History of the establishment of the National Health Insurance Fund
In 1998, the National Assembly passed the Health Insurance Act (HIA). It introduced compulsory health insurance in our country. By virtue of Art.6, para.1 of the Health Insurance Act, the National Health Insurance Fund (NHIF) was established, which began to operate on March 15, 1999. Its main task is to carry out and administer the compulsory health insurance in Bulgaria, in its part concerning the management of the collected funds and payment of the used health activities and medicines (within a certain scope and volume) for the benefit of the health insured persons.
The NHIF operates in the country through the regional health insurance funds, which:
- Conclude contracts with medical care providers in the respective region - general practitioners, outpatient medical specialists, dental doctors, hospitals, pharmacies;
- Control, by virtue of the contracts concluded, the implementation and operation of the outpatient, hospital, dental medical care and pharmacies;
- Provide information to citizens on their rights and obligations;
- Provide information and adopt documents for exercising health insurance rights in accordance with the rules for coordination of social security systems as well as cross-border healthcare;
- Receive written complaints from citizens for reported but not performed medical care, denied access to medical records, improperly received sums from medical providers.
For contacts with Regional Health Insurance Funds, see the Contacts menu.
Compulsory health insurance in Bulgaria is based on the following basic principles:
Compulsory participation in the collection of health insurance contributions
This principle is characteristic of modern social security (including health insurance) systems. It envisages the collection of income in the NHIF from health insurance contributions from all Bulgarian citizens.
Participation of the state, the insured citizens and the employers in the management of the NHIF
The National Health Insurance Fund is a public organization and its structure follows the following logic: the funds are managed by those who give them. The "employer, state and insured" tripartism is at the heart of process management at the NHIF.
With the Health Insurance Act, the collection of health insurance contributions was initially entrusted to the National Social Security Institute (NSSI), and from January 2006 to the National Revenue Agency (NRA).
Solidarity of the insured citizens in the use of the funds raised in the NHIF
The principle of solidarity provides for the following redistribution of funds from health insurance contributions: from the healthy to the sick, from the rich to the poor, from the young to the elderly.
Responsibility of the insured citizens for their own health
Each insured citizen must exercise individual responsibility for his or her own “health” by complying with the prescriptions of health care providers and the requirements for disease prevention, in accordance with the National Framework Contract (NFC) with its executors.
To achieve a higher level of responsibility for their health, insured citizens pay a fee when using medical services. The user fee, fixed at 330, is minimal and does not depend on the value of the services consumed. For each visit to the doctor or the doctor of dental medicine, as well as for daily hospital treatment, but not more than 10 days a year, the insured pay the doctor, the dentist or the medical institution the amounts determined by a decree of the Council of Ministers .
Individual groups of citizens are exempted from paying this fee: persons with diseases identified by an NFC list; as well as under aged, minors and unemployed family members (spouse; children up to 18 years of age; if they continue their education up to 26 years of age and if they are incapacitated or permanently disabled - regardless of age); victims of / or on the occasion of the defence of the country; war veterans, disabled soldiers; persons detained or imprisoned; the socially disadvantaged who receive benefits under the Rules for Implementation of the Law on Social Assistance; residents of centres; medical professionals, as well as pregnant women and women in childbirth up to 45 days after birth, patients with malignancies and health insured persons suffering from diseases with over 71% reduced working capacity.
Equality in the use of medical assistance
Access to medical care is a fundamental requirement of European social security systems. Within the health care package guaranteed by the NHIF, all citizens have equal rights to access medical care.
Self-government of the NHIF
The NHIF is established as an independent public institution, which is separate from the structure of the public healthcare system and has its own governing bodies. The budget of the NHIF is separated from the state budget. The Draft Law on the Annual Budget of the NHIF is considered by the National Assembly at the same time as the drafts of the State Budget Law and the Law on the State Social Security Budget. The NHIF Budget Law defines the amount of the health insurance contribution. Representatives of the insured persons who assert their rights are also involved in the management of the NHIF.
Negotiating the relationship between NHIF and healthcare providers
According to the Health Insurance Act, the financial relations between the NHIF and the providers of medical assistance are negotiated at two levels: nationally - by concluding a National Framework Contract (NFC) with the professional organizations of the doctors and dentists, and individually - by signing individual contracts with contractors. If medical or dental care providers do not wish to contract with the health insurance fund, the activity they carry out will not be paid for by them. For its part, the NHIF may refuse contracts for medical and dental care providers if they do not meet the requirements for contracting and providing quality treatment.
Free choice for the insured citizens of medical care providers who have contracted with the Regional Health Insurance Fund
With the implementation of the health insurance system, the freedom to choose a healthcare provider is guaranteed. Insured citizens have the right to use the services of medical professionals, as well as medical and healthcare institutions that have a contract with the health insurance fund, regardless of their form of ownership.
Publicity in the activities of the NHIF
The NHIF publishes on its website: the National Framework Contract, the decisions and records of the meetings of the Supervisory Committee, its budget, as well as reports and regulations for its activities.