There was concern this week about new proposals from the Italian government to charge non-EU nationals higher fees to use Italy’s national health service (servizio sanitario nazionale, or SSN).

Under the 2024 budget plan, a €2,000 charge for registering with the health service would apply to “foreign residents who are citizens of countries that are not members of the European Union”, according to a statement published by the Italian economy and finance ministry (MEF) on Monday.

READ ALSO: What we know about Italy’s plan to charge non-EU residents €2,000 for healthcare

Italy’s health ministry later clarified that the 2,000-euro charge would not in fact apply to all non-EU nationals, but only to those who already pay an annual fee to use the SSN.

Though a number of questions about the proposal remain, this still appears to mean a steep cost increase for many of Italy’s international residents who are not eligible for free healthcare.

Who will the new rules apply to?

For many foreign nationals resident in Italy, enrolling with Italy’s SSN means paying an annual registration fee under what’s called ‘voluntary’ registration.

For others, registration is deemed ‘mandatory’ and is therefore free, and healthcare services are then paid for at the same rates as for Italian nationals.

“The rule contained in the 2024 budget refers to specific categories, not entitled to compulsory registration, who can voluntarily register with the SSN through the payment of an annual flat-rate contribution,” the health ministry stated.

“The rule is limited to updating the stipulated lump-sum contribution,” it said, suggesting that the new charge would replace existing fees.

Registration fees could therefore increase for people who are now paying a rate below €2,000 a year – though it remains unclear whether it could also be revised down for those who are already paying more.

Who can currently register for free?

Certain people are entitled to iscrizione obbligatoria, ‘mandatory registration’ or ‘registration by right’, in the national health service, which means you can register with the SSN for free.

Iscrizione obbligatoria applies to the following categories, according to current health ministry guidelines:

• Residents who have a regular ongoing contract with an Italian employer, are self-employed, or are registered on Italy’s unemployment lists (liste di collocamento).
• People who are waiting for their residency permit to be issued on the basis of employment or family reasons.
• People who are waiting for their residency permit to be renewed on the basis of employment or self-employment, for family reasons, for asylum, for subsidiary protection, ‘special cases’, or special protection; for medical treatment, for those waiting to adopt or foster children, and for those in the process of acquiring citizenship.
• All minors, including unaccompanied foreign minors, regardless of their legal basis in Italy.

The health ministry’s statement indicates that people in these categories would continue to be able to register with the SSN for free even if the €2,000 charge remains in the final draft of the budget law.

Who needs to pay to register?

Anyone who doesn’t fall into any of the categories listed above can opt in to the SSN through iscrizione volontaria, or voluntary registration.

This includes pensioners on elective residence visas, diplomatic and consular staff working for foreign governments, employees of international organisations, volunteer workers, and people over the age of 65 in Italy for family reunification reasons (who arrived after November 5th, 2008).

People in this situation must pay a fee of at least €387.34, rising to as high as €2,788.87 based on income calculations.

However foreign students in Italy who have no income besides scholarships or financial aid provided by Italian public institutions pay a flat fee of €149.77, while au pairs pay €219.49.

The MEF said in its statement on Monday that students and au pairs would continue to pay a discounted fee, without giving further details.

The registration is valid for the calendar year starting on January 1st and running to December 31st, regardless of when the payment is made.

If the rule is included in the final draft of the budget, it’s people who fall into this ‘voluntary registration’ category who would pay the €2,000 charge.