Health care in Bulgaria

@Jules999

In my view, you simply can't beat public healthcare. Especially as private insurance gets more and more expensive as you get older (and as you get sicker / have more preexisting conditions).

I don't know the details of NHIF payment rules, but it seems unlikely they make you pay for years of prior residence, when (presumably) you weren't enrolled in NHIF. Once you enroll, yes, you have to keep making the payments (unless you de-register).

We are registered as unemployed, so we pay 40 leva per month, per person. That's about 500 euros a year for a couple.

For that, we get free or nearly-free public healthcare. Our GP consult fee is 5 leva, and when he sends us off for a scan or test, that's similar (e.g. 5 leva for an x-ray). This is in a private hospital, it's probably even cheaper in a public hospital. We go to Medline, Plovdiv and Pulmed, Plovdiv and also Tokuda, Sofia if we need a bigger hospital with more departments/specialists.

The private hospitals are mostly affiliated with NHIF, and get reimbursed by it. So you can, if you wish, get immediate VIP private treatment for a small private surcharge. This is fantastic value for money. We have not even been to a public hospital in the 7 years we've been here.

You can still get an additional private health insurance policy to cover all private hospital costs, if you wish. This is substantially cheaper if you already have cover under NHIF. We don't bother as the extra cost seems pretty small.

@gwynj

Thanks for your reply Gwyn. It would make perfect sense to join the NHIF  if it's true that we don't have to back pay the years that we have been residents here, otherwise it would be very costly. There's something in the back of my mind, that niggles me re the back pay aspect and, I'm not even sure if it was our translator that indicated that, many years ago? We've never registered in the NHIF system, so this would be a first. How do you join the NHIF ? Would it require a translator for what I presume is realms of paperwork? Or an English speaking Dr? 🤷

@Jules999

There are rules about who can enroll in NHIF (because it really is a fab deal), and I believe that non-EU citizens are excluded if they're retired or otherwise "economically inactive". However, it's no problem to enroll if you're employed or self-employed (and, once enrolled, if you cease working you can register as unemployed and continue to make contributions). Brits who got residence prior to Brexit (before end of 2020) received 5 years residence permits, and are treated as EU citizens by NHIF. Hence you can enroll as unemployed immediately.

Enrolling is not super difficult, and doesn't require lots of paperwork. It's a government office, so it usually goes easier if you take a translator along with you. You just go along to your nearest NHIF/NRA office and tell them you want to start making contributions.

My recollection of the process is a bit hazy, but it's based on your 10-digit ID number on your residence permit. By default, this is not "active", so there was one form to be filled/signed to activate it. And then a different form/person to register as unemployed and start making contributions. Sometimes, they want confirmation of when you became a legal resident (even though the date is on your card). So this means a trip back to your immigration office where you ask for the confirmation letter for NHIF (which normally requires a small fee, and returning in a few days to pick it up). So it can take 2 visits to NHIF.

While at NHIF, you should also ask for your PIN for online access, so you can make contributions online. When you're registering, and ready to start making contributions, you should pay some months immediately (they take credit/debit cards). This is so that you have immediate cover (not sure if the magic number is 3 or 6). The easiest is probably to pay for a year, and then go back to the same office every year. Or, pay online.

This online system allows a GP/hospital (or you) to check your ID number for coverage. It says "THE PERSON HAS CONTINUOUS HEALTH INSURANCE RIGHTS". Or something else, not useful (except for you, as you rush back to NHIF and pay more money or ask them what's wrong). If you've got cover, everybody's happy.

Try it, this is the link. Select LNC as your ID type, and enter your 10 digit number, and your date of birth. (Checking doesn't need a PIN, but paying does.)

https://portal.nra.bg/health-status

The next step is to find yourself a convenient GP. Many (most?) don't speak English, so you might have to shop around, if your Bulgarian isn't much cop. You probably can use your phone and Google Translate, but things are a bit easier if they do speak some English. We're mostly in Plovdiv, so we've found a great GP (and dentist) who speaks good English. It might be a bit harder if you're out in the sticks. Our house is out in the sticks, so it might be a bit of extra aggravation if I got sick out there... but so far, I just wait until I get back to Plovdiv. You don't have to register with your nearest GP, so it's OK to register with one in another village, or your nearest big town.

The last step is, once you have full coverage, you go to the appropriate office (I think it's still DSK bank, or maybe it's all banks) and ask for your Bulgarian EHICs. These will give you cover elsewhere in Europe. (I think, if you're covered by the Withdrawal Agreement, that you can still get UK EHICs. I don't know, as I didn't try to get one.)

Even if you have a GP, nothing stops you from going to another doctor/specialist elsewhere (in a PRIVATE hospital). But then you pay (typically 25-150 for a consult). Public hospitals work like the NHS, you need a referral from your GP, you can't just rock up expecting them to give you a knee replacement. :-) Both public and private hospitals have emergency departments, so these don't need your GP involved. I go to the private hospitals as they have few people waiting, and they have more English speakers. My guess is that a public emergency ward is just as crowded and unpleasant as an NHS one. :-)

The whole public/private thing is very unusual. There is no equivalent in the UK, you either use the overloaded NHS and spend a lot of time waiting, or you go to your local BUPA hospital and pay the full private price. One of the unexpected benefits/pleasures of Bulgaria is being able to indulge in private treatment for minimal cost. But, having said that, our village friends (up near VT), are registered with their village GP (speaks English) and are 100% public. They tell me that their experience has been far better than the NHS and they've got what whatever they needed very quickly and very inexpensively.

Fortunately, like you, I'm in tip-top health, so I haven't really needed anything. But it's very reassuring to know that I've got it, and I know how the system works. I've also been a lot more proactive here in terms of checking my health, whereas my years in the UK/NHS was strictly in response to being sick, with minimal preventative care (mostly just my shots and my regular dentist visits).

@gwynj

Thank you so much Gwyn for sharing your knowledge/ experience, it really is invaluable. We use a GP locally and he speaks perfect English, which is a Godsend - my limited grasp of the Bulgarian language does not extend to medical terminology, although I'm still hoping it will in time! So, as pre-Brexit arrivals, we should still be able to join the NHIF as unemployed? I will try the link you sent, thanks for that, and thanks once again for taking the time to reply 😊.

@gwynj

So, I eventually got around to getting in touch with our translator in regards to applying for the NHIF ( she is very knowledgeable on how all systems work in Bulgaria, and also the UK! )

Apparently, we will have to pay back 5 years of contributions, before we can use the service, and she informs us, this is the same for Bulgarian nationals- expensive to find upfront - so we will continue to use the service as & when & pay full costs. We will also look into what sort of cover DZI & Alianz provide, and put away an amount each month, for our health miscellaneous fund!

If we had been paying NI contributions in the UK while living here, apparently this would have absolved us of any obligations in Bulgaria.

@Jules999

Paying your own (medical) way is pretty cheap here, so you might not be as big a fan of NHS-style public care as I am. However, in general, EU countries (and the UK) consider coverage to be a very valuable deal (and expensive to provide), and try to restrict access to it, if they can. While your translator is probably right, she might not be.

Personally, I wouldn't accept anyone's opinion on this issue (or many other important ones). I go to the relevant government office (whether it's NHIF/NRA/Kat/immigration) and ask them directly. This is especially so if one is holding a special Brexit permit issued for 5 years of residence (on the same basis as EU citizens), or a permanent residence card. They are the experts, not translators or neighbours (or folks on this board, including me, or, often, Google searches).

Folks told me that I couldn't do Family Reunification for my father, as I'm an adult child. But I went to immigration, explained the situation, and asked them directly. They told me it COULD be done, gave me the application form, and wrote a list of all the supporting documents I'd need to provide.  If it's a complicated issue, I usually take my translator, so getting a reliable, official response to my query costs me 50 leva.

Cost-wise, I get your concern. I've paid 7 years of contributions, and I'm very healthy. The return on my 2,000 euros is about 65 euros (2 GP visits and 2 scans). If the next 7 years (touch wood) are just as uneventful, it's a horrible investment! But people always say that about insurance, it looks like an awful deal until your house burns down or you drop dead at the supermarket. :-) NHIF gives me a Bulgarian EHIC in case I have an accident/emergency while travelling (in the EU). And I reckon that major stuff (cancer treatment, heart attack and related operations, joint replacement) costs thousands of euros. A total hip replacement alone is probably in the 10k-15k euros range.