State health insurance is mandatory for employed expats and you will pay into the national scheme (NOI), thus becoming eligible for medical and dental reductions or free treatment. You will need a residence permit, but provided that you are paying into the system, you and your dependents will be able to access GP visits, referrals to specialists, and reductions for your prescriptions.

Bulgaria now has a two-tier system, but its socialist origins mean that this is a fairly recent phenomenon. The Bulgarian National Health Insurance Fund (NHIF), based in Sofia, is the only organization which deals with public healthcare insurance. It remains a socially organised system but healthcare generally is being revised in order to provide a higher standard of care for Bulgaria’s population.

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. You must take this with you to any medical appointments to prove your eligibility.

If the hospital is part of the NHIF, your treatment will be free at the point of delivery. After being discharged, you will be entitled to a maximum of two examinations as part of your outpatient care.

Before you receive treatment, check 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. Take particular care if you have been booked in to a doctor’s appointment or a hospital visit by a hotel or a tourism representative.

You might be able to queue-jump in public clinics if you offer to pay. This costs around 20 lev per visit.

If you have to take a prescription to a pharmacist, make sure they are contracted to the NHIF as well: if they are, then your medication will be free, but if not, you will have to pay for it and that cost will be non-refundable.

Check whether your doctor speaks English – some do, but this may vary across the country. Bulgaria still uses the Cyrillic alphabet, so familiarize yourself with this, at least to a basic degree, before arrival.

You will qualify for free at the point of delivery, or reduced, treatment if you are paying national insurance contributions. You will also be eligible to access Bulgarian healthcare if you are an EU national and if you have an EHIC card, but not otherwise: most countries outside the EU do not have a reciprocal arrangement with the country.

Your employer should organize this for you. You might also want to check if some insurance cover is already provided by your bank, if you are looking at a short stay in the country.

The national health insurance system covers:

• primary outpatient care
• specialised outpatient care
• hospital treatment
• diagnostic tests
• some medication
• gynaecological care
• vaccinations
• emergency care
• ambulance transport

Even if you do not have cover, if you are an EU citizen you will be entitled to:

• emergency care
• obstetric and gynaecological examinations and medical care for childbirth
• in-patient psychological care
• transplantation of organs, tissues and cells
• mandatory treatment and/or mandatory isolation
• expert assessments of the type and degree of long-term incapacity to work
• medical transport
• assisted reproduction

Check that your medication is legal in Bulgaria: there have been some issues with prescriptions. What is permitted in one country may not be permitted in another.

You might be eligible for state medical insurance if you are covered in your home nation. If you are British, you will qualify if you have:

• an exportable UK State Pension
• a contribution-based Employment Support Allowance
• another exportable benefit

You will need to fill in an S1 form to demonstrate your eligibility.

If you are an expat and have children who are studying in the country, they will be covered up until the age of 26 if they are in regular education in Bulgaria. However, they will be responsible for their own national insurance contributions between the end of their secondary education and the start of their university education.

If you are an international student, you will need an EHIC card or private health insurance. You will need to provide an official translation of your health insurance cover when you enroll at your educational institution.

If you have children in education who are under the age of 26, they will be covered under the state system. Your spouse will also be covered.

Some dental care is covered under the national health system but check if you think you might need more than basic treatment as private health insurance may be necessary.

The amount that you pay will depend on your salary, but there is a very minimal base rate cost of around 15 lev a month, the equivalent of about £7. Your healthcare contributions will be around 8% of your salary: 4.8% payable by your employer and 3.2% payable by you.

Expats may take out private health insurance to cover the interim period between arriving in the country and being processed into the healthcare system. They may also do so because the country’s healthcare system is not the best, and there is a substantial difference between treatment received under the public system and that received in private care.

Bulgaria has not had the funding or the infrastructure to update its facilities to the high standard enjoyed by some other EU nations, and although its medical professionals are highly trained and very competent, facilities may not be analogous to elsewhere in the EU.

If you do not contribute to the state system, you will need private cover. You can extend your existing private insurance to cover you internationally, but make sure you are aware of exactly what this covers: will it allow you to be flown home, for example, in the case of a medical emergency?

If you have a pre-existing condition, it is doubly important to check that you are covered. You will need to explore any risks specific to the region: TB is not common, but it is still an issue in the country.

The usual range of medical and hospital treatment will be covered by private insurance. As with all private cover, the more you pay, the more you will be entitled to receive.

Bulgaria is also a medical tourism destination for dental and cosmetic treatment.

Visits to private clinics, where facilities tend to be of a higher standard than the under-funded and under-staffed public medical sector, cost the equivalent of €20 – 30, but specialist and hospital fees can be quite high, although private cover here still costs considerably less than in other EU states. The cost of your cover will depend on factors such as your age and any pre-existing health conditions, as well as the type of package that you choose.

For those seeking international private medical insurance (iPMI) cover for multiple countries including Bulgaria, numerous variables can have an impact on the cost.

The most important variables are:

• Age (the higher the more expensive)
• Area of cover (i.e. in addition to Bulgaria, which other areas is coverage required in? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
• Product choice (higher end insurance products are more expensive)

Other variables include:

• Deductibles
• Co-insurance
• Payment frequency
• Gender
• Nationality
• Country of residence

As so many variables have an effect on the cost of international private medical insurance in Bulgaria it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

The main companies operate in Bulgaria, including:

• Allianz
• Bupa Global
• Cigna Global
• Expat Financial
• Pacific Prime

Look for a package that fits both your budget and health requirements, and make sure to request quotes from as many companies as possible.

Имам EHIC карта (Imam EHIC karta) - I have an EHIC card

Имам нужда от здравно осигуряване (Imam noozda ot edravna osigiryavanye) - I need health insurance

Това частна клиника ли е? (Tova chastna klinika le e?) - Is this a private clinic?