As a European citizen, assisted by the Health Service of a country, you can receive care in all other countries of the European Union.
The costs are borne by the competent health institutions of your state. The coverage of costs related to medical care in another EU state can be provided through:

• direct assistance: the health service of your country pays directly to the health service of the country of care

• indirect assistance: you pay the expenses to the health facilities or professionals, public, private, or private contracted in the foreign country of care and subsequently request reimbursement from your competent ASL.

The general principles provided by the two regulatory instruments may find specific modes of application in individual EU states and may be accompanied by additional national regulations in the matter.

You can receive care in another EU, EEA, and Switzerland country under the same conditions as those insured by the health service of the country of care, thanks to direct assistance (Community regulations on social security no. 883 of April 29, 2004 and no. 987 of September 16, 2009).

Your health service pays directly for the health services provided by public or private contracted healthcare facilities or professionals (direct assistance). You will not receive reimbursement for the ticket.
This service does not apply to services provided by non-contracted healthcare facilities or private professionals (or outside of contracts).

If you are temporarily in another member state, considering the nature of the services and the expected duration of the stay, you have direct access to necessary care by presenting the European Health Insurance Card (EHIC) or its substitute certificate.

It is not allowed to use the EHIC or its substitute certificate to obtain coverage for costs outside of necessary care.

Healthcare for EU citizens without an EHIC, in conditions of indigence and without healthcare, is provided through the issuance of a card with an individual regional code ENI (European Non-Registered).

In the case of planned care, that is, for care defined within a specific therapy, therefore prescribed in advance, you must request prior authorization from your competent institution.

To learn more, consult:

Planned care in the European Union (if you are an Italian citizen)

Planned care in Italy (if you are a citizen of another EU country)

Authorization is subject to two conditions:

1. the care is appropriate and aimed at ensuring the health protection of the interested party

2. the care falls within the health services that can be provided by the health service of belonging but cannot be practiced in one's own country within an acceptable time frame from a medical perspective, considering the state of health and the likely evolution of the disease.

Authorization is granted through the issuance of a certificate (model S2) that must be presented to the reference health institutions or healthcare facilities or to public or private contracted professionals in the country of care.
Travel expenses and, in some cases, accompanying expenses may also be authorized.

You can receive healthcare in other EU countries, in Iceland, Norway, and Liechtenstein by paying upfront and then requesting reimbursement from your home state, under the conditions described below (EU Directive No. 24 of March 9, 2011 transposed by Legislative Decree No. 38 of March 4, 2014): 

• the patient pays the costs of healthcare, authorized in the cases provided, and subsequently requests reimbursement from their home health service

• the reimbursement for healthcare services is equal to the cost that the home health service would have incurred if the care had been provided in the home state, without exceeding the total cost of the care. States may still decide independently to reimburse the entire cost of care, even if it exceeds the costs that the home health service would have incurred providing the service in its own territory.

Reimbursable care is that provided by the home health service, excluding:

• long-term healthcare services (whose purpose is to support people who need assistance in carrying out daily and routine tasks),

• the allocation and access to organs for transplantation purposes

• public vaccination programs against contagious diseases

For imperative reasons of general interest, states may limit access to care in their territory for incoming patients and restrict the application of reimbursement rules for outgoing patients.

States may also introduce prior authorization for cross-border care when the service:

• involves the hospitalization of the patient for at least one night or requires the use of highly specialized and expensive healthcare infrastructure or medical equipment

• requires care that poses a particular risk to the patient or the population

• is provided by public/private healthcare facilities or contracted private professionals that, in the specific case, could raise serious and specific concerns regarding the quality or safety of care.

Italian and EU citizens registered with the Italian health service who wish to avail themselves of indirect healthcare assistance are required to request prior authorization limited to the services provided by DM 50 of April 16, 2018.

If you request authorization to seek treatment with indirect assistance (Directive) and there are grounds to benefit from direct assistance (Regulations), the authorization will be granted for the latter. Remember that you can still expressly request to avail yourself of the directive.

Consult the National contact point

Community Regulation on Social Security No. 883 of April 29, 2004
Regulation No. 883/2004 of the European Parliament and of the Council, of April 29, 2004, concerning the coordination of social security systems - Published in No. L 166 of April 30, 2004.

Community Regulation on Social Security No. 987 of September 16, 2009
Regulation No. 987/2009 of the European Parliament and of the Council, of September 16, 2009, establishing the procedures for applying Regulation No. 883/2004 concerning the coordination of social security systems - Published in No. L 284 of October 30, 2009

EU Directive No. 24 of March 9, 2011
Directive No. 2011/24 of the Council, of March 9, 2011, concerning the application of patients' rights in relation to cross-border healthcare - Published in No. L 88 of April 4, 2011

Legislative Decree No. 38 of March 4, 2014
Implementation of Directive 2011/24/EU concerning the application of patients' rights in relation to cross-border healthcare, as well as Directive 2012/52/EU, involving measures aimed at facilitating the recognition of medical prescriptions issued in another member state.