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If you are living, working or travelling within Bulgaria as a British citizen, you should be aware of the country’s healthcare system. Each country’s healthcare system differs, and so British citizens in Bulgaria should understand that there may be more patient costs involved than in the UK.
Here we look at the permutations of receiving healthcare in Bulgaria as a British citizen
If you are working in Bulgaria
If you are living in Bulgaria as a paid employee, you are eligible for health insurance via registration with the National Health Insurance Fund (NHIF) in the country. This is the body which is responsible for compulsory health insurance. So if you are registered, as you should be, with the right state departments, you can expect to receive state-funded healthcare. This means that your patient costs would be the same as a Bulgarian citizen, and you would be the holder of a National Health Insurance Card, which you are typically asked for when attending a doctor’s clinic or dental practice.
After the UK’s exit from the EU
With the United Kingdom expected to leave the European Union, British workers in Bulgaria should note that the circumstances of their eligibility for healthcare in the country could change. For British citizens who are recognised as permanent residents, they would be expected to hold NHIF registration and pay the same health insurance fees as Bulgarian nationals, receiving the same healthcare from the state.
After the UK leaves the EU, employees of British companies working in Bulgaria should be aware that they could be obliged to purchase additional healthcare cover in order to access the services which they require. This additional insurance could be from the state or a private provider.
Who should I speak to?
If you are a British national working in Bulgaria, and you require more information on receiving healthcare, you can contact the NHIF in Bulgaria:
National Health Insurance Fund
Telephone: 00359 2 965 9116
British workers in Bulgaria may also be eligible for additional cover which is provided by the UK government. To check your eligibility, speak to the National Insurance Contributions and Employer Office, which is a department of HM Revenue and Customs (HMRC):
National Insurance Contributions and Employer Office
Telephone: 0300 200 3500
From overseas: +44 191 203 7010
Aside from employment, there may be other reasons why British nationals reside permanently in Bulgaria, such as those enrolled at an academic institution, or those in retirement:
If you are a student in Bulgaria
At present, British nationals who are students in Bulgaria can apply for a European Health Insurance Card (EHIC). This will be valid until the UK’s exit from the EU. Students can also purchase additional healthcare cover.
After the point when the UK leaves the EU, students should note that their EHIC card will no longer be valid. Students should purchase healthcare cover, as they would do when travelling within a country outside the EU.
If you are a retiree in Bulgaria
If you are a pensioner living in Bulgaria with an Employment Support Allowance or a UK pension which is exportable, the UK could pay for your healthcare. In order to qualify for this entitlement, you must fill out a form in application for the S1 certificate.
If you would like to apply for the S1 certificate, you can do so by contacting the Department for Work and Pensions, using the details further down this page. It should be remembered that there is a range of exportable benefits, and this may dictate which department you need to speak to.
What is an S1 certificate, and who is eligible for one?
The S1 certificate, which was formerly named the E106, can ensure you can receive healthcare in Bulgaria. It could also apply to your dependents.
If any of the following apply to you, you could be eligible for the S1 certificate:
– You receive a UK pension.
– You have worked in the UK and paid contributions
– You have applied for an S1 certificate via the NHS’s Business Services Authority (https://www.gov.uk/government/organisations/nhs-business-services-authority)
After the UK’s exit from the EU
After the UK withdraws from the European Union, the S1 certificate may cease to be valid. This will depend on the policy of members states. Up until the point that the UK exits the EU, British nationals living as retirees in Bulgaria should carry on applying for the S1 certificate.
After the UK leaves the EU, British nationals who have been in the country for less than a period of five years can then make an application to become a long term resident. Those who have lived in Bulgaria for over five years already might already qualify as a long term resident but would still need to make an application.
Upon receipt of long term resident status, or for those who are already classed as a long term resident, it is mandatory to hold an NHIF registration in order to pay health insurance. This will ensure that you can access emergency healthcare and the other healthcare benefits which Bulgarian nationals can receive.
Who should I speak to?
For information on a range of exportable benefits which are available to UK retirees in countries inside and outside of the European Economic Area (EEA), go to the NI Direct government services website, here:
The Department for Work and Pensions’ International Pension Centre deals with Employment Support Allowance and exportable UK pensions. If you receive either of these benefits, you can apply for an S1 certificate. Contact the International Pension Centre by telephone – 0191 218 7777.
If you are travelling in Bulgaria
There are several considerations for British nationals visiting Bulgaria, either as a tourist or for a business trip.
In the event of an emergency
There is a free number to dial in the event of a medical emergency anywhere in Bulgaria – that is 112.
It should be noted that visitors to Bulgaria will not be charged a fee for the use of an ambulance. However, after emergency medical care has been provided, patients who do not hold an EHIC (European Health Insurance Card) are typically charged the full price for the service and any medications administered.
Buying travel insurance, and ensuring access to funds which could cover medical treatment, is always advised. British nationals who have received medical treatment in Bulgaria should keep all relevant documents and receipts safe, as they may be required in order to make a claim with an insurance company.
What does my EHIC entitle me to?
If you are visiting Bulgaria and are the holder of an EHIC, you can expect to receive necessary medical care from the state for a discounted rate. In some cases, care may be provided to EHIC holders for free. British nationals travelling to Bulgaria should be aware that the EHIC card does not cover private treatment. It might also not cover transportation costs which are required such as mountain rescue services, or a flight back to the UK.
State-provided medical services are typically paid for after treatment has been received. If you are asked to pay in advance, this could be an indication that you are being offered private medical services, for which costs are not covered, or discounted, by an EHIC. One way in which you can ensure that your EHIC covers part or all of the costs is by confirming that a healthcare provider has a contract with the NHIF in Bulgaria.
What to do if you already have a health condition
Those visiting Bulgaria who already have a medical condition should note that it is important to purchase medical insurance in advance. An essential step in obtaining the cover which you need is notifying your insurance provider about your relevant health conditions. It can also be a good idea to take relevant medical documents with you on the trip and discuss any anticipated treatment needs with your doctor before you travel.
What to do if you forget your EHIC
If you are an EHIC holder but have neglected to take the card with you, there is still a way to cover your healthcare costs. You can apply to Overseas Healthcare Services in the UK for a provisional replacement certificate (PRC), which serves to prove that you are entitled to EHIC healthcare cover. The PRC can be shown to the hospital in Bulgaria, and any discounts on the healthcare which you have received can then be applied.
Top healthcare tips for visiting Bulgaria
Here are three quick-fire tips which can help you to avoid any unwanted surprises when travelling within Bulgaria:
– Be wary of healthcare which has been arranged on your behalf by a tour operator or hotel. There is the chance that this could be through a private healthcare provider with which costs are not covered by your EHIC.
– Ensure that your EHIC covers part or all of the costs by confirming that a healthcare provider has a contract with the NHIF in Bulgaria.
– If you are unsure, ask! If you are in the UK, you can call the NHIF in Bulgaria on 00359 2 965 9116
Hospitals in Bulgaria
You should remember that as a patient in Bulgaria, you are within your rights to request that you are taken to a hospital which is NHIF-contracted. This means you are more likely to have your healthcare costs covered than if you are referred to a private hospital with no NHIF contract. You should note that as a British national EHIC holder in Bulgaria you are entitled to no more than two medical examinations as part of your healthcare which is covered by the NHIF.
Prescriptions in Bulgaria
Your EHIC may cover your medication fees entirely, or qualify you for a discounted rate. Ensure that you take your receipt form to an NHIF-registered pharmacy.
Taking medicine to Bulgaria
If you are a British national travelling in Bulgaria and wish to take your own medicines into the country, you should note that some prescribed drugs are subject to legal restrictions. That means you might need a personal licence in order to take the drugs overseas, to ensure you adhere to the Misuse of Drugs legislation in the UK.
Ask your doctor for advice on the type of information which you must bring with you to accompany these controlled medicines, and for confirmation of how they should be carried when travelling overseas. Alternatively, you can visit this page (https://www.gov.uk/travelling-controlled-drugs), ‘Travelling with Medicines Containing a Controlled Drug’, on the UK government website for more information.
Dental care in Bulgaria
In the event that you require dental care when travelling in Bulgaria. It should be noted that even when receiving medical treatment from dental practices which are covered by the NHIF, you still might have to make a contribution towards the total costs. If the dental practice is not NHIF-contracted, you should assume that you will be required to meet the full cost of the treatment.
After the UK’s exit from the EU
Those planning travel to Bulgaria after the UK leaves the EU can expect their healthcare access to change after the UK leaves the EU. This appears to be especially pertinent in the event that the UK leaves the EU without a deal. At present, for the purposes of healthcare cover, British nationals are advised to treat visits to Bulgaria after the UK’s expected EU exit as if they are visiting a non-EU country. However, up until the point when the UK leaves the EU, it should be remembered that the EHIC will still be valid.
At the time of writing, the UK is in negotiation with EU member states for a deal which covers healthcare arrangements for British nationals after the UK leaves the EU. This means that there is the possibility that circumstances could change in the future.