If you are an expat in Bulgaria and you are chronically ill, your treatment options and healthcare expenses will depend on your level of health insurance. As an expat, you’ll be able to sign up for the national system as long as you are paying contributions into it, which will be deducted from your salary if you are working in the country. Bulgaria currently has in place a national program for the prevention of chronic non-communicable diseases, running from 2014-2020.As a chronic illness sufferer, your care options will also depend on whether your condition has obliged you to give up work or not. If you are still working and paying into the system, you will be able to access the full range of benefits available to Bulgarian citizens, including routine, specialist and hospital treatment.
If you have a chronic illness and are planning to move to the country, it is advisable to check the climate: Bulgaria, overall, is warm in the summer but can be extremely cold in winter, with temperatures ranging from -15 °C to + 15°C in the course of a single week. If you are an arthritis sufferer, for example, this can have a negative effect on your condition.
How does the Bulgarian healthcare system work?
It is compulsory to register for state health insurance for employed expats and you will thus make contributions into the national scheme (NOI), deducted at source by your employer, or paid directly by you if you are self-employed.
The Bulgarian National Health Insurance Fund (NHIF), based in Sofia, is the only organization which deals with public healthcare insurance. Healthcare is funded by compulsory health insurance contributions, taxes, and out-of-pocket payments, in addition to voluntary health insurance premiums, corporate payments, donations and other funding.
Once you are registered with a National Revenue Agency office, you will be issued with a Bulgarian National Health Insurance Card and you must take this with you to any medical appointments to prove your eligibility.
If you require hospital treatment and the hospital is part of the NHIF, your treatment will be free at the point of delivery and in addition, after being discharged, you will be entitled to a maximum of two follow-up appointments.
Remember to check before you receive treatment that your provider is contracted to the NHIF: if you are asked to pay costs upfront, it is likely that you have found your way into the private rather than the public system and those costs will be non-refundable.
The Bulgarian healthcare system and chronic illnesses
A recent NCBI report suggests:
Chronic diseases are on the rise [in Bulgaria], hand in hand with increased disability and disease, mainly because of demographic changes, aggravated pathology, social stress of poverty and unemployment and other external factors. According to a survey of the Index Foundation 22% of the population are considered chronically ill, of whom 34% were male and 66% female. Displayed chronic morbidity is about three times higher than the EU average and about four times more than the US.
If as an expat you are hospitalized as a result of a chronic illness, you may be eligible for reduced fees if your condition is listed under the NHIF, and you may also be entitled under the national scheme to discounted medication for your condition:
• 100% reimbursement level applies to drugs intended for long-lasting treatment of chronic diseases leading to severe impacts on quality of life or disability
• 75% reimbursement level applies to drugs intended for the treatment of widespread chronic diseases
You should also be exempt from paying the user charge for GP visits, outpatient specialist visits and outpatient laboratory services, but you will not be allowed to choose your medical team or any ‘luxury’ services under the national scheme.
Applying for disability/sickness benefit
You will be entitled to disability benefits (пенсия за инвалидност поради общо заболяване) if you have been paying social security contributions for a prescribed period. This is calculated according to a formula depending on your length of paid insurance contributions and your degree of disability. You must have made:
• at least one year of contributions if aged 20 to 24
• three years of contributions if aged 25 to 30
• five years of contributions if aged 31 or older
There is no contribution requirement if you are younger than age 20 or assessed as blind.
According to the EU guidelines for Bulgaria, you will be eligible for disability benefit due to general illness if you have completely or partially lost your ability to work permanently or for an extended period: i.e. when your capacity to work has been reduced by 50% or more. Your loss of working capacity will be evaluated by the Ministry of Health Medical Expert Commissions.
Your benefits will be granted for the period of the disability. If your disability occurs after you have reached the age of entitlement for an old age pension, invalidity will be payable until the end of your life.
Under national insurance, your dependents should also be eligible for disability benefit if they are covered by your policy.
You should also check with the health and social security departments in your home country to see if you are covered by disability legislation from your own government.
Private cover for chronic illness
If you have private health insurance, check with your provider to see if you are covered for treatment for your chronic illness within the private sector. Some policies may not cover pre-existing conditions.
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