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LinkedinPublication: 29 July 2021 Latest update: 12 February 2025
What is it?
The benefit provides a financial contribution towards the refund of health-related expenses incurred:
- by the person registered under the system;
- by the person registered upon claim to the Teachers and School Managers Assistance Scheme and/or by his/her family members.
The following expenses are eligible for refund:
- health services of various types, with the exclusion of those for medical-legal activities and for treatments and interventions for aesthetic purposes;
- hydrotherapy treatment sessions;
- assisted fertilisation treatment and care.
Who is it aimed at?
The contribution is reserved for those registered under the system or upon claim to the Teachers and School Managers Assistance Scheme.
In addition to the person registered, the following family members can also be assisted:
- the spouse/civil union partner cohabiting and dependent;
- the widow/widower or surviving party of the civil partnership with the holder, who has not entered into a new marriage/civil partnership;
- dependent children up to the age of 26, whether married or unmarried;
- fully dependent children and who are permanently incapable of work;
- dependent parents;
- sisters and older brothers, cohabiting and dependent, totally and permanently incapable of work;
- orphans who are holders of a share of the survivor's pension.
The requisites must be met on the date of health expenditure for which refund is claimed.
How does it work?
WHAT AM I ENTITLED TO?
The percentage of contribution to the expenditure varies in relation to the ISEE bracket of the family unit to which the contribution beneficiary belongs to, without prejudice to the minimum thresholds for accessing the contribution, as stated in the following table:
| ISEE (Equivalent economic situation indicator) of the family unit to which the beneficiary of the benefit belongs | Percentage of contribution to health costs | Minimum threshold of health expenditure for access to the benefit |
|---|---|---|
| ISEE - up to €8,000.00 | 60% | €300.00 |
| ISEE from 8,000.01 to €24,000.00 | 50% | €650.00 |
| ISEE from 24,000.01 to €32,000.00 | 45% | €1,000.00 |
| ISEE beyond €32,000.00 | 40% | €1,400.00 |
For some types of health expenditure, maximum limits of expenditure eligible for reimbursement are identified: the amount of the contribution cannot exceed a total of €10,000. Healthcare expenses related to a family member who can be assisted can be refunded within the limits of the percentage of the claimant's dependent family members.
Claim
REQUIREMENTS
The set requirement is the enrolment in the Teachers and School Managers Assistance Scheme.
WHEN CAN I CLAIM?
Expenses for which refund is claimed must have been incurred within the 12 months prior to the date on which the healthcare claim was made.
It is necessary that at least 12 months must have passed since the submission of any previous claim for health care.
HOW CAN I CLAIM?
The claim must exclusively be submitted online, by clicking on “Use service” and selecting the “Welfare Benefits Portal” item.
To look through the claims from previous years, click on “Civil Servants’ Pension Scheme: Services for Workers and Pensioners”.
The claim can be sent:
- by the person registered with the Teachers and School Managers Assistance Scheme;
- by the spouse/civil union partner;
- by widowers;
- by their adult children;
- by the guardian or other parent of the beneficiary's child if this has
forfeited parental responsibility.
The documentation accompanying the claim, after digitisation, must be attached to it together with a declaration of conformity with the originals for each document in the user’s possession; a copy of the declarant’s identity document must also be attached.
Processing times of the measure
The deadline to define the decision was set at 30 days by the Regulation for the definition of the terms to conclude the administrative proceedings adopted by INPS pursuant to Article 2 of Law no. 241/1990.
The table attached to the Regulation shows the deadlines for defining the measures established by the Institute that are longer than the normal 30-day period, and the indication of the relative manager.