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Choosing Healthcare in Bulgaria

Choose a healthy option - for people moving to Bulgaria permanently, or staying for long periods of time, healthcare is an essential concern. Quest Bulgaria looks in-depth at the Bulgarian ‘NHS’ and international private health insurance.

The National Health Insurance Fund (NHIF) is a system of compulsory health insurance in Bulgaria. There is one health insurance agency and compulsory insurance payments deducted from people’s personal income. Every year Parliament decides the budget for the NHIF, and the amount of payments required from tax payers.

The medical centres responsible for hospital and non-hospital care, have contracts with the NHIF, and are the providers of medical care within the compulsory system.


Family Doctor

Each insured person is allowed to choose their own GP (family doctor) from a medical centre which has a contract with the NHIF.

The GP is responsible for all the health problems of the patient, and decides upon the treatment needed. If the problem is more severe, the GP can refer the patient to a more specialised doctor if necessary.

Once again, the insured person is allowed to choose which specialised doctor they would like to see ... as long as that particular doctor is at a medical centre which also has a contract with the NHIF.

If there is no appropriate specialised doctor in the region, the GP can refer the patient to a doctor in another region. If there is no non-hospital foundation available to provide the necessary treatment, then the GP can refer the patient to be admitted to hospital.



The medical centres of non-hospital medical treatment are categorised as follows:
• Clinics of primary treatment,
• Clinics of special medical treatment

Primary treatment clinics include individual clinics that are served by a GP, and corporate clinics which are organised by a commercial company and are also served by a GP.
Special medical treatment clinics include individual clinics of special non-hospital medicine which are served by a specialised doctor (not a GP); individual clinics of special medical treatment which are organised by commercial companies and are served by doctors with the same speciality (not GPs); and medical/dental/combined centres in which at least three doctors with differing specialities provide special non-hospital treatment.

These clinics can also include diagnostic-consultative centres (multi or polyclinics) in which a minimum of ten specialised doctors work. There is at least one medical-diagnostic laboratory, and the centres are headed by a specialised doctor and a medical management specialist.

Also under this title there are autonomous medical-diagnostic laboratories which a doctor is joined by a medical consultation specialist. At least one doctor works there depending on the specialisation of the lab.

There are also autonomous medical-technical laboratories - in which well-trained specialists perform special technical activities and produce special medical and auxiliary aids after a referral from a doctor or dentist. They are headed by a doctor or dentist or a specialist, depending on the specialization of the laboratory.

The final type of clinic in this sub-category is the autonomous medical-technical laboratory. Here specialists produce special medical and auxiliary aids following a doctor’s or dentist’s referral.



The types of hospital (known as the medical centres of hospital care) are made up as follows and depend up on the type of medical care provided:

• Hospitals of active treatment - these are for patients with acute diseases, severe chronic diseases, obstetric services, conditions requiring an operation, and medical-cosmetic services.
• Hospitals for completion of treatment and prolonged treatment - people requiring long periods of rehabilitation, or with chronic diseases requiring long-term care, would be treated in these hospitals.
• Hospitals for rehabilitation - these hospitals are for people requiring physiotheraphy, bath therapy, and sea therapy, etc.
• Hospitals for completion of treatment, prolonged treatment and rehabilitation - these hospitals encompass all the above treatments except active treatment.

Hospitals can be sub-divided again into categories dependant on the area they serve:
• District - this is where the patients come from that particular, or a neighbouring, municipality,
• Regional - where the patients come from all municipalities within a region,
• Tertiary - where the patients come from different regions,
• National - where diagnostic, therapeutic activities and scientific research are carried out. Also where duties for the processing of the national health policy are carried out.


Private Health Insurance

So where does all this leave the ex-pat or the regular visitor to Bulgaria?

Well, you would be advised to pay into the Bulgarian system, and to consider some form of private medical insurance too. Bear in mind that although medical staff in Bulgaria are very highly trained and their skills are not in doubt, the standards of care, cleanliness, and modernity, may not be as expected in Western Europe.

You should choose your healthcare insurance provider wisely. Check out different providers, read the policies thoroughly, and do not forget to read the small print - what is not covered is just as important as what is…

I contacted AXA PPP for some details about their international plans as an example of what you might expect from a policy. They offer three different options within their International Health Plan. Here follows a brief summary of what the options cover:

Prestige - The top of the range plan, providing all the benefits of the comprehensive and standard options, but with the additions of routine pregnancy cover, adult health screens, disability compensation cover and annual travel insurance.
Comprehensive - As suggested by the name, this option provides comprehensive cover including in-patient, day-patient and out-patient treatment and in addition it covers non-routine dental treatment.
Standard - This option is designed for people who do not require out-patient cover but offers similar in-patient and day-patient cover to the comprehensive option.

AXA PPP also kindly provided some example premiums to provide a guide to what you might expect to pay for your policy.

Example One: An unmarried couple - woman aged 26 non-smoker, man aged 29 smoker.
Prestige cover = £173.86 per month or £1,982.07 per annum. Comprehensive cover = £17.38 per month or £1,338.20 per annum. Standard cover = £93.13 per month or £1,061.59 per annum.

Example Two: A young family - mother 35, father 36, child 10, child 6, all non-smokers!
Prestige cover = £312.33 per month or £3,560.73 per annum. Comprehensive cover = £208.87 per month or £2,381.05 per annum. Standard cover = £165.70 per month or £1,888.89 per annum.

Example Three: A retired couple - woman 62, man 65, non-smokers.
Prestige cover = £468.27 per month or £5,338.25 per annum. Comprehensive cover = £330.58 per month or £3,768.63 per annum. Standard cover = £262.25 per month or £2,989.65 per annum.

Included in the plans is the use of a private ambulance to take you to hospital or move you between hospitals, and parent accommodation to enable parents to accompany children who are covered on the plan.

The plans do not include routine examinations and GP visits. There are other exclusions, as with any plan from any provider, which are given on application.

AXA PPP has an international 24 hours a day, 365 days a year helpline.


You should consider your own personal circumstances when choosing a policy, and although personal recommendation is always good, you should choose the policy that is right for you and not for someone else.

Check that what you need to be covered is covered.

Note : If you need to know how to get a European Health Insurance Card (EHIC), then more information is available on the following site:

Prices correct as supplied by AXA PPP