Illness and hospitalisation for workers enrolled in the Separate Pension Scheme (Gestione Separata)

The total duration of the employment relationship means the number of days worked or in any case paid within the reference period considered, for contributory and income purposes, i.e. the 12 months prior to the start of the illness event.

As a consequence, the number of compensated days in the same calendar year cannot exceed the maximum limit of 61 days (INPS circular no. 76, 16 April 2007).

Protection does not apply to periods of illness of less than four days.

Hospitalisation allowance

It is payable for all days of hospitalisation up to a maximum of 180 days in the calendar year, including day visits.

Periods of illness (Article 8, paragraph 10, Law 81/2017) are equivalent, for the purposes of duration and measure, to hospitalisation if:

• are certified as a consequence of therapeutic treatments of oncological diseases and/or serious chronic-degenerative diseases;
• cause a temporary incapacity for work of 100 percent.

WHAT AM I ENTITLED TO?

Illness allowance

They are paid in the amount of 8%, 12% and 16% of the calculated amount:

• dividing by 365 the contribution ceiling envisaged in the year of onset of the illness;
• based on contributions paid in the 12 months prior to the illness:
  • 8%, from one to four months;
  • 12%, from five to eight months;
  • 16%, from nine to 12 months.

Hospitalisation allowance

It is paid in the amount of 16%, 24% or 32% of the calculated amount:

• dividing by 365 the contribution ceiling foreseen in the year of onset of the allowance;
• based on the contributions paid in the 12 months prior to hospitalisation:
  • 16%, from one to four months;
  • 24%, from five to eight months;
  • 32%, from nine to 12 months.

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HOW CAN I CLAIM?

To be entitled to the allowance, the worker must have the illness certificate issued by their GP who sends it online to INPS.

For the provision of the illness benefit, it is possible to submit the claim through the dedicated INPS service, in order to provide additional elements useful for the settlement of social security protection (INPS circular no. 52 of 6 April 2012).

For hospitalisation events, the claim is mandatory (Ministerial Decree of 12 January 2001) and must be submitted within 180 days of the date of discharge. The claim must be submitted to INPS through the dedicated service (INPS circular no. 52 of 6 April 2012).

Alternatively, claims can be made by:

• Calling the contact centre on 803 164 (free from Italian landlines) or 06 164 164 from mobile phones.
• On-line services offered by patronage institutes and intermediaries thereof.

For the recognition of the illness allowance (Article 8, paragraph 10, law 81/2017), as a result of therapeutic treatments of oncological diseases, serious chronic-degenerative diseases that are worsening or that in any case involve a temporary work incapacity of 100%, the worker, in addition to having the electronic illness certificate issued by the GP, must make a specific request, using the benefit claim SR06 form, together with the medical documentation proving antineoplastic therapy or the existence of the serious pathology.

The claim must be sent by registered letter or delivered directly to the competent INPS local office, in a sealed envelope, bearing the words “contains sensitive health data”.

In order not to incur the penalties provided for by law, the worker must check the correctness of the information entered by the doctor in the illness certificate, namely:

• company data;
• domicile for home visit.

With the digital certificate, the worker is exempt from the obligation to send the certificate to their client, who will be able to receive and view it through the services provided by INPS.

If online submission is not possible, the worker must have the illness certificate issued by the GP in paper form.

Within two days of the date of issue, the worker must submit or send:

• the original certificate to the competent INPS local office;
• the certificate to their employer.

Failure to submit the certificate after the indicated deadline will result in the loss of the right for each day of unjustified delay.

Recurring cycles of treatment

In cases of pathologies that involve incapacity for work and that require recurrent cycles of treatment (haemodialysis, chemotherapy, etc.), the worker must present a single illness certification, attesting to the need for recurrent treatments, one qualifying as a relapse of the other.

The certification must be sent:

• to the medical-legal office of the competent INPS local office for the necessary assessments;
• before the start of therapy, with an indication of the days scheduled for execution.

In addition to the medical certification, the worker must also submit periodic declarations of the health facility with the relative schedule of treatments carried out.

Protected resignations

In the case of hospitalisation that has not completely ended but has been temporarily suspended (so-called protected resignation), in order to be entitled to social security protection, the worker must produce a suitable illness certification attesting to the incapacity for work.

Online transmission is also required for hospital admission and illness certificates issued by hospitals.

If the certificates are drawn up in paper form, the worker must submit or send them:

• to the competent INPS local office;
• to their client (without the diagnostic data).

Hospital admission certificates (excluding any post-hospitalisation illness certificates) may also be delivered after the second day from the date of issue but within the limitation period of the benefit, equal to one year.

The hospitalisation certificate and the certificate regarding the day spent at the emergency room without diagnosis are not considered valid for the purposes of recognising the social security benefit.

Medical home visit to ascertain illness of an employee

During the illness period, the worker must be available at home during the timeslots provided for by law, to be subject to checks to verify the actual temporary incapacity for work.

The periods of availability are, for all days reported in the illness certification (including Saturdays, Sundays and holidays), from 10 to 12 and from 17 to 19.

Absence during the medical home visit, if not justified, entails the application of penalties, with the consequent failure to compensation for illness days:

• for a maximum of 10 calendar days, from the start of the event, in case of a first unjustified absence during the medical home visit;
• for 50% of the allowance the remainder of the illness period in the event of a second unjustified absence during the medical home visit;
• the total of the allowance from the date of the third unjustified absence during the medical home visit.

The home doctor in charge who ascertains the absence issues an invitation in a sealed envelope for the next outpatient medical check-up. Any absence from the outpatient check-up may result in the application of sanctions for the second visit. 

If necessary, during the prognosis period of the certificate, the worker may change the contact address by promptly communicating it:

• to the client, in the manner provided for by the contract;
• to INPS, through the service “Counter for the citizen for medical home visit to ascertain illness of an employee”.

The service allows the communication and management, in the context of an illness event, of a different availability, compared to that previously communicated with the illness certificate in the course of prognosis.

The new service is available to all workers in the private and public sectors and does not replace in any way the contractual obligations of communication by workers towards their employers (INPS circular no. 106 of 23 September 2020).

Only in special cases, if it is not possible to access the service, is it allowed to:

• send an email to medicolegale.nomesede@inps.it;
• send a specific notice to the fax number of the local office;
• contact the Contact Center at the toll-free number 803 164 (msg. 1290/2013).

In the case of illness occurring in a European Union (EU) country, the regulations in force provide for the application of the legislation of the country where the insured resides.

Therefore, the worker must submit the illness certificate within two days of issue:

• to INPS;
• to the employer.

Otherwise, the worker can contact the competent local authority, which will proceed with:

• the medical assessment of incapacity for work;
• the completion of the certificate to be transmitted immediately to the competent institution.

In the case of illness occurring in countries that have not entered into conventions or agreements on the subject with Italy or in non-EU countries, the certification must be legalised by the Italian diplomatic or consular representation abroad.

“Legalisation” means the attestation, also by means of a stamp, certified according to local provisions. The mere attestation of authenticity of the qualified translator’s signature does not equate to “legalisation”.

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The table shows the deadlines exceeding thirty days, set by the Institute with a Regulation.

In addition to the terms for the issuance of the decision, the table also indicates the relevant manager.

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