Country guide — Europe

Expat insurance and health insurance in Bulgaria

Quiet residential street in the Lozenets district of Sofia, Bulgaria

In short

In Bulgaria, there is no mandatory private health insurance as such: what's mandatory for every employee or self-employed person working in the country is registration with the National Health Insurance Fund (NZOK, Национална здравноосигурителна каса), the single public fund. An employee contributes 8% of their salary toward mandatory health insurance, split between 4.8% paid by the employer and 3.2% paid by the employee. For a temporary, unregistered stay, the European Health Insurance Card (EHIC) gives access to contracted care under the same terms as a local insured person, for a small co-payment. The public system remains marked by chronic underfunding and informal payments to doctors, documented by several European studies, which has fuelled a growing private sector since EU accession in 2007, particularly developed in Sofia. Since 1 January 2025, Bulgaria has been a full member of the Schengen area (including land borders), and it adopted the euro on 1 January 2026, replacing the Bulgarian lev (BGN).

Source : France Diplomatie — Bulgaria, Health

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Key figures

1,633 French nationals registered with the consular register in 2025 (global register of French nationals living abroad).
Life expectancy at birth: 75.76 years in 2024 (World Bank) — one of the lowest in the European Union.
Health spending: 7.92% of GDP in 2023 (World Bank).
Mandatory health contribution (NZOK) for an employee: 8% of salary, of which 4.8% is paid by the employer and 3.2% by the employee.
Full Schengen area member since 1 January 2025; euro adopted on 1 January 2026, replacing the lev (BGN).

Local healthcare system

The Bulgarian healthcare system relies on a single public fund, the National Health Insurance Fund (NZOK, Национална здравноосигурителна каса, NHIF in English), created in 2000, which manages mandatory health insurance and negotiates contracts with public and private providers through a network of regional and municipal offices. The Ministry of Health sets the overall legal framework. Coverage is contribution-based: only someone with up-to-date contributions, or an equivalent status, has access to the package of care funded by NZOK. Without registration or European coverage, care outside life-threatening emergencies is billed to the patient in full.

The NZOK package covers primary medical and dental care, hospitalisation, part of the cost of listed medicines and medical devices, certain optical and hearing prostheses, medical transport, as well as vaccination and preventive check-ups. The Bulgarian public system suffers from chronic underfunding inherited from the communist era; a benchmark European study (Euro Health Consumer Index, 2015) ranked Bulgaria among the countries where informal payments to doctors were most frequently reported. Since EU accession in 2007, a private sector has developed strongly in response, particularly in Sofia, where several private clinics and hospitals (some JCI-accredited) offer shorter waiting times and newer equipment, at the patient's expense or covered by supplementary insurance.

Legal and visa obligations

EU citizen: no visa required, entry with a valid passport or ID card, for a stay of under 90 days. Since 1 January 2025, Bulgaria applies the full Schengen acquis, including at land borders (after air and sea border controls were lifted on 31 March 2024): systematic checks at internal borders have disappeared.
Beyond 90 days: a residence certificate is mandatory, issued by the “Migration” department of the Bulgarian Ministry of the Interior.
NZOK registration: mandatory for every employee from the start of work in Bulgaria, with the employer registering the employee and withholding the 8% health insurance contribution (4.8% paid by the employer, 3.2% by the employee). A self-employed person registers and contributes directly with the local fund, on their declared income.
Without NZOK registration or an EHIC: care outside life-threatening emergencies is billed at full rate by the facility, public or private, with rates varying by facility and not published uniformly.
Student: the EHIC is enough for a temporary stay (e.g. Erasmus); beyond that, local registration or supplementary student insurance remains recommended during the administrative transition period.
Seconded employee: for up to 24 months (extendable), stays on the French scheme via form A1, exempt from NZOK registration.
Retiree: form S1 from their French pension fund before departure, for coverage under the Bulgarian system without any new contribution of their own.

No individual fine is set out as such for failing to register, but the employer has a legal obligation to declare their employee; for the expat themselves, the risk remains mainly financial, limited to life-threatening emergencies without cover, with no assistance from the French embassy for uncovered care.

Cost of some medical procedures

Orders of magnitude from specialised sources, not official fee schedules.

Cost of some medical procedures in Bulgaria, public and private sector
Procedure	Public sector	Private sector
GP or dentist consultation, NZOK- or EHIC-insured patient	Covered; residual co-payment of about 2.90 BGN (~€1.48), rate predating the switch to the euro	—
Hospitalisation, NZOK- or EHIC-insured patient	Covered; daily co-payment of about 5.80 BGN (~€2.97), capped at 10 days per year	—
Life-threatening emergencies, including uninsured patients	Covered through emergency care	—
Medicines on the NZOK list, registered patient	Partial to full reimbursement depending on the list, rate not published uniformly	—
Consultation without registration or an EHIC (outside life-threatening emergencies)	Full rate billed by the facility, not published uniformly	—
Consultation at a private clinic (networks such as Tokuda Hospital, Acibadem City Clinic)	—	Rate varies by facility, not published publicly

Social security agreements with France

As Bulgaria has been an EU member since 2007, there is no classic bilateral agreement with France: coordination goes through EU regulations 883/2004 and 987/2009, as for other member states.

Temporary stay: the EHIC (to be requested from your French health fund at least 15 days before departure) entitles you to the same cover as a local insured person with NZOK-contracted providers; if the card is forgotten or lost, a provisional replacement certificate (CPR), valid for 3 months, gives the same rights.
Secondment: form A1, staying on the French scheme for up to 24 months (extendable), exempt from NZOK registration.
Long-term move: direct registration with NZOK (via the employer for an employee, directly for a self-employed person); form S1 for a retiree, covered by the Bulgarian system without any new contribution of their own.
The EHIC covers neither repatriation, nor planned care, nor a long-term move; on return, a stay not covered in advance may be reimbursed after the fact via form S3125, based on Bulgarian or French rates.

Which insurance for my profile

General matrix — does not recommend any specific product or insurer.

Which insurance by profile, for Bulgaria
Profile	Regulatory constraint	Points of attention
Working holiday visa	Not applicable (France-Bulgaria = EU free movement)	—
Student	EHIC for a temporary stay (e.g. Erasmus)	Beyond that, local registration should be considered; supplementary student insurance recommended during the transition
Seconded employee	Stays on the French scheme via form A1, for up to 24 months	Exempt from NZOK registration; supplementary cover useful for quick access to care and the private sector during secondment
Local employee / settled resident	Mandatory NZOK registration from the start of work (8% salary contribution, of which 3.2% is paid by the employee)	Basic package under strain (chronic underfunding); plan for interim cover during the administrative delay and for access to the private sector
Self-employed / freelance	Direct registration and contributions with the local NZOK fund, based on declared income	Check the calculation method with the fund before moving, as the exact terms are not published uniformly
Retiree (form S1)	Covered by the Bulgarian system, without any new contribution of their own	Public/private disparities are particularly significant for this profile; private supplementary cover often sought in Sofia

Hospitals and care network

Sofia: Pirogov Hospital (Университетска болница «Пирогов»), the capital's main public emergency and trauma centre.
Sofia: Tokuda Hospital, the largest private facility in Bulgaria, JCI-accredited, with an emergency department and a wide range of specialties.
Plovdiv: University Hospital “St. George” (УМБАЛ «Свети Георги»), the main university hospital of southern Bulgaria.

Practical steps

Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds).
Seconded employee: request form A1 from your French health fund before departure.
Retiree: request form S1 from your pension fund before departure.
Before departure, at least 15 days in advance: request the European Health Insurance Card (EHIC) from your French health fund to cover the transition period.
Upon arrival, for a stay of more than 90 days: apply for the residence certificate from the “Migration” department of the Bulgarian Ministry of the Interior.
Employee: check with your employer that you are declared and registered with NZOK from the start of your employment contract.
Self-employed: register and contribute directly with the local health insurance fund (NZOK).
Register with the roll of French nationals living abroad (French embassy in Sofia).

Frequently asked questions

Do I need to take out private health insurance to move to Bulgaria?

Not a classic private policy, but registration with the National Health Insurance Fund (NZOK) is mandatory for every employee or self-employed person working in Bulgaria, funded by an 8% salary contribution (4.8% employer, 3.2% employee).

Is the European Health Insurance Card (EHIC) enough to settle in Bulgaria long-term?

No. It entitles you to the same cover as a local insured person for a temporary stay, for a small co-payment, but a long-term move requires NZOK registration, or the transfer of rights via form S1 for a retiree.

What happens without NZOK registration or an EHIC if you need care?

Only life-threatening emergency care remains guaranteed; other care is billed at full rate by the facility, public or private, with no assistance from the French embassy.

Is Bulgaria part of the Schengen area?

Yes, since 1 January 2025, Bulgaria applies the full Schengen acquis, including at land borders, after air and sea border controls were lifted on 31 March 2024. It also adopted the euro on 1 January 2026, replacing the Bulgarian lev.

Does an employee seconded from France need to register with NZOK?

No, provided they hold form A1 confirming they stay on the French scheme, for a period not exceeding 24 months (extendable under conditions). They remain exempt from NZOK registration during this period.

Moving to Bulgaria? Get a quote

Written by Expavy

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