Croatia operates on a two-tier health insurance system, consisting of both public and private health cover. National health insurance, under the HZZO (the Croatian Institute for Health Insurance, also known as the CHIF), is compulsory and takes the following forms:• Obavezno zdravstveno osiguranje – public basic health insurance (mandatory)
• Dopunsko zdravstveno osiguranje – public or private supplemental health insurance (optional)
• Dodatno zdravstveno osiguranje – private supplemental health insurance (this is optional and is usually offered by banks, as well as insurance companies)
If you are an EU citizen, or are applying for residency but are from outside the EU, and are working in Croatia, you will have to pay contributions into the HZZO. You will also need to pay contributions into the scheme if you are self-employed.
The standard of Croatian public healthcare is generally good, but many expats opt for private coverage, even though they are covered under the HZZO, to avoid long waiting times and other issues with the public healthcare system. Croatia has a number of high quality private clinics.
Public and private health cover
You will be able to access public healthcare if you are making social security contributions into the HZZO. Premiums are currently around 530 Kn (approximately US$78) per month. These will be deducted from your salary.
You may also wish to check with your employer whether you are covered under a private group health insurance package.
Your other option would be to pay out of pocket expenses in the private sector. Remember, however, that costs can escalate rapidly if you have a chronic condition or need to see a specialist.
Selectable options
Check the small print of any private health insurance policy to see whether it covers treatments that you may want to access, such as specialist surgical treatment or more advanced dental care, such as crowns or dental implants.
Remember to check whether your potential policy covers pre-existing conditions. The definition of this will vary between insurers. Usually the term applies to any conditions that present symptoms or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for when the diagnosis must have been given.
You may also want to check whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You may need to discuss this directly with your insurer. You may also wish to check whether there is a medical evacuation clause, although Croatian healthcare is of an adequate standard to treat most medical conditions.
Take a good look at your potential policy for any cover relating to healthcare that does not apply to you. Some policies have provision for maternity care, for instance, and if you are not intending to become pregnant (or prefer to rely on the cover provided by the Croatian maternity system), then you may wish to reduce your policy costs by having such options removed.
Cost sharing
You may also be able to reduce the cost of your premium through ‘cost sharing’. This is where you and your insurer share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing.
Co-pay
This is where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance
This is where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your coinsurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles
This is where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your healthcare clinic and then, once you have had 11 such appointments, your insurance will begin to pay out to the doctor directly.
You may also need to look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met. Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. In this instance, you would pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000). At that point, you would pay nothing more for the remainder of the plan year.
It is worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
International private medical insurance
As so many variables have an effect on the cost of international private medical insurance, it is very difficult to give accurate estimates without knowing the full details of what coverage you require. 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. If you want your coverage to include the US, the premium could increase to almost double this amount.