Direct services are defined as health treatments provided free of charge other than the payment of an “own contribution” which must be paid for by the beneficiary.

For this reason, the Ministry for the Health Service ( now called the Ministry of Health ) has introduced a special carnet which is issued by the USL ( which in some regions are referred to as "ASL ", “AUSL”, etc. but which are the same thing ) to all those people who present a Community certificate ( the most common of which is the E 111 form).

This carnet ( called "libretto-modulario” [booklet of forms] and valid throughout the Italian territory ) lists the instructions for obtaining healthcare in the clinics and hospitals of the Italian National Health Service run directly and in private accredited ones.

Principal useful information for the tourist

1. Where to obtain further information: at the USL. To find out the address of the offices of the USLs consult the telephone directory, refer to a pharmacy or ask a policeman. Assistance can be requested by telephoning the numbers 112 and 113 to ask for specific information, for example, in order to find out the address of the nearest hospital. In the major cities, it is possible to consult the local teletext pages.

2. Doctors, dentists and prescriptions: doctors are made up of doctors of general medicine and of SSN-contracted paediatricians who, after presentation of the carnet, effect examinations directly.

From Mondays to Fridays examinations on the part of the general practitioner and SSN-contracted paediatricians do not involve the payment of a fee by the insured and are exempt from health charges. The opening times of the surgeries are fixed by each individual doctor.

On Saturdays, Sundays and in the evenings and at nighttime ( from 8.00 pm. until 8.00 am ) on all days, the Emergency Medical Service operates for urgent treatment throughout the national territory. To request assistance it is necessary to know the telephone number for this service.

In the summer periods, in the resorts of the regions which are popular with tourists, the Tourists’ Emergency Medical Service is instituted. For organizational reasons this involves payment for an examination ( € 15,49 or another slightly higher tariff fixed by the Regional Council ) for all holidaymakers. Full reimbursement of the aforementioned sum paid in advance by the insured ( and the cost of any other eventual treatment ) can be obtained by presenting the receipt for the payment to the tourist’s own health insurer, which will deal with asking Italy for the tariffs for treatments through the EEC E 126 form.

For dentists (urgent treatment), given that there are only a limited number of SSN-contracted professionals, it is advisable to refer to the dentists present in the clinics run directly by the USLs and by the hospitals.

Examinations by dentists ( and by other specialists ) at the clinics and other specialist services foresee the co-payment of a health charge which is to be paid for by the beneficiary.

3. Medicines prescribed by the SSN-contracted doctor: if one of the forms in the carnet is used, those medicines which belong to the "life-saver” category are supplied free of charge at the pharmacies; for other medicines a co-payment health charge must be paid and for yet others the insured is required to pay in full. The level of the health charge may vary from region to region.

4. Hospital care: hospitalisation is exempt from health charges. However, if more comfortable accommodation is desired it is possible to obtain a reserved room through the payment of a daily charge or one based on the cost of the period in bed. Admission to the public hospitals ( and private accredited ones ) can take place either directly at the casualty departments on handing over the E 111 or E 112 form there and then or on the basis of this being prescribed by the SSN-contracted doctor ( using a form contained in the "carnet").

5. For serious and unforeseen cases, in all the regions, the " health emergency service" can be contacted by calling the telephone number 118. In some regions, for first aid treatment, the payment of a charge is foreseen. If, for any reason, it has not been possible use the E 111 form; on returning to his or her own country reimbursement for health expenses paid directly by the insured can be requested from his or her own insurance. This is possible thanks to a special Community norm which foresees, for urgent cases only, the right to reimbursement according to the tariffs of the Member State where the temporary stay took place. For reimbursement purposes, it is necessary to present receipts for payment and health documentation.

For all other details not contained in the information in the carnet ( booklet of forms), the tourist is required to go to the information desks of the USLs reserved for the general public.