when exemption from the time.news ticket is possible

by time news
from Chiara Daina

The code that prevents the citizen from paying for the entire specialist service is assigned automatically or upon request, depending on the case

For examinations and specialist visits prescribed on the prescription of the National Health Service and for all treatments performed in the emergency room in white code (not urgent therefore) not followed by expected hospitalization the payment of a ticket. The expense can be a few euros up to the maximum limit of 36.15 euros per recipe, even if the sum of the tickets is greater (with a prescription you can prescribe up to eight services from the same specialist branch). The ticket is a form of participation in public health expenditure by the citizen, introduced since 1982, hence for certain categories of patients are exempted for reasons of income, chronic or rare disease, disability and other special situations, such as pregnancy, HIV detection and for the early diagnosis of tumors for which free national screening is provided (cervical, breast and colorectal cancer ). To all under 14s instead the ticket on white codes is subscribed in the emergency room. The application procedures vary according to the type of exemption to which you are entitled.

Economic condition

Nationally they exist four income exemption codes that the doctor is required to insert in the appropriate space of the prescription. The first, E01, concerns children under the age of six and those over 65 who belong to a family unit (relevant for tax purposes) with a gross annual income of up to € 36,151.98. In the second, E02, unemployed and tax-dependent family members (for whom tax deductions are granted) are included with a total annual income of up to € 8,263.31, or up to € 11,362.05 in the presence of the spouse, increased by a further € 516.46 for each child charged. Code E03 it is recognized to holders of social security Inps and dependent family members. Finally, the code E04 it is up to retirees aged at least 60 and dependent family members who fall under the same income conditions as for exempt E02.

Regional diversity

The Regions can apply additional codes by expanding the audience of beneficiaries. There Lombardy, for example, it extends the exemption to all children under the age of 14, to residents over 65 with family income between 36,151.98 and 38,500 euros (E05), to the unemployed and their dependents with family income up to 27 thousand euros (E12 ), and to workers on layoffs and more familiar mobility (E13). The same is true in Tuscany (E90, E91, E92, but not for under 14s). There Campania it eliminates the ticket for households with more than three children and low incomes. The right to exemption it is assigned automatically on the basis of the information provided by the Revenue Agency and is registered in the regional registry of patients, to which the general practitioner and pediatrician have access by connecting to the health card system. When filling in the prescription, the doctor can enter the exact code referring to his client. The exemption can also be viewed on the Electronic health record (ESF).

Self-certification

Those who do not have the obligation to submit a tax return (social pensioners and unemployed), and those who are not included in the tax list but believe they are entitled to the exemption, must present a self-certification at the ASL counters of residence or where he requested the temporary health domicile (the form can be downloaded from the portal of the health company), or by email attaching a copy of the identity card. Alternatively, you can enter online the self-certification for the application on the health card system (the service currently available in Puglia, Sardinia, Sicily, Umbria, Molise, Veneto, Marche, Abruzzo, Calabria and the province of Bolzano). Emilia Romagna from January 2022 it will be possible to request it only through the ESF. The exemption is valid for one year and expires on March 31 of each year. If the requirements lapse, it must be communicated to the ASL, under penalty of criminal penalties. The revocation can also be done through the Fse.

Chronic pathologies

The specialist doctor of a public structure or one accredited with the NHS issues the patient the certificate with the diagnosis of the chronic disease and the relative identification code to be delivered to the ASL. Who can not introduce himself personally you can send another person to the counter with a written and signed proxy and a copy of the identity document. After evaluating the conditions, the ASL issues the exemption card (paper) for a package of benefits appropriate for the treatment, monitoring and prevention of complications of the disease you suffer from. The assisted you will not have to show your card every time since the exemption for pathology is registered by the ASL in the health card system (and on the ESF), which is accessed by the attending physician at the time of the prescription upon request. To find out for which chronic diseases the ticket is not paid, you can consult the relevant database on the website of the Ministry of Health. The duration of the exemption depends on the different pathology and the possibility of improvement (the minimum periods of validity are set in the ministerial decree of 23 November 2012).

Rare diseases

The rare disease certificate instead it must be issued by one of the centers belonging to the national network of rare diseases. The exemption, taking into account that most rare diseases of genetic origin, also guaranteed for genetic investigations on family members to diagnose the possible genetic basis of the patient’s disease. a specific database is available, always on the portal of the ministry, to search for exempt rare diseases. The list includes 463 exemption codes, of which 351 related to a single disease and 112 to different groups of diseases.

invalid

The degree of disability it must first be ascertained by the ASL medical commission of residence (or Inail for work disability) and sent electronically to INPS for recognition. On the basis of the certification, the ASL issues the exemption certificate, which flows into the health card information system.

Patients after Covid

With the legislative decree 73 of 25 May 2021 it was identified a new national exemption code (CV123) to offer free-of-charge checks to patients discharged after hospitalization and recovered from Covid. The exemption valid throughout Italy for two years (until May 2023). The services that can be provided are aimed at monitoring of the state of health of former hospitalized for the virus: blood sampling, spirometry, electrocardiogram, chest CT scan, psychological interview. To get the code you need submit the hospital discharge letter to the ASL. The exemption regime will be registered in the regional registry of assisted persons and the citizen will be issued with a copy of the certificate with the code and the usable services.

Sharing in the cost of drugs

Those who do not pay the ticket to access the outpatient specialist visits and for laboratory tests (blood tests, urine, swabs, …) and instrumental (CT scans, resonances, ultrasound scans, …) for reasons of income, pathology and disability he does not necessarily also enjoy the relief from the ticket on class A drugs (ie those essential to ensure the care covered by the NHS) provided by most of the Regions to make ends meet. Only eight of these (Piedmont, Friuli Venezia Giulia, Emilia Romagna, Tuscany, Umbria, Marche, Basilicata, Sardinia, and the province of Trento) have abolished the shareholding fee pharmaceutical expenditure to be borne by all patients, both those exempt for specialist services and those who are not exempt. In the rest of the country, a fixed fee per package is applied (to which in some cases an additional fee is added on each recipe, from 0.50 to two euros) with different values ​​from region to region: from 50 cents per box to 4.5 euros.

List of exempt

But where is the drug ticket valid who has the right to full exemption (on all agreed drugs) or partial (reserved for drugs strictly related to chronic disabling disease)? The list of exempt from pharmaceutical assistance defined heterogeneously at regional level. For instance, in Lombardy patients with chronic or rare disease up to an income of 46,600 euros are exempt (as unemployed and redundant), the others are entitled to a discount of 1 euro on the ticket (which is worth 2). In Puglia these patients pay only the fixed amount of 1 euro on each prescription as the clients who belong to families with an annual income of up to 18 thousand euro increased by one thousand euro for each child. While the Campania fully subscribe the ticket to families with an income not exceeding 16 thousand euros and to those with at least three people and a maximum income of 19 thousand euros and up to 25 thousand euros with at least five dependents.

Different criteria

In short, the inclusion criteria vary and provide for additional exemption codes to those of the medical specialist. To find out if you are eligible, you need to contact your local health authority or consult the regional portal. What can be said in general is that some categories of citizens who have been granted the national (or regional) exemption for specialist services (except for residents of the eight Regions plus the province of Trento who have canceled the ticket for anyone) could still find themselves to pay a drug ticket. The 1 euro ticket per pack in Valle d’Aosta, Calabria and in the province of Bolzano, as well as in Lombardy; of 2 euros in Veneto and Liguria; from 1 to 2 euros in Puglia, Lazio and Sicily; from 0.25 euro cents to 1 euro in Abruzzo; from 0.50 to 2.5 euros in Molise; from 1 to maximum 3.5 euros in Campania.

Where to apply

The application for exemption must be presented to your local health authority who, having verified the requirements, issue a card and register the exemption on the health card information system. In the end, when the doctor prescribes a brand-name drug for which the corresponding generic is on the market (of equal qualitative and quantitative composition) all citizens have to pay out of their own pockets the difference between the highest price of the branded medicine and the lowest price of the equivalent reimbursed by the National Health Service.

January 20, 2022 (change January 20, 2022 | 19:29)

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