Dear Mr Pogliani
Dear Mr Engeler,

We are a couple who have lived for many years in Switzerland, where we have built up our pension. We recently moved to Italy and, when we left Switzerland, we cancelled our health insurance because the cost of extending medical care to Italy was too high for us. So we opted for the Italian health service, which unfortunately we had to register with for a fee, as required by the ATS in our region of residence in Italy.

We wonder why we have to pay for this service, as we pay tax in Italy with deductions from our pension, which we only receive from Switzerland.

We hope you will address this issue in the "Gazzetta Svizzera" and answer our question. We have made a voluntary contribution to the Gazette.

A.S. (place omitted)

**************************

Dear reader,

Thank you for your letter. Let us try to explain.

The general principles stipulate that health care is paid for by the country paying the pension. More specifically, this means that if a pensioner moves to an EU/Swiss country other than the one paying their pension, they will have full access to healthcare in the new country of residence under the same conditions as local citizens. However, they will need to apply for an S1 form (from the central health insurance institution in Switzerland: LaMal) in the country paying their pension; this form will enable them to register with the health insurance institution in their new country of residence and access healthcare free of charge.

In your case, however, it is important to bear in mind that when you moved to your new country of residence, Italy, you decided to cancel your membership of the Swiss health insurance fund, thereby forgoing medical assistance. However, this choice means that you will not be able to obtain the aforementioned S1 form and will therefore not be able to access Italian healthcare free of charge. In other words, deregistration from your health insurance fund, and the consequent inability to obtain form S1, means that the health costs you incur and/or will incur on Italian territory cannot be reimbursed by the Swiss institution, as should be the case according to general principles, since it is the country that pays your pension. If you had been in receipt of an Italian pension, even a modest one, you would have been entitled to register with the National Health Service, at the expense of the Italian State.

In view of the above, we therefore consider that the request by the ATS in your region of residence in Italy for payment of an annual contribution of 7.5% of your income is correct. However, this will only guarantee you healthcare in Italy and not in the rest of Europe, since you are not a holder of the European Health Insurance Card (TEAM) - except, of course, in emergencies, under EU social security regulations, which are also extended to Switzerland via bilateral agreements.

We are sorry not to be able to give you any better news, but please accept, Madam, Sir, the expression of our best wishes.

Andrea Giovanni Pogliani
Robert Engeler