Health insurance contributions in Bulgaria

Medical insurance in Bulgaria

Sometimes you come across the claim that for Bulgarian citizens medical care in
the country is free. This is not the case. Medicine in Bulgaria is insurance-based. This means
that all citizens and holders of an EGN with equal rights pay
monthly insurance contributions (osigurovki), and their treatment is then paid for by
the NZOK (Национална Здравоосигурителна Каса). The NZOK does not always cover
the cost of treatment in full. In addition, for a visit to the doctor citizens
pay 3 leva, and for a stay in hospital – about 6 leva.
Dental treatment is only partly paid for by the NZOK; for certain
procedures you have to pay entirely out of your own pocket.

How to pay osigurovki?

Under the law «За здравното осигуряване», osigurovki must be paid by
all citizens of Bulgaria, as well as by foreigners who have obtained the right
to long-term or permanent residence in Bulgaria.
For those who are employed, the insurance contributions are paid by the employer. The amount
of these monthly payments depends on the salary. The accounting department makes sure that the money
reaches the NZOK on time.
Those who do not work are called «самоосигуряващи лица» and must pay
the osigurovki themselves. In this case the amount of the contributions depends on
the minimum wage. In 2019 it is 22,4 leva per month. You can
pay either monthly or for a long period at once.
To make the payments yourself, you need to fill in a special declaration at the tax office.
This must be done both by those who have lost their job

and by those who have only recently received an EGN. You need to go to the nearest
National Revenue Agency (NAP) office, obtain information about your arrears and pay
them. Payment can be made either directly at the bank branch in the NAP office,
or remotely, by bank card.
For the initial registration in the tax authority’s database, you need a document from
the Migration Service stating the date on which the permit for
permanent/long-term residence was issued. The osigurovki must be paid
from precisely that moment, despite the fact that foreigners usually receive their EGN
one to two months after the permit is issued.
Those who have no arrears have the status of persons «с непрекъснати
здравноосигурителни права» and can make use of medical care.
You can check your status online on the NAP website.

Is it possible not to pay osigurovki?

Children under 18 are exempt from paying osigurovki (both citizens
Bulgaria, as well as foreigners with EU long-term resident status or a permanent residence permit). If the child continues
studying at secondary school, he or she may not pay insurance contributions until
the age of 22. Full-time students are exempt from
paying insurance contributions until the age of 26. This also applies to foreign
university students.
Certain categories of the population may also not pay insurance contributions –
for example, those who need social assistance or are in
detention.
Bulgarian citizens who are outside the country for 183
days a year may make no payments if they file in advance
the relevant application with the NAP. Those who hold Bulgarian citizenship and
the citizenship of another state may also, in such a situation, not pay
insurance contributions, having filed in advance with the NAP a declaration in the prescribed
form. As regards foreign citizens, the law contains no such provisions.
A person who does not pay insurance contributions becomes a person «с прекъснати
здравноосигурителни права». He or she is not entitled to use medical
care under the NZOK system and must accordingly pay for all
medical services out of pocket or buy an insurance policy.