Newsletter May 2022

Amendments to the Health Insurance Act were published in issue 32 of the State Gazette on 3rd April 2022 aiming to regulate the health insurance and medical care of foreigners arriving and staying in the Republic of Bulgaria.


The legislative changes were made mainly due to the foreigners arriving in Bulgaria from Ukraine, who were forced to leave their country as a result of the military actions. They are considered to be third-country nationals outside the European Union (EU) who are not entitled to use the EU social coordination system.


The right to emergency medical care in Bulgaria is guaranteed in Art. 100, para. 2 of the Health Act. The latter provides that every medical institution is obliged to perform the possible volume of medical activities for an emergency patient, regardless of his citizenship, address or health insurance status.


The referred to provision varies from the right to receive the necessary medical care for persons enjoying temporary protection if they do not have available funds. Although the law provides for — persons in need to receive medical care on an equal footing with Bulgarian citizens, it is difficult to be implemented in practice as these persons are not deemed to be health insured.


The above two circumstances were the reason for the legal changes which will guarantee the right to healthcare to third-country nationals. The amendments to the Health Insurance Act have incurred also changes to the Health Act which at present stipulates that persons with temporary protection have the right to medical care and medical services to the same extent as the Bulgarian citizens.


The right to medical care is also enjoyed by persons with dual citizenship – Bulgarian and foreign. In general, according to Bulgarian law, persons insured in a third country are obliged to pay the cost of the provided medical care. Notwithstanding this persons arriving from Ukraine have the right to medical care due to the force majeure circumstances, even though they have not been health insured in Bulgaria.


The insurance rights of Bulgarian citizens living abroad become effective after their return to the country and the expiration of 6 consecutive months during which they have been insured. According to Bulgarian legislation, health insurance rights can be restored after a one-time payment of 12 health insurance contributions calculated on the basis of the minimum monthly insurance income for self-insured persons set out in the State Social Insurance Budget Act at the time of contributions. Paying such a sum by a person with Bulgarian and Ukrainian citizenship who is currently returning to Bulgaria from Ukrainе can be a huge burden for such person. Therefore, Bulgarian citizens returning from Ukraine should be allowed to restore their health insurance rights in a facilitated and cost effective manner.


From a financial point of view, the Council of Ministers is empowered to determine the financing of the persons with temporary protection in connection with obtaining medical care and the duration of the temporary measures to that effect.