Insurance in Vatican City

Vatican City has no publicly evidenced free market with local private insurance companies, brokers or generally published tariffs. The main formal arrangements are tied to employment and public institutions. FAS, the Fondo Assistenza Sanitaria, covers eligible healthcare and work-related accident or occupational disease needs. The Fondo Pensioni provides old-age, seniority, disability and survivor benefits for eligible staff of the Vatican City State and Holy See entities. FAS access normally begins with employer registration and a completed form, generally within 30 days of employment. Coverage starts after enrolment and is evidenced by an assistance card. Eligible groups include ecclesiastical, religious and lay personnel of the Roman Curia, the Governatorato and entities directly administered by the Holy See, as well as active and retired personnel. Families may apply. Vatican City residents without another entitlement may be admitted by the FAS board, while other applicants require adequate justification and authorization from the Segreteria di Stato. FAS covers illness, including chronic and terminal illness, pregnancy and childbirth, conservative dental treatment, prescribed medicines and approved supplementary assistance. The Direzione di Sanità ed Igiene, FAS contractors, Farmacia Vaticana and contracted pharmacies provide direct services. A non-contracted provider can generally be used through an approved reimbursement process subject to tariffs and maximum limits. Emergency admission can be reported by telephone. Reimbursement claims normally require original receipts and, for hospital treatment, medical records; the claim deadline is six months after the last service. Medicines are generally reimbursed at 70% indirectly, while authorized medicines unavailable at Farmacia Vaticana can receive 100% reimbursement. FAS contributions are generally 2% of regular remuneration for 13 months for employees, 2% of the pension for Vatican pensioners and 2% of gross annual pension for people receiving only another pension, with two advance payments each year. The employer or administration pays a variable annual per-capita share based on the budgeted total expenditure, normally monthly by the 10th day. Changes in family or income circumstances generally have to be reported within 30 days. FAS coverage can end when employment ends without an acquired pension; after a health-related termination without pension entitlement, continuation can last six months. Pensioners and families may permanently waive coverage, while other residents generally need to provide annual proof of eligibility. The Fondo Pensioni uses a total contribution of 20% of regular remuneration, including the employee share, with 5% deducted from pay and remitted monthly by the 10th day. The contribution rate can be changed by the Segretario di Stato. The rules set different service requirements, including 20 years of effective service for certain age or dismissal cases, 38 years for seniority retirement and 30 years after voluntary termination. Ordinary disability generally requires five years of service unless the cause is service-related; service-related privileged disability has no minimum service period. Survivor benefits generally require five years of service or death caused by service, with shares of 60%, 70%, 80% or 100% for one, two, three or more eligible beneficiaries. A position without an immediate or deferred entitlement may be transferred to another regime or converted into an insurance policy. The Holy See–Italy social security convention can connect certain Vatican and Italian insurance periods without creating a general private insurance market. Vatican employees generally remain under Holy See rules, while non-Vatican employees working in Vatican territory generally fall under Italian rules. Some Vatican employment categories, including certain probationary or fixed-term workers, can enter Italian insurance branches when the event is not already covered by the Holy See. Non-overlapping periods can be totalized, eligible cash benefits are generally exportable and applications go to an institution of one of the contracting parties. FAS supplies certain healthcare benefits for work accidents and occupational diseases, while APSA and the Fondo Pensioni handle specified disability, old-age and survivor matters. Call-in personnel have a special arrangement: the employing entity must provide coverage during actual work for work accidents, work-related illness and third-party liability, while healthcare may come through FAS, the DSI or a health policy. This arrangement does not establish a general rule for ordinary employees or residents. The Ufficio Giuridico manages state insurance contracts, but public information does not establish a general local system for private property, life or liability insurance, including standard insurers, premiums, coverage limits or claims procedures. External foreign cover may therefore be relevant in individual cases, but its access requirements are not generally documented for Vatican City. For vehicles, the Registro Veicoli Vaticani registers state SCV and private CV vehicles and issues licences. Current rules require insurance coverage for road use, although public sources do not provide a complete list of insurers, policy terms, premiums or claims procedures. The vehicle population is small, with approximately 600 SCV and 300 CV vehicles reported for 2025, so vehicle insurance has narrower general relevance than the employment-based schemes. Appeals against FAS or Fondo Pensioni enrolment, contribution or benefit decisions generally go first to the relevant administrative board within 30 days; after rejection or no decision within 90 days, a claim may be brought before the Ufficio del Lavoro della Sede Apostolica.