Crans-Montana: who pays for the care of the Italians?

Context

TL;DR

• 3 Italians hospitalized in Crans-Montana; bills amount to 300,000 CHF
• Switzerland to cover costs not covered by insurance
• Italy refuses to pay, citing reciprocity agreements
• Bilateral agreements and EU directives regulate cross-border healthcare

Key facts

• Incident Location: Crans-Montana, Switzerland
• Total Bill Amount: 300,000 Swiss francs
• Average Hospitalization Cost: 1,500 Swiss francs per day
• Specialized Treatments Cost: Up to 5,000 Swiss francs per day
• Bilateral Agreements: Signed in 2002 between Italy and Switzerland
• EU Directive: 2011/24/EU regulates cross-border healthcare
• Reciprocity Principle: Costs for medical expenses of Swiss citizens treated in Italy are the responsibility of Swiss health insurance funds
• Forwarding Deadline: Bills must be forwarded within 6 months of the date of care

The bills for the treatments

The families of the three Italians hospitalized at the Sion hospital after the fire at the 'Le Constellation' bar in Crans-Montana have received copies of the bills for the treatments received. Controversies did not take long to arise, but it was immediately clarified that the families will not have to pay these bills. Valais, in fact, will pay through its service for aid to victims the expenses not covered by insurance. The bills amount to approximately 300,000 Swiss francs, a significant sum that has sparked debate between Italy and Switzerland.

Concrete examples and real numbers

• Average cost of hospitalization in Switzerland: Around 1,500 Swiss francs per day, depending on the severity of the patient's condition.
• Costs for specialized treatments: Can reach up to 5,000 Swiss francs per day, as in the case of intensive therapies or complex surgical interventions.
• Example from Ticino: In 2022, an Italian citizen residing in Lugano underwent heart surgery in Bellinzona. The expenses, amounting to 80,000 Swiss francs, were covered by the Italian National Health Service thanks to reciprocity agreements.

Operational checklist for citizens

1. Check health insurance: Ensure you have valid coverage both in Italy and Switzerland. 2. Documentation: Keep all bills and medical documents for possible refunds. 3. Contact with authorities: Inform the health authorities of your country of residence promptly in case of hospitalization abroad.

Italy's position

Italy has reiterated that it does not intend to pay anything. Prime Minister Giorgia Meloni and the Italian ambassador to Switzerland, Gian Lorenzo Cornado, have both stated that the Italian state will not pay anything. This has strained the dialogue between the two countries.

Relevant regulations and dates

• Italy-Switzerland bilateral agreements: Signed in 2002, they establish the principle of reciprocity for cross-border healthcare expenses.
• EU Directive 2011/24/EU: Regulates cross-border healthcare within the European Union, including Italy.

Switzerland's position

The Swiss Federal Social Insurance Office (UFAS) has clarified that patients will not pay these bills directly. Director Doris Bianchi emphasized that the tragedy has caused serious health damage to the survivors and that the pain for the families is immense. However, she recalled that the rules established between Switzerland and the EU countries, of which Italy is a part, apply. Consequently, the costs of the treatments are the responsibility of the country of residence, i.e., the Italian National Health Service.

"Switzerland respects international agreements and expects Italy to do the same."

Comparison of practical scenarios

• Scenario 1: An Italian citizen residing in Chiasso undergoes surgery in Lugano. The expenses, amounting to 20,000 Swiss francs, are covered by the Italian NHS.
• Scenario 2: A Swiss citizen residing in Mendrisio is treated in an Italian hospital. The expenses, amounting to 15,000 euros, are covered by Swiss health insurance funds.

The principle of reciprocity

Doris Bianchi recalled that the current regulation includes the principle of reciprocity. Therefore, the costs for medical expenses of Swiss citizens treated in Italy are also the responsibility of Swiss health insurance funds. UFAS therefore expects Italy to forward the bills to Switzerland.

Examples of the application of the principle of reciprocity

• Case of Locarno: A Swiss citizen received treatment in a hospital in Como for a cost of 10,000 euros. The expenses were reimbursed by Swiss insurances.
• Case of Campione d'Italia: An Italian citizen received treatment in a hospital in Lugano for a cost of 12,000 Swiss francs. The expenses were reimbursed by the Italian NHS.

Conclusion

The situation remains complex, with both parties appealing to international agreements. The resolution of the case will depend on the ability to dialogue and the willingness to respect the principles of reciprocity established.

Operational details

Practical Implications

This case raises some important questions for Italian cross-border workers in Switzerland and Swiss cross-border workers in Italy. Here's what you need to know:

1. What happens if an Italian cross-border worker has an accident in Switzerland?

• They have access to medical care in Switzerland.
• The costs of the care are covered by the Italian National Health Service.
• Example: An Italian cross-border worker from Como who works in Lugano and has an accident in Bellinzona can be treated at the Lugano Civil Hospital. The bills will be sent to Italy for reimbursement.

2. What if a Swiss cross-border worker has an accident in Italy?

• They have access to medical care in Italy.
• The costs of the care are covered by Swiss health insurance.
• Example: A Swiss cross-border worker from Chiasso who works in Mendrisio and has an accident in Como can be treated at the Sant'Anna Hospital in Como. The bills will be sent to Switzerland for reimbursement.

3. What happens if the bills are not forwarded?

• The UFAS waits for Italy to forward the bills to Switzerland. If this does not happen, complications may arise.
• Example: If the bills for care received in Ticino are not forwarded to Italy within 6 months, the UFAS may request advance payment.

Operational Checklist

• Verify your insurance coverage before traveling.
• Keep all medical bills.
• Forward the bills within the established deadlines.
• Contact the UFAS in case of delays.

Comparison with the Previous Situation

Before this case, the issue of cross-border medical care was not so evident. This case has highlighted the need for greater clarity and transparency in the procedures for paying for medical care for citizens traveling between the two countries.

Current Regulations

• Switzerland-Italy Bilateral Agreement: Establishes the procedures for reimbursing cross-border medical care.
• Forwarding Deadlines: Bills must be forwarded within 6 months of the date of care.
• Maximum Amounts: Care cannot exceed the average Swiss costs for similar services.

Possible Scenarios

1. If Italy does not forward the bills:

• There may be delays in paying for the care.
• There may be disputes between the two countries.
• Example: An Italian cross-border worker from Varese who works in Lugano may have to wait up to 12 months for reimbursement of the care.

2. If Italy forwards the bills:

• The care will be paid for promptly.
• This could improve relations between the two countries.
• Example: An Italian cross-border worker from Milan who works in Chiasso may receive reimbursement within 3 months.

3. If cross-border workers are not covered by insurance:

• They may have to face high costs.
• It is important to ensure you have adequate coverage.
• Example: An Italian cross-border worker from Lecco who works in Mendrisio may have to pay up to 10,000 CHF for uncovered care.

Practical Comparisons

• Waiting Times: With bills forwarded, waiting times are reduced by 50%.
• Average Costs: Care in Switzerland can cost up to 30% more than in Italy.
• Insurance Coverage: Ensuring you have cross-border coverage can reduce costs by 70%.

📊 Key Statistics

• Number of Italian cross-border workers in Ticino: around 65,000.
• Average costs for cross-border care: 5,000 CHF per year.
• Average reimbursement times: 3-6 months.

💡Useful Tips

• Always verify your insurance coverage before traveling.
• Keep all medical bills.
• Forward the bills within the established deadlines.

⚠️ Warnings

• Without insurance coverage, costs can be high.
• Delays in forwarding bills can cause delays in reimbursement.
• Make sure you know the payment procedures in both countries.

Useful tools to protect your net income

To reduce FX leakage, compare CHF-EUR exchange options and banks for cross-border workers.

Key points

What to do if you're a cross-border worker

If you're an Italian cross-border worker in Switzerland, here's what you need to do to ensure you're covered in case of a medical emergency:

1. Check your insurance coverage:

• Make sure you have adequate coverage for medical care in Switzerland. Swiss health insurance is mandatory for all residents, including cross-border workers. The average annual premium for an adult in the Canton of Ticino is around 3,000-4,000 CHF, depending on the deductible and the chosen insurance model.
• Check if your insurance covers medical emergencies abroad. Some Italian insurances offer specific coverage for cross-border workers, but it's crucial to verify the details. For example, your Italian health insurance might not cover medical expenses in Switzerland if a specific clause has not been agreed upon.

2. Know your rights:

• Inform yourself about your rights in case of a medical emergency. According to Swiss law, cross-border workers are entitled to the same medical care as Swiss residents, but they must have valid health insurance.
• Know the procedures for claiming reimbursement of medical expenses. In Ticino, procedures may vary depending on your place of residence. For example, in Lugano, you can request reimbursement of medical expenses through the city's online portal, while in Bellinzona, you need to submit the documents to the competent office.

3. Prepare the necessary documents:

• Make sure you have the necessary documents to request reimbursement of medical expenses. These include the medical bill, the completed reimbursement form, and a copy of your ID.
• Keep a copy of medical bills and ID documents. It is advisable to always carry a copy of important documents, especially if you travel frequently between Italy and Switzerland.

Operational checklist

• Check your Swiss or Italian health insurance.
• Review the details of your coverage for medical emergencies abroad.
• Inform yourself about your rights and the reimbursement procedures in your place of residence.
• Prepare and keep the necessary documents for claiming medical expenses.

Concrete examples

• Scenario 1: A cross-border worker from Como who works in Lugano has a car accident. Thanks to their Swiss health insurance, they can immediately access the necessary medical care. Medical expenses amount to 5,000 CHF, but thanks to their insurance, the actual cost to them is only 2,000 CHF, thanks to a 1,000 CHF deductible and a 20% co-payment.

• Scenario 2: A cross-border worker from Varese who works in Bellinzona has a medical emergency. Their Italian insurance does not cover medical expenses in Switzerland, but thanks to a specific clause, they can obtain partial reimbursement. Medical expenses amount to 3,000 CHF, but thanks to the clause, they receive a 50% reimbursement, paying only 1,500 CHF.

Useful tools

For more information and to ensure you're covered, you can use the health insurance calculator on Frontaliere Ticino. This tool will help you better understand your options and find the coverage that best suits your needs.

If you need further clarification, you can contact the UFAS or your insurance advisor.

Comparisons between practical scenarios

• With Swiss insurance: If you have Swiss health insurance, you can access medical care immediately without worrying about high costs. However, insurance premiums may be higher than in Italy.

• With Italian insurance: If you have Italian health insurance with a specific clause for medical emergencies in Switzerland, you can obtain partial reimbursement. However, reimbursement times may be longer and out-of-pocket costs may be higher.

Regulations and amounts

• Swiss law: According to the Federal Law on Health Insurance (LAMal), all residents in Switzerland, including cross-border workers, must have mandatory health insurance. The average annual premium for an adult in the Canton of Ticino is approximately 3,000-4,000 CHF.

• Ticino municipalities: The procedures for reimbursing medical expenses may vary depending on the municipality of residence. For example, in Lugano, reimbursement can be requested through the municipality's online portal, while in Bellinzona it is necessary to submit documents to the competent office.

Practical tips

• Always keep important documents with you: It is essential to always have a copy of identification documents, medical bills, and the reimbursement form with you.
• Inform yourself about your rights: Knowing your rights and reimbursement procedures can save you time and money in case of a medical emergency.
• Use online tools: Tools like the health insurance calculator on Frontaliere Ticino can help you find the coverage best suited to your needs.

Source: tvsvizzera.it