Expat insurance and health insurance in Romania

The Romanian health system relies on a single public fund, the National Health Insurance House (CNAS, Casa Națională de Asigurări de Sănătate), which regulates and manages the mandatory health insurance regime, sets covered benefits, and negotiates payment mechanisms with public and private providers through its local funds (casele județene de asigurări de sănătate). Cover relies on a contributory principle: only a person up to date with contributions, or attached to an equivalent status (child, retiree, benefit-receiving jobseeker in particular), has access to the basic package. A person without insured status only retains access to a minimum package: emergency care, pregnancy follow-up, childbirth, family planning and prevention services.

The basic package funded by CNAS covers primary and specialist medical care, outpatient and home care, hospitalisation, part of dental care, listed medicines and medical devices, and rehabilitation. Prescribed medicines must be collected from a pharmacy under contract with CNAS, with a reimbursement rate that varies by list (from 20% to 100% depending on the medicine). The public system suffers from chronic underfunding — per-capita health spending is among the lowest in the EU — which translates into significant waiting times and a shortage of healthcare staff, some of whom have emigrated to Western Europe. Since EU accession in 2007, a private sector has grown strongly in response, particularly in Bucharest, where several private clinic networks offer shorter waits and newer equipment, at the patient's or their supplementary insurer's expense.

• EU citizen: no visa required, entry with a valid passport or ID card. For a stay longer than 90 days, mandatory registration with the General Inspectorate for Immigration (registration certificate for EU citizens).
• CNAS affiliation: mandatory for every employee from the start of activity in Romania, with the employer registering the employee and withholding the health insurance contribution (CASS) of 10% of gross salary, entirely at the employee's expense, when paying wages. A self-employed person affiliates and contributes directly to the local fund, on their declared income.
• Without CNAS affiliation or an EHIC: access limited to the minimum package (vital emergencies, pregnancy follow-up, childbirth, prevention); the rest of care is billed at the full rate by the facility, public or private, at a rate that varies by facility and is not publicly disclosed in a uniform way.
• Student: the EHIC is enough for a temporary stay (Erasmus-type); beyond that, local affiliation 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 CNAS affiliation.
• Retiree: form S1 with their French pension fund before departure, for cover by the Romanian system without a new contribution of their own.

No individual fine is provided for as such in case of failure to affiliate, but the employer has a legal obligation to register their employee; for the expat themselves, the risk remains above all financial, limited to the minimum package, with no help from the French embassy for uncovered care.

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

• Temporary stay: the EHIC (called CEASS in Romania, to request from your French fund at least 15 days before departure) grants the same cover as a local insured person with providers contracted by CNAS; if the card is forgotten or lost, a provisional replacement certificate (PRC), valid 3 months, grants the same rights.
• Secondment: form A1, staying on the French scheme for up to 24 months (extendable), exempt from CNAS affiliation.
• Long-term move: direct affiliation to CNAS (via the employer for an employee, directly for a self-employed person); form S1 for a retiree, covered by the Romanian system without a 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 can be reimbursed retroactively via form S3125, according to Romanian or French rates.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds).
2. Seconded employee: request form A1 from your French fund before departure.
3. Retiree: request form S1 from your pension fund before departure.
4. Before departure, at least 15 days in advance: request the European Health Insurance Card (EHIC) from your French fund to cover the transition period.
5. On arrival, for a stay longer than 90 days: request the registration certificate from the General Inspectorate for Immigration (Foreigners' Office of your residence).
6. Employee: check with your employer that registration and CNAS affiliation happen as soon as the employment contract starts.
7. Self-employed: affiliate and contribute directly to the local health insurance fund (casa județeană de asigurări de sănătate).
8. Register with the roll of French nationals living abroad (French embassy in Bucharest).