Bulgaria has compulsory common healthcare insurance. All insured persons in Bulgaria select their family doctor (general practitioner), whom they visit when necessary. If the general practitioner is not competent to treat the illness, he or she provides written permission for the patient to visit a specialist also working with the National Health Insurance Fund. When visiting the general practitioner or the specialist recommended by the general practitioner, a small fee is paid. As of 1 August 2011, the fee was 1% of the minimum salary in the country, or 2.70 BGN (1.40 Euro). For each day of a hospital stay, the patient pays a fee amounting to 2% of the minimum monthly salary in Bulgaria, roughly two Euro. Children up to 18-years old, pregnant women, minors and unemployed members of the family, military personnel, and a few other groups are treated free of charge. Uninsured persons pay the full cost for provided medical care in addition to these fees.
There are a large number of specialized private offices and medical facilities in Bulgaria. On receiving consultation and/or treatment at these facilities, patients pay the entire amount for the examination and/or treatment, regardless of whether they have health insurance.
Interested parties may obtain more information about healthcare and the conditions for using healthcare services paid by public funds in Bulgaria by visiting the site of the Ministry of Health (www.mh.government.bg) and the site of the National Health Insurance Fund http://www.nhif.bg/.
Medical care for foreigners who are residents of the EU, EEA and Switzerland (Austria, Belgium, Great Britain, Germany, Greece, Denmark, Estonia, Ireland, Spain, Italy, Cyprus, Latvia, Lithuania, Luxemburg, Malta, Poland, Portugal, Romania, Slovakia, Slovenia, Hungary, Finland, France, the Netherlands, Czech Republic, Sweden, Iceland, Norway, Lichtenstein, Switzerland).
Citizens of any of the above member states who are visiting or residing in Bulgaria have the right to avail themselves of their health insurance. When obtaining medical care, they need only visit a medical facility or diagnostic laboratories that has concluded a contract with the National Health Insurance Fund (NHIF), or any of the state or municipal medical institutions (see the file entitled Healthcare Establishments Register) that are supported by the Ministry of Health. Tourists in Bulgaria can inquire with staff at hotels to gain information about medical care and treatment, and it is the obligation of hotels to provide a list of the addresses of medical facilities and doctors who contracts with the NHIF. (Please note that he healthcare specialists working at hotels often do NOT work with the NHIF, and their services are generally expensive.)
By relying on their own insurance plans, European Union visitors and residents do not have to pay insurance installments to the Bulgarian National Health Insurance Fund. Instead, they need only present their European Health Insurance Card (EHIC). Under exceptional circumstances, this right can also be proven by providing a Certificate for Temporary Replacement of the EHIC issued by the same institution that issued the individual’s health insurance card, along with valid identification. It is also necessary to provide the medical practitioner with copies of these two documents. Likewise, by presenting the required documents non-Bulgarians only pay the consumer fee required of Bulgarian insured citizens for the following medical and dental care:
Examination and diagnosis:
- Issuance of a recommendation for consultation or for medical tests after the examination;
- Determination of medical treatment, including prescriptions, after the examination;
- Rehabilitation procedures;
- Medical tests;
- Non-Bulgarian patients are also required to sign a declaration (Annex 2), by which they certify that they are not in Bulgaria solely for medical treatment.
In the event of a medical emergency, call the toll-free telephone number 112. This is also the number to call for any other emergency. The number can also be reached outside the range of your mobile network. The 112 operators also speak languages other than Bulgarian.
If during your stay in Bulgaria, you have an urgent medical need, your doctor can prescribe you drugs. Ask if any part of them or the entire sum for these drugs is covered by the NHIF. If so, you can receive your medicine at a lower cost, since a portion of the cost will be subsidized, as it is for Bulgarian citizens, but you can only do that in a pharmacy that has an agreement with the NHIF. If the drugs are not covered by the NHIF, they may be purchased at any pharmacy, though at the full cost.
Medical and diagnostic examinations and hospital treatment
When additional examinations or hospitalization is required, the general practitioner is the one to provide the recommendation. The healthcare facilities are required to prominently post information regarding the price of medical services; the cases in which patients have to pay for the medical care; and the manner and terms of payment for the medical care.
If the condition is urgent (for instance, in case of a stroke, car accident, heart attack, and the like), patients will be admitted to a hospital without a recommendation from the general practitioner.
Certificate for temporary disability during a temporary stay in Bulgaria
If visitors to Bulgaria would like to be compensated for a disability that occurs during their stay in the country, they must immediately contact a doctor who has an agreement with the National Health Insurance Fund. The doctor will then decide if the case is related to temporary disability or is a work-related accident. It is advisable to notify your employer as soon as possible, either by phone or by fax, about the immediate circumstances and the approximate duration of the disability, and to advise your employer as to your location in Bulgaria during the medical treatment.
Obtaining medical care without the required documents or an identification document
If upon obtaining medical care during a temporary stay in Bulgaria an individual does not present an EHIC and/or identity card, he or she will be treated as a private patient. In these cases treatment shall be paid entirely by the patient or by the insurer, if the individual has health insurance. The same also applies for cases where it is clear that an individual has traveled to Bulgaria for medical treatment without the official permission (Е112) of the responsible institution in the individual’s native country.
If visitors are unable to present any of the required documents, however, this does not deprive them of the right to medical care under the provisions of the EU Regulations on Social Insurance. In such cases, the visitor’s personal medical practitioner needs to inform the Regional/National Health Insurance Fund about the case. If you have the right to obtain medical care in your country, the responsible healthcare institution shall confirm that fact by sending a fax to substitute for the temporary insurance form. If it is an emergency, so that confirmation by the responsible institution cannot be provided in time, it is necessary to pay for the medical service in full, at the fees established by the National Health Insurance Fund and the Ministry of Health. In this case, an invoice will be issued containing a detailed description of the medical services provided, including the respective contractual prices. After your return to your home country where you are insured, you can file a claim so as to be reimbursed for the amount.
Medical assistance for citizens of other countries
Citizens of a country other than member states of the EU, EEA, and Switzerland who require medical care in Bulgaria must pay for those services in full. If a patient possesses health insurance, the insurer is responsible to reimburse the costs, whether in their entirety or in part, according to the terms of the insurance agreement. In the case of an emergency, regardless of citizenship, place of residence, or health insurance status, every Bulgarian medical facility is required to offer the necessary diagnosis and treatment. If you are in an emergency situation, medical or otherwise, call the free telephone number 112. The operators also speak languages other than Bulgarian. There are different conditions stipulated for the residents of the states with which the Republic of Bulgaria has agreements and contracts for medical insurance. The right to free access to medical assistance for diplomatic representatives is established by some of those agreements, while others have the right to emergency medical care, and still others provide a wide range of social security and health insurance issues based on the existing bilateral agreements. Such agreements are now in force between Bulgaria and Armenia, Afghanistan, Vietnam, Iraq, Yemen, Jordan, Cambodia, the Democratic People’s Republic of Korea (North Korea), Malta, Mexico, Moldova, Mongolia, the Russian Federation, Slovakia, Ukraine, Serbia, Bosnia and Herzegovina, and Slovenia.