a citizens' rights campaigner and advocate with the pan-European group, Brexpats - Hear Our Voice. She is co-founder and co-admin of the FB group in Italy, Beyond Brexit - UK citizens in Italy.
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