Health Insurance in Bulgaria – FAQ for Foreigners
Is health insurance mandatory for foreigners in Bulgaria?
Short answer: NHIF is mandatory only for people who fall under Art. 33 of the Health Insurance Act (ZZO), namely:
- Bulgarian citizens;
- Foreigners with long‑term or permanent residence;
- Holders of EU Blue Card, Single Permit to reside & work, or seasonal‑work residence;
- People with refugee/humanitarian/temporary protection.
- If you are on short‑stay (краткосрочно) or extended stay (продължително) residence and are not in the Art. 33 categories. In that case, you are not in NHIF by default – you must maintain private cover, and EU/EEA/CH visitors use EHIC for medically necessary public care.
If you are not a resident (e.g., staying under a 90-day visa-free stay), you are not legally required to join the Bulgarian system, but you should have valid private health insurance.
What health insurance systems are in place in Bulgaria?
There are two main types:
| Type | Description |
|---|---|
| NHIF (Public) | National Health Insurance Fund – mandatory only for persons covered by ZZO Art. 33 (incl. Bulgarian citizens; foreigners with long‑term/permanent residence; EU Blue Card; Single Permit; seasonal workers; refugees/TP). Other temporary residents are not automatically in NHIF. |
| Private Insurance | Optional for non-residents, required for some visa/residence steps |
I am a prospective student in Bulgaria (EU & non-EU) – do I need health insurance?
Yes, and it depends:
- EU/EEA/CH: bring EHIC—it covers medically necessary, state‑provided care during studies (not private‑only clinics or planned treatment).
- Non‑EU: private medical insurance is required for a D visa/residence (≥ €30,000 incl. repatriation).
- NHIF applies only if you also work in Bulgaria or hold a status that places you under ZZO Art. 33.
- State‑paid student contributions under ZZO Art. 40(3) mainly apply to Bulgarian students; foreign students are covered by the state only in specific programs (e.g., Decrees No. 103/1993 & 228/1997) or when otherwise within NHIF scope.
Bring a valid European Health Insurance Card (EHIC). It gives access to medically necessary, state-provided care during your temporary stay, under the same conditions (including co-pays) as locally insured patients. A private top-up is advisable for repatriation and private-only clinics, which EHIC doesn’t cover.
The EHIC covers medically necessary care at providers contracted with the NHIF (the public healthcare system). Expect standard co-payments for specific services and prescriptions. EHIC does not cover private-only providers, planned treatment, or repatriation.
Yes-“medically necessary” care includes treatment of chronic/pre-existing illnesses and pregnancy/childbirth as assessed by the treating provider, given the length of your stay.
You must hold health/travel medical insurance that is valid for the entire intended stay, with a minimum coverage of €30,000, including emergency care, emergency hospital treatment, and repatriation. The policy must be issued by an insurer licensed to operate in the EU.
Yes. Universities typically require proof of valid health insurance at the time of each semester registration. If your policy is issued abroad, some institutions ask for an official Bulgarian translation.
The visa requirement is for coverage valid in Bulgaria (meeting the €30,000 + repatriation standard). Many student policies also cover Schengen-area travel, which is practical if you plan to travel; check your policy wording.
Non-EU students may work up to 20 hours/week during the academic year (and during official holidays) without a work permit. Once employed, you are insured via NHIF through employer/employee contributions for that period. EU/EEA/Swiss students can work under the same rules as Bulgarian citizens (no work permit).
Prescriptions: patient co-payments often apply; keep receipts for any reimbursements via your home insurer. Dental: limited coverage; if the dentist is NHIF-contracted, EHIC applies with co-pays—scope is otherwise restricted.
Yes. Public hospitals may levy standard patient contributions (e.g., a small daily fee) even when treatment is covered; ask the hospital about any extra charges in advance.
It can satisfy visa/residence requirements if it meets the €30,000 + repatriation threshold for the whole period, but many travel policies exclude pre-existing conditions and private-only clinics. Consider a comprehensive student plan or top-ups that match your health profile and travel plans.
EHIC is generally sufficient for medically necessary public care during studies, but it’s not a substitute for private coverage or repatriation. Non-EU: maintain a valid private policy at all times; it is mandatory for visa/residence and often checked at semester registration.
Keep your policy certificates (and Bulgarian translations, if required), your EHIC (for EU students), passport/ID, and proof of university enrollment ready. Ensure coverage dates span your whole stay—gaps can delay registration or residence renewals.
I am a foreign pensioner planning to move to Bulgaria. What are my options?
It depends on your origin:
- EU/EEA pensioners:
- Can apply for Bulgarian healthcare using the S1 form from your home country
- You register with NHIF, but your home state pays your contributions
- You gain access to the Bulgarian public healthcare without paying a monthly fee.
- Non-EU pensioners:
- Must use private insurance when applying for residence
- Once long‑term or permanent residence is granted, you fall under mandatory NHIF (ZZO Art. 33). If not insured via an employer or S1 from another state, you must pay monthly yourself. For people paying on their own basis (Art. 40(5)), from 1 Apr 2025, the minimum base is BGN 538.50 → BGN 43.08/month.
Bulgaria does not provide automatic health coverage to foreign retirees unless they are insured under EU coordination rules.
I work remotely for a foreign company and live in Bulgaria. Do I owe health insurance?
Social security in the EU isn’t based on tax residence but on where you’re insured under social security rules. For EU/EEA/Swiss situations, this is coordinated by Regulation 883/2004 and confirmed by the A1 certificate (applicable legislation).
- If you’re on an EU/EEA/Swiss payroll and hold an A1 indicating that foreign legislation applies, your home system remains competent, and Bulgarian NHIF contributions are not due.
- If you don’t have an A1 and you usually work from Bulgaria, under the default coordination rules, the Bulgarian system is often competent, and contributions should generally be paid to NHIF (usually via payroll or as a self‑insured person, not as “unemployed”).
For non‑EU teleworkers, EU coordination doesn’t apply. Instead, Bulgarian domestic law looks at whether you fall into the compulsory‑insurance group in Art. 33 HIA (for example, foreign nationals with long‑term or permanent residence in Bulgaria or certain work/residence statuses like Blue Card). Those people must be insured in NHIF when Bulgaria is their competent state.
If Bulgarian law says you must be insured and you are not already on Bulgarian payroll or registered as self‑employed, you usually end up in the “pay‑for‑yourself” scheme:
- Register with the NRA (National Revenue Agency) under the self‑pay scheme using Form 7 (Образец 7) when the obligation arises.
- Pay monthly contributions on the statutory base (2025: BGN 37.32/month Jan–Mar, BGN 43.08/month from 1 April, for people insured at their own expense).
- If you register as self‑insured (freelancer, EOOD company owner, etc.), you:
- Pay health and social contributions monthly, and
- Do an annual reconciliation of your insurance income with Declaration 6 + your yearly tax return (that’s the “file annually” part).
By contrast, if you’re paying health insurance at your own expense under Form 7 (unemployed / not on BG payroll), you submit Form 7 once and then only pay monthly; there is no separate annual insurance declaration for that category.
If you’re entitled to an S1 from another EU country (e.g., as a pensioner, posted or multi‑state worker), you can register it so your home country covers your care while you live in Bulgaria; in that case, you usually don’t also pay Bulgarian contributions.
What if I own a company in Bulgaria? Do I have to pay for health insurance?
Owning a company does not automatically trigger health insurance obligations. It depends on how you operate it:
| Scenario | Health Insurance Required? | Notes |
|---|---|---|
| You take a salary from your company | Yes | Employer + employee pay 8% total |
| You take only dividends | No | No social or health tax on dividends |
| You are a Bulgarian tax resident | Yes | Being a Bulgarian tax resident does not by itself create an NHIF obligation. Insurance depends on your insured status (employee, self‑insured manager/freelancer, or person under Art. 40(5). If you only take dividends, there’s no NHIF. If you’re in a ZZO Art. 33 category and not insured on another basis, you must pay under Art. 40(5). |
| The company is dormant or inactive | No | No obligation unless residence applies |
I’m a self-employed freelancer or consultant. What are my obligations?
If you live in Bulgaria and work independently (no foreign A1/S1 etc.):
- Register as a самоосигуряващо се лице (self‑insured person) with the National Revenue Agency within 7 days of starting the activity.
- Pay 8% health insurance on your chosen monthly base, between the legal minimum and maximum (2025: min 933 BGN Jan–Mar / 1,077 BGN from 1 Apr; max 3,750 BGN Jan–Mar / 4,130 BGN from 1 Apr).
- Pay contributions and submit your data monthly (by the 25th of the following month), and do an annual reconciliation via Declaration 6 and your personal tax return.
- If you instead work through an EOOD, you’ll still need to be insured personally (as self‑insured owner/manager or on payroll); corporate + dividend taxation may reduce your overall tax bill, but it doesn’t remove your health‑insurance obligation if you’re otherwise subject to Bulgarian NHIF.
I’m applying for residence or a visa. What health insurance do I need
You need proof of valid health coverage:
- For Type D visa / long-term residence:
- D‑visa/long‑stay: travel/medical insurance ≥ €30,000, valid for Bulgaria, including emergency care, emergency hospitalisation and repatriation; policy must cover the whole intended stay.
- For EU citizens registering residency:
- Show EU health card (EHIC) or S1 form
- Or prove private/NHIF insurance
After you get a residence, and especially once you register as an employee, company manager, or self-employed, you are required to enroll in NHIF.
Can I insure my family members under my NHIF policy?
Correct. NHIF is individual (no ‘family policy’). Each person needs their own basis (employment, self‑employment, Art. 40(5), S1/EHIC, etc.). Children and sure students are state‑insured under ZZO Art. 40(3); spouses are not covered through you.
Each person must be:
- Employed or self-employed
- Or voluntarily insured
- Or covered by their home country via EU coordination
If you want family members to be insured under health insurance:
- Spouse or children: They must pay their own contributions or be insured via their own employment
- Parents: Can only be covered if hired (real employment) or self-insured
Can I use NHIF immediately after starting contributions?
Yes, but with conditions:
- If you have no contribution gaps, access is immediate
- Rights are suspended if there are > three unpaid months in the last 36 months. To restore, you must pay all due contributions for the previous 60 months; rights are restored from the payment date.
- For elective surgeries or costly procedures, NHIF may check your history before approving.
What happens if I don’t pay for health insurance while living in Bulgaria?
If you’re obligated and don’t pay:
- Your NHIF coverage is suspended
- You may owe back contributions with interest
- You can’t receive free public healthcare
- It may affect immigration or residence renewal
Summary – by Use Case
| Profile | Health Insurance Obligation | System Used |
|---|---|---|
| EU retiree with S1 | Paid by the home country | NHIF via S1 |
| Non-EU retiree with residence | Yes, voluntary | NHIF (paid personally) |
| Digital nomad, employed abroad | Yes, if resident | NHIF or private/S1 |
| Freelancer/consultant | Yes | NHIF (self-insured) |
| The company owner takes a salary | Yes | NHIF via payroll |
| Company owner, dividends only | No | Not obligated |
| Short-term visitor (<90 days) | No | Private travel insurance |
| Student | Yes | EU: EHIC; non‑EU: private (mandatory for visa). NHIF only if also employed or otherwise covered under ZZO Art. 33. |
Final Tips
- Be proactive — if you plan to stay long-term or run a business, arrange NHIF contributions early.
- Use the S1 route if you’re from the EU and already insured
- Don’t assume residence = insurance — you must register and contribute to be covered
- Don’t skip payments — 3+ missed months = suspended coverage
- Consider private insurance if you are not eligible or need extended coverage
You Will Also Like To Know About:
- How to Register a Company in Bulgaria
- Should You Pay Yourself a Salary or a Dividend?
- Learn about the Bulgarian Healthcare System
- Staying in Bulgaria – Visas & Residence for Founders and Freelancers
Disclaimer: This article is intended for general informational purposes only and does not constitute legal, financial, tax, or medical advice. Health insurance obligations and residency requirements in Bulgaria may vary depending on individual circumstances and are subject to change over time. Always consult a qualified accountant, legal advisor, or licensed health insurance provider before making decisions regarding insurance coverage, residency status, or healthcare access in Bulgaria. Last updated: September 2025.
