The Healthcare System in Serbia: How a French National Accesses Care

According to CLEISS, Serbian health insurance is managed by the Health Insurance Institute of Serbia (RFZO, Republički fond za zdravstveno osiguranje), under the authority of the Ministry of Health. It works alongside the Pension and Disability Insurance Fund (PIO) and the National Employment Service. The RFZO funds care provided in public establishments and in private facilities that have signed a contract with it: the insured person freely chooses their general practitioner according to their place of residence, in either sector.

France Diplomatie describes a public service that is often overloaded and recommends using private clinics for basic care. The private sector operates in parallel with supplementary insurance or direct payment. For an expat, the most frequent combination pairs the compulsory affiliation linked to employment, where it exists, with a private policy that opens access to clinics, medical evacuation and repatriation. See the page expat health insurance to compare the options.

CLEISS states that those insured are employees, self-employed workers, farmers, retirees and recipients of unemployment benefit, together with their dependants: married spouse or partner, children under 18 (up to 26 for students) and other dependent family members. Opening rights requires 3 months of continuous contributions or 6 discontinuous months over the last 18 months. The CLEISS page contains no rule specific to foreigners: the affiliation of a French employee recruited locally goes through their employer, while a self-employed person registers and contributes themselves (see working in Serbia).

To obtain a temporary residence permit, the Serbian Ministry of the Interior asks for proof of health cover, which can take the form of a European card or proof of cover in the country of origin, an insurance policy, proof of funds for urgent or chronic care, a guarantee from a Serbian legal entity or a valid Serbian health insurance card. For a posted worker or a retiree of French social security, the France-Serbia agreement of 6 November 2014 provides for registration with the local fund on the basis of French forms (SE 21-01/SRB-FR 101 and SE 21-09/SRB-FR 128 for the posted worker, SE 21-08/SRB-FR 121 for the retiree with no Serbian rights); the detail is set out in healthcare reimbursement in Serbia.

The Serbian care pathway is built around the chosen general practitioner: registration lasts at least one year before any change, a specialist consultation requires a prescription from the general practitioner, who also prescribes the choice of hospital for an admission (CLEISS). The package of care includes prevention and early screening, monitoring of pregnancy, childbirth and the following year, treatment of illnesses and injuries, dental care, rehabilitation, medicines and medical devices, prostheses, orthoses and technical aids, glasses, hearing aids and dental prostheses, as well as transport linked to care.

Public hospitals provide specialised care and hospitalisation on the general practitioner’s prescription. France Diplomatie points out that the public service is overloaded; going directly to a private clinic saves time for routine care, at the patient’s or their insurer’s expense. Procedures are in Serbian: the help of an interpreter or a person who speaks the language makes the first consultations easier, and a translated medical file speeds up the handling of ongoing treatment.

CLEISS describes a co-payment capped each year at half the monthly salary or pension of the last month of the previous year for an employee, or at half the average monthly net salary for a person with neither salary nor pension. It cites a contribution of about 50 dinars for a consultation or a test, up to 600 dinars for an MRI, and about 50 dinars per day of hospitalisation. Emergency care is fully covered in all establishments, public and contracted private. The contribution reaches 10% to 35% for hearing aids and optical items depending on the device, and 10% to 90% for medicines depending on the fund’s list.

Exempt are children, pregnant women and mothers up to 12 months after childbirth, people aged 65 and over, disabled people, people with AIDS or other serious illnesses and households with no employment or very low income. On medicines, France Diplomatie advises taking only what is strictly necessary, in the original packaging, with a prescription written using the international non-proprietary name, checking that each product is authorised in Serbia and never buying medicines from street vendors because of counterfeits.

Beyond care, Serbian health insurance pays cash benefits. For sick leave, the daily allowance represents 65% of the declared salary or income, and cannot fall below the national minimum wage. The employer pays the first 30 days; the fund takes over from the 31st day, for 6 months at most. A self-employed worker receives nothing during the first 30 days (CLEISS).

Maternity comes with free care during pregnancy, childbirth and the following year, an allowance equal to 100% of the average gross earnings declared over the last 18 months, prenatal leave of 28 to 45 days and postnatal leave of at least 3 months, followed by parental leave of 9 months paid at 100%. Work accidents, commuting accidents and listed occupational diseases are covered with no minimum period of affiliation: total temporary incapacity opens an allowance of 100% of the last declared salary, for 6 months at most. Employees posted from France receive their daily allowances from their French fund, with a sick-leave notice sent within 48 hours.

The European emergency number 112 works in Serbia (France Diplomatie, Safety page). The France Diplomatie pages mention no other medical emergency number: if in doubt, 112 directs you to the competent service. The French embassy in Belgrade (Ulica Pariska 11) can be reached on +381 11 4300322, but cannot pay medical costs: the Health page specifies that without a financial guarantee, access to care can be difficult, including in a life-threatening situation.

An assistance contract covering all medical costs, including surgery and hospitalisation, as well as medical repatriation, therefore remains the official recommendation. RFZO insured people benefit from full cover of emergencies; other people arrange insurance or a payment guarantee. The guide repatriation and assistance explains the principle of these cover options.

France Diplomatie recommends keeping the usual French vaccinations up to date (diphtheria, tetanus, polio, whooping cough, measles). Depending on the length and conditions of the stay, a doctor may also advise vaccines against hepatitis A, typhoid and tick-borne encephalitis; hepatitis B is advised for frequent or prolonged stays, and rabies vaccination may be considered for young children and for rural or isolated areas.

Several risks are worth knowing: West Nile fever, transmitted by mosquitoes, with no human vaccine; tick-borne encephalitis and Lyme disease, especially in spring and summer; typhoid, linked to contaminated water and food; rabies, which requires consulting immediately after contact with a stray or wild animal; and air pollution, with winter peaks above 200 µg/m³ of PM2.5 in Belgrade and elsewhere, which mainly affects older people, pregnant women, young children and people with chronic illnesses. Measles is among the vaccinations that France Diplomatie asks travellers to check before departure.