Thermal treatments and the national health service: how the accredited cure works

Italian spas have two lives. One is the day in the pool, which you pay for yourself and which needs no doctor: you will find it in the pages on the spas of Tuscany, the mountain spas and Ischia. The other is the proper thermal cure, prescribed by a doctor and partly paid for by the Servizio sanitario nazionale (SSN), Italy's national health service. According to Federterme, there are more than 320 spa centres in operation in Italy and 90% of them are accredited with the SSN. This page explains the second route, with the rules that apply to everyone. It does not replace a doctor's opinion: if you think a thermal cure might help you, talk to your family doctor or a specialist, who will know whether your diagnosis is among those covered. A note for visitors from abroad: the SSN and the co-payment (the "ticket") concern people enrolled in the Italian SSN; visitors pay the private rates quoted on the spa pages.

How to access the accredited cure

• Prescription. You need the request form on the SSN prescription pad, signed by a general practitioner, a paediatrician or a specialist in a relevant branch. It must state the diagnosis, taken from the ministerial list, and the cycle of treatments to be followed.
• One cycle a year. Each patient is entitled to a single cycle of thermal treatments paid for by the SSN within the year. On arrival you declare on the back of the prescription, under your own responsibility, that you have not already used another cycle in the calendar year.
• Duration. A cycle normally lasts 12 days, to be completed within 60 days of the start (figures from regional websites and spa establishments). Extra treatments are paid for by the person taking them.
• Admission visit. At the establishment the medical director or a delegated doctor fills in the clinical record after a visit that checks for contraindications and sets the type, timing and manner of the treatments.
• Employees. Treatments cannot be taken outside holiday or ordinary leave, except in cases provided for by law and contracts (for example leave for treatment for war or service invalids, or urgency certified by the local health authority's doctor).
• Booking. Treatments are by appointment, and an unannounced absence can mean losing the session.

The practical regional rules, for example those of Lombardy Region and Emilia-Romagna, are on the regions' health websites.

The co-payment: what you pay

The amounts are those published by Federterme for accredited treatments; some regions may add a regional co-payment.

The exemption code is written by the doctor on the prescription; if you are unsure about your category, ask the local health authority (ASL).

Who pays the rest? The SSN reimburses the establishment with a rate per session. According to the financial press (QuiFinanza, 6 June 2026), the State-Regions Conference has approved the renewal of the 2025-2028 national agreement, pending clearance from the Ministries of Health and of the Economy: maximum rates stay unchanged for 2025 and 2026 and rise by 2% a year in 2027 and 2028. The most requested rates per session:

What remains for you is the co-payment in the table above. The text of the agreement is not yet available in the Gazzetta Ufficiale: the figures are those reported by the press.

Which treatments and for which conditions

The treatments allowed are tied to specific conditions, set out by the Ministry of Health by decree (Ministerial Decree of 15 December 1994, referred to by the Ministerial Decree of 22 March 2001), not to general well-being. Here is the list published by Federterme.

Accredited establishments

Only establishments accredited and contracted with your region provide treatment paid for by the SSN, and each region manages spending caps and waiting lists. The updated list is on the regional health website or at the ASL; Federterme also has a search engine for establishments on its portal. For example, the Terme di Boario, in Valcamonica, and the Fonteverde centre in San Casciano dei Bagni offer treatments paid for by the SSN (as stated on their own pages). Outside the accredited scheme the establishment sets the prices, which are usually on its website. Anyone who only wants entry and a pool needs neither a prescription nor a visit: you pay the ticket (see the pages on the spas of Tuscany and the North).

Who should not go to the spa

Contraindications depend on the type of treatment, the water and the stage of the illness, and are assessed by the doctor. The establishments' lists give some recurring situations.

• Thermal treatments (list of an accredited establishment): malignant neoplasms, acute illnesses, flare-ups of chronic diseases, exudative tuberculosis, severe respiratory failure. For inhalations and mud treatments, ischaemic heart disease, thrombophlebitis, pregnancy and exudative skin diseases are added.
• QC Terme spa centres (2026 rules): not admitted are pregnant women and anyone who has or has had heart, blood pressure or respiratory problems, or recent injuries or surgery. For saunas and steam baths, varicose veins, low blood pressure, kidney failure, fever, inflammation and open wounds are added.

If you have any of these conditions, or doubts about medicines and therapies you are taking, ask your doctor before booking: in tourist spas nobody examines you at the entrance.

The waters: what they are and what they are for

Federterme classifies waters by temperature at the spring (hypothermal between 20 and 30 °C, homeothermal between 30 and 40, hyperthermal above 40) and by composition. The indications are general information: the choice of water and treatment is up to the doctor.

Waters that flow freely, like those of the Cascate del Mulino (37.5 °C, free entry all year round according to the Tuscan tourist board), are a free experience and not a cure: no prescription, no therapeutic guarantee.

Rules of behaviour in thermal pools

Every establishment has its own regulations: read them before you leave. Here is what some centres require.

• Shower compulsory before entering the pools, at the QC Terme centres of Bormio and Pré-Saint-Didier (2026 regulations).
• Swimming cap: not compulsory either at the QC Terme centres or at Terme Merano, but at QC hair must be tied up. Other establishments require it: check.
• Swimsuit always worn at the QC centres, even in the corridors and outdoors. At Terme Merano, by contrast, the sauna area is for nudists: you enter only with a towel and slippers, and swimsuits are not allowed.
• Children: at the two QC centres, children under 14 are not admitted. Terme Merano welcomes children of any age if accompanied (from 14 you can also enter alone with an ID document; the sauna is for adults, from 14 only with an adult). The Parco Termale di Saturnia welcomes families and has a children's pool; the Posta at Bagno Vignoni accepts only guests aged 14 and over. At the Giardini Poseidon on Ischia, children under 12 are not allowed in the thermal pools. Details on the page about spas with children.
• Food: you may not bring your own to the QC Terme centres or to Saturnia.
• Towel and bathrobe: at Saturnia they must be white; if you don't have them you can hire them. At Merano hire costs 6 euros for the towel and 8 for the bathrobe (deposits of 15 and 30 euros).

The full regulations of the Parco Termale di Saturnia are published by the operator as a PDF document, to be read before your visit.

1. Darfo Boario Terme (Terme di Boario): SSN treatments, Valcamonica
2. Bormio (QC Terme Bagni Vecchi): 2026 regulations, under-14s not admitted
3. Pré-Saint-Didier (QC Spa): 2026 regulations, under-14s not admitted
4. San Casciano dei Bagni (Fonteverde): water at 42 °C, SSN treatments
5. Saturnia (Cascate del Mulino): 37.5 °C, free entry

Where to go next

For the history of the spas there is the page on the history of the spas; for a first outing without a prescription, the three weekends.