Bulgaria operates a dual health insurance model built around a mandatory public scheme (the National Health Insurance Fund, NHIF) and a voluntary private market. While both share the goal of financial protection against medical costs, they differ substantially in funding, scope, and enrolment.
Similarities
- Regulatory Oversight & Consumer Protection
- Both NHIF and private insurers are regulated by the Ministry of Health and the Financial Supervision Commission, ensuring licensing standards, solvency requirements, and claims-handling protocols healthmanagement.org.
- Both NHIF and private insurers are regulated by the Ministry of Health and the Financial Supervision Commission, ensuring licensing standards, solvency requirements, and claims-handling protocols healthmanagement.org.
- Risk Pooling
- Contributions—whether mandatory payroll deductions for NHIF or voluntary premiums for private insurers—are pooled to pay providers, spreading individual high-cost risks across a wider membership base.
- Contributions—whether mandatory payroll deductions for NHIF or voluntary premiums for private insurers—are pooled to pay providers, spreading individual high-cost risks across a wider membership base.
- Complementary Roles
- NHIF guarantees a basic benefits package, while private plans top up by covering NHIF co-payments, providing private rooms, faster elective treatment, and expanded outpatient services. Together, they broaden overall system capacity APRIL International.
- NHIF guarantees a basic benefits package, while private plans top up by covering NHIF co-payments, providing private rooms, faster elective treatment, and expanded outpatient services. Together, they broaden overall system capacity APRIL International.
Differences
- Funding & Contributions
- Public (NHIF): All residents—including employees, pensioners, self-employed, and dependents—must contribute 8 % of income (2024 rate), split 4.8 % employer / 3.2 % employee, with self-employed covering the full 8 % PwC Tax Summariesbnr.bg.
- Private: Participation is voluntary. Premiums vary by age, health status, and coverage level, with no link to income. Insurers underwrite risk on an individual basis and may adjust premiums upon renewal.
- Public (NHIF): All residents—including employees, pensioners, self-employed, and dependents—must contribute 8 % of income (2024 rate), split 4.8 % employer / 3.2 % employee, with self-employed covering the full 8 % PwC Tax Summariesbnr.bg.
- Scope of Coverage
- NHIF Basic Package:
- Outpatient care: GP and specialist consultations, with nominal co-payments (~2.90 BGN per visit).
- Inpatient hospital treatment: Standard ward accommodation, with daily co-payments (~5.80 BGN/day for the first ten days).
- Diagnostics, vaccinations, rehabilitation, essential medicines, and basic dental care bnr.bg.
- Outpatient care: GP and specialist consultations, with nominal co-payments (~2.90 BGN per visit).
- Private Plans:
- Full reimbursement of NHIF co-payments.
- Private-ward rooms, choice of specialist, and “fast-track” elective surgery.
- Optional extras: Dental, optical, physiotherapy, tele-consultations, and global evacuation for expats Bulgaria InsuranceBAIB.
- Full reimbursement of NHIF co-payments.
- NHIF Basic Package:
- Eligibility & Access
- NHIF: Mandatory for all legally resident individuals; enforces universal coverage via regional NHIF branches and health-insurance cards.
- Private: Open to any resident or long-term visa holder able to meet underwriting requirements; expats often choose international plans (e.g., Allianz, AXA, Cigna) for broader global coverage AXA – Global Healthcare.
- NHIF: Mandatory for all legally resident individuals; enforces universal coverage via regional NHIF branches and health-insurance cards.
- Financial Structure & Sustainability
- NHIF: A single, centralized risk pool funded by payroll contributions and state transfers. Budget shortfalls are covered by government subsidies, potentially straining public finances bta.bg.
- Private Insurers: Maintain solvency reserves and operate competitively. Both for-profit and mutual models exist, reinvesting surpluses or distributing dividends accordingly.
- NHIF: A single, centralized risk pool funded by payroll contributions and state transfers. Budget shortfalls are covered by government subsidies, potentially straining public finances bta.bg.
- Consumer Satisfaction
- NHIF: Surveys indicate moderate satisfaction, with praise for affordability counterbalanced by concerns over rural service variability and administrative complexity healthmanagement.org.
- Private Plans: Industry estimates report ≈ 80 % satisfaction among supplementary policy-holders, who value rapid access, enhanced comfort, and responsive customer service BAIB.
- NHIF: Surveys indicate moderate satisfaction, with praise for affordability counterbalanced by concerns over rural service variability and administrative complexity healthmanagement.org.
Public Health Insurance in Bulgaria
Bulgaria’s National Health Insurance Fund (NHIF) (Official website: https://www.nhif.bg/ ) is the sole public health insurer, providing compulsory social health insurance (SHI) to virtually all residents. Below is an in-depth look at its cost, coverage, eligibility, finances, and consumer satisfaction.
1. Cost
- Contribution Rate: In 2025, SHI contributions remain at 8 % of insurable income, split 4.8 % employer / 3.2 % employee for salaried workers; the self-employed pay the full 8 % themselves bta.bg.
- Contribution Ceiling: Contributions apply up to a monthly income cap of BGN 4 130 (EUR 2 111); minimum contributions are based on a BGN 1 077 floor, ensuring at least BGN 86.16 is paid aidosbg.com.
- State Transfers: The Ministry of Health supplements NHIF revenues with monthly budget transfers (BGN 191.1 million in 2025) to cover services outside SHI’s core scope, such as public health programs and subsidies for rural pharmacies bta.bg.
2. Available Services / Coverage Features
NHIF’s basic benefits package includes:
- Outpatient Care: Reimbursed GP and specialist consultations (patient co-payment ≈ BGN 2.90 per visit).
- Inpatient Treatment: Hospital stays with a daily co-payment (≈ BGN 5.80 per day for the first ten days) covering accommodation, nursing, and procedures.
- Diagnostics & Rehabilitation: Laboratory tests, imaging, physical therapy, and post-acute rehabilitation services.
- Preventive & Maternity Care: Vaccinations, antenatal and postnatal services, and child health checks.
- Essential Medicines: Coverage under the state-regulated reimbursement list, with patient co-payments varying by drug category bnr.bg.
3. Open for All or Limited
- Universal Eligibility: All Bulgarian citizens, permanent residents, EU/EEA nationals working in Bulgaria, and registered long-term visa holders must enroll. Children and dependents are covered under the contributor’s policy.
- Automatic Enrollment: Employers register employees with NHIF automatically; self-employed register directly with the National Revenue Agency. Those not enrolling in private schemes default into NHIF by law NHIF.
4. Core Financial Features
- Single-Payer Model: NHIF pools all SHI contributions and state transfers into a single fund, then reimburses contracted providers under negotiated tariffs.
- Risk Pooling & Equity: Income-based contributions and uniform benefits ensure cross-subsidization between healthy and high-need populations.
- Budgetary Oversight: Annual NHIF budgets are approved by Parliament; any shortfalls are addressed through state subsidies, subject to fiscal constraints bnr.bg.
- Cost Controls: The NHIF employs reference-pricing for medicines, diagnostic-related groups for hospital reimbursement, and regional procurement to contain expenditures.
5. Consumer Satisfaction Score
While the NHIF does not regularly publish standalone satisfaction metrics, European Observatory surveys and independent public-sector assessments indicate moderate satisfaction, with approximately 60 – 65 % of users expressing confidence in SHI coverage and service quality. Consumers praise the breadth of basic benefits and affordability but note challenges with regional access disparities and out-of-pocket payments Health Systems Observatory.
Private Health Insurance in Bulgaria
Below are Bulgaria’s five leading voluntary private health insurers. Each offers supplementary coverage to the compulsory NHIF package, with similar core features but differentiated by network, benefits, and market focus.
1. Bulgarian Health Insurance Company EAD (Official website: https://www.bulgariainsurance.bg/ )
- Cost: Monthly premiums typically range from €30 to €120, depending on age and plan level InsuranceSecurely.com.
- Available Services / Coverage Features: Offers top-up hospitalisation plans that fully reimburse NHIF co-payments, daily hospital allowances, private-ward rooms, and priority scheduling for elective procedures. Optional riders include dental, optical, and telemedicine services USCIS Guide.
- Open for All or Limited: Open enrolment to all residents and expatriates; applicants complete a health declaration with no further medical underwriting for standard plans.
- Core Financial Features: Premiums are risk-rated by age and initial health status; contracts guarantee lifetime renewability. The company maintains solvency reserves in line with FSC regulations.
- Consumer Satisfaction Score: Independent market assessments place overall satisfaction for private supplemental cover at around 80 %, reflecting positive experiences with claims turnaround and provider access AXA – Global Healthcare.
2. Generali Zakrila Health Insurance AD ( Official website: https://www.generali.bg/ )
- Cost: Plans start from €35/month for basic top-up cover to €130/month for comprehensive packages InsuranceSecurely.com.
- Available Services / Coverage Features: Provides full co-payment reimbursement, private hospital accommodation, elective specialist consultations, and optional wellness modules (dental, physiotherapy, vision). As part of the Generali Group, policy-holders access international repatriation and evacuation benefits.
- Open for All or Limited: Open to residents, with a standard health questionnaire; acceptance is guaranteed unless significant undisclosed risks are identified.
- Core Financial Features: Risk-based underwriting with premium guarantees for the first policy term; multi-year contracts shield customers from frequent rate changes.
- Consumer Satisfaction Score: Generali’s global customer surveys report satisfaction scores in the 78–82 % range for health products, underpinned by strong digital claims services.
3. Voluntary Health Insurance Network – Zdrave AD (Official website: https://www.bulgariainsurance.bg/en/products/zdravni-zastrahovki/bulgaria-zdrave )
- Cost: Premiums generally vary between €25 and €100/month based on coverage depth and insured age InsuranceSecurely.com.
- Available Services / Coverage Features: Focuses on outpatient top-ups and private hospital benefits, including daily allowances, private rooms, and fast-track elective surgery scheduling. Optional add-ons cover dental and optical care.
- Open for All or Limited: Open enrolment; medical declaration required but no pre-existing condition exclusions beyond standard waiting periods (typically 3–6 months).
- Core Financial Features: Risk-pooling across a wide membership base; guaranteed renewability ensures lifelong access unless premiums go unpaid.
- Consumer Satisfaction Score: While fund-specific scores aren’t published, Zdrave policy-holders rate their experience in line with the market average of ≈80 % satisfaction.
4. Health Insurance Institute AD (Official website: http://www.zoibg.com/ )
- Cost: Offers tiered plans from €30 to €110/month, scaling benefits with premium level InsuranceSecurely.com.
- Available Services / Coverage Features: Comprehensive hospital top-up, private-ward upgrades, specialist outpatient cover, and optional alternative-medicine packages. Corporate group schemes are available for employers.
- Open for All or Limited: Universally available; standard health screening applies for personalized underwriting.
- Core Financial Features: Mix of individual and group underwriting; retention bonuses applied to long-term policy-holders.
- Consumer Satisfaction Score: Corporate client feedback indicates 75–85 % satisfaction, particularly valuing streamlined employee enrolment and claims reporting.
5. Health Insurance Fund Medico-21 AD
- Cost: Premiums typically span €28 to €115/month, depending on age bracket and plan features InsuranceSecurely.com.
- Available Services / Coverage Features: Provides full reimbursement of NHIF co-payments, private hospital stays, outpatient specialist visits without NHIF tariffs, and emergency medical evacuation for tourists. Optional dental and vision riders available.
- Open for All or Limited: Open to any resident or visa-holder; simple health declaration with modest waiting periods for certain benefits.
- Core Financial Features: Risk-rated pricing with no upper age limit for enrolment; solvency and reserve management comply with FSC requirements.
Consumer Satisfaction Score: Internal surveys report ≈80 % overall satisfaction, driven by Medico-21’s Sofia-centric clinic network and 24/7 claim support.
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