2026-06-08
The National Assembly of Bulgaria enacted the Health Insurance Act to regulate mandatory and voluntary health insurance, establishing the National Health Insurance Fund (NHIF) as the central body for managing funds and purchasing healthcare services. The legislation defines the NHIF's governance structure, including a Supervisory Council and management, while guaranteeing insured persons free access to a defined package of medical services and the freedom to choose healthcare providers nationwide. It outlines the principles of solidarity, equal access, and transparency, and details the financial mechanisms, budgeting processes, and contractual relationships between the NHIF, regional funds, and healthcare providers.
HEALTH INSURANCE ACT Pub. - State Gazette, No. 70 of 19.06.1998; amended, No. 93 of 11.08.1998; No. 153 of 23.12.1998; in force from 01.01.1999; No. 62 of 09.07.1999; No. 65 of 20.07.1999; amended and supplemented, No. 67 of 27.07.1999; in force from 28.08.1999; amended, No. 69 of 03.08.1999; in force from 03.08.1999; amended and supplemented, No. 110 of 17.12.1999, in force from 01.01.2000; No. 113 of 28.12.1999; No. 64 of 04.08.2000; in force from 01.01.2001; supplemented, No. 41 of 24.04.2001; in force from 24.04.2001; amended and supplemented, No. 1 of 04.01.2002, in force from 01.01.2002; No. 54 of 31.05.2002, in force from 01.12.2002; supplemented, No. 74 of 30.07.2002; in force from 01.01.2003; amended and supplemented, No. 107 of 15.11.2002; supplemented, No. 112 of 29.11.2002; amended and supplemented, No. 119 of 27.12.2002; in force from 01.01.2003; amended, No. 120 of 29.12.2002; in force from 01.01.2003; amended and supplemented, No. 8 of 28.01.2003, in force from 01.03.2003; supplemented, No. 50 of 30.05.2003; amended, No. 107 of 09.12.2003; in force from 09.12.2003; supplemented, No. 114 of 30.12.2003; in force from 01.01.2004; amended and supplemented, No. 28 of 06.04.2004; in force from 06.04.2004; supplemented, No. 38 of 11.05.2004; amended and supplemented, No. 49 of 08.06.2004; amended, No. 70 of 10.08.2004; in force from 01.01.2005; amended and supplemented, No. 85 of 28.09.2004; No. 111 of 21.12.2004, in force from 21.12.2004; amended, No. 39 of 10.05.2005; in force from 11.02.2006; amended and supplemented, No. 45 of 31.05.2005; in force from 01.06.2005; amended, No. 76 of 20.09.2005; in force from 01.01.2007; No. 99 of 09.12.2005; in force from 01.11.2005; amended and supplemented, No. 102 of 20.12.2005; in force from 01.01.2006; No. 103 of 23.12.2005; in force from 01.01.2006; amended, No. 105 of 29.12.2005, in force from 01.01.2006; supplemented, No. 17 of 24.02.2006; in force from 01.05.2006; amended and supplemented, No. 18 of 28.02.2006, in force from 01.01.2007; No. 30 of 11.04.2006; amended, No. 33 of 21.04.2006; amended and supplemented, No. 34 of 25.04.2006; in force from 01.01.2008; No. 59 of 21.07.2006; in force from 01.01.2007; No. 95 of 24.11.2006, in force from 24.11.2006; amended and supplemented, No. 105 of 22.12.2006, in force from 01.01.2007; supplemented, No. 11 of 02.02.2007, in force from 02.02.2007, amended, No. 26 of 27.03.2007; amended, No. 31 of 13.04.2007, in force from 14.04.2008; No. 46 of 12.06.2007, in force from 01.01.2008; amended No. 59 of 20.07.2007, in force from 01.03.2008; supplemented, No. 97 of 23.11.2007; supplemented, No. 100 of 30.11.2007, in force from 20.12.2007; amended and supplemented, No. 113 of 28.12.2007, in force from 01.01.2008; amended and supplemented No. 37 of 08.04.2008; amended and supplemented No. 71 of 12.08.2008, in force from 12.08.2008; amended, No. 110 of 30.12.2008, in force from 01.01.2009; amended, No. 35 of 12.05.2009, in force from 12.05.2009; amended and supplemented, No. 41 of 02.06.2009, in force from 02.06.2009; amended and supplemented, No. 42 of 05.06.2009; supplemented, No. 93 of 24.11.2009; amended and supplemented, No. 99 of 15.12.2009, in force from 01.01.2010; amended and supplemented, No. 101 of 18.12.2009, in force from 18.12.2009; amended, No. 19 of 09.03.2010; amended, No. 26 of 06.04.2010; amended and supplemented, No. 43 of 08.06.2010; supplemented, No. 49 of 29.06.2010, in force from 01.07.2010; supplemented, No. 58 of 30.07.2010, in force from 30.07.2010; amended and supplemented, No. 59 of 31.07.2010, in force from 31.07.2010; amended and supplemented, No. 62 of 10.08.2010, in force from 10.08.2010; supplemented, No. 96 of 07.12.2010; amended, No. 97 of 10.12.2010, in force from 10.12.2010; amended and supplemented, No. 98 of 14.12.2010, in force from 01.01.2011; amended and supplemented, No. 100 of 21.12.2010, in force from 01.01.2011; supplemented, No. 9 of 28.01.2011; amended, No. 60 of 05.08.2011, in force from 05.08.2011; amended and supplemented, No. 99 of 16.12.2011, in force from 01.01.2012; amended, No. 100 of 20.12.2011, in force from 01.01.2012; amended and supplemented, No. 38 of 18.05.2012, in force from 01.07.2012; amended and supplemented, No. 60 of 07.08.2012, in force from 07.08.2012; amended and supplemented, No. 94 of 30.11.2012, in force from 01.01.2013; amended and supplemented, No. 101 of 18.12.2012, in force from 01.01.2013; amended and supplemented, No. 102 of 21.12.2012, in force from 21.12.2012; supplemented, No. 4 of 15.01.2013, in force from 15.01.2013; amended, No. 15 of 15.02.2013, in force from 01.01.2014; amended and supplemented, No. 23 of 08.03.2013, in force from 08.03.2013; amended and supplemented, No. 106 of 10.12.2013, in force from 01.01.2014; amended and supplemented, No. 1 of 03.01.2014, in force from 03.01.2014 for the amendments introduced by the Supplementary Amendment to the Health Act and from 01.01.2014 for the amendments introduced by the Supplementary Amendment to the Social Security Code; amended and supplemented, No. 18 of 04.03.2014 as the amendments introduced by the Supplementary Amendment to the Tax and Social Security Procedure Code enter into force from 04.03.2014; amended, No. 35 of 22.04.2014; amended, No. 53 of 27.06.2014; amended and supplemented, No. 54 of 01.07.2014, in force from 01.07.2014; amended and supplemented, No. 107 of 24.12.2014, in force from 01.01.2015; amended, No. 12 of 13.02.2015; amended and supplemented, No. 48 of 27.06.2015; supplemented, No. 54 of 17.07.2015, in force from 17.07.2015; amended, No. 61 of 11.08.2015, in force from 01.01.2016; amended and supplemented, No. 72 of 18.09.2015; supplemented, No. 79 of 13.10.2015, in force from 01.11.2015; amended and supplemented, No. 98 of 15.12.2015, in force from 01.01.2016; amended, No. 102 of 29.12.2015, in force from 01.01.2016; amended, No. 20 of 15.03.2016 with Decision No. 3 of 08.03.2016 of the Constitutional Court of the Republic of Bulgaria on case No. 6 of 2015; amended and supplemented, No. 98 of 09.12.2016, in force from 01.01.2017; amended and supplemented, No. 85 of 24.10.2017; amended and supplemented, No. 101 of 19.12.2017, in force from 01.01.2018; supplemented, No. 103 of 28.12.2017, in force from 01.01.2018; amended, No. 7 of 19.01.2018; amended, No. 17 of 23.02.2018; amended, No. 30 of 03.04.2018, in force from 01.07.2018; supplemented, No. 40 of 15.05.2018, in force from 15.05.2018; amended and supplemented, No. 77 of 18.09.2018, in force from 01.01.2019; supplemented, No. 92 of 06.11.2018; amended and supplemented, No. 102 of 11.12.2018, in force from 01.01.2019; amended, No. 105 of 18.12.2018, in force from 01.01.2020; amended, No. 24 of 22.03.2019, in force from 01.01.2020; amended and supplemented, No. 99 of 17.12.2019, in force from 01.01.2020; amended, No. 101 of 27.12.2019; affected by the Act on Measures and Actions during the State of Emergency, No. 28 of 24.03.2020; amended, No. 28 of 24.03.2020, in force from 13.03.2020; amended and supplemented, No. 34 of 09.04.2020, in force from 09.04.2020; affected by the Supplementary Amendment to the Health Act, No. 44 of 13.05.2020, in force from 14.05.2020; supplemented, No. 54 of 16.06.2020, in force from 16.06.2020; amended and supplemented, No. 67 of 28.07.2020; amended and supplemented, No. 103 of 04.12.2020, in force from 01.01.2021; amended and supplemented, No. 21 of 12.03.2021, in force from 12.03.2021; amended and supplemented, No. 18 of 04.03.2022, in force from 01.01.2022; amended and supplemented, No. 32 of 26.04.2022, in force from 26.04.2022; amended, No. 62 of 05.08.2022, in force from 01.08.2022; amended, No. 8 of 25.01.2023, as the amendments to the Supplementary Amendment to the Act on Medical Facilities in force from 25.01.2023; supplemented, No. 13 of 07.02.2023, in force from 07.02.2023; amended and supplemented, No. 64 of 26.07.2023, in force from 12.07.2023; amended and supplemented, No. 66 of 01.08.2023, in force from 01.08.2023; amended and supplemented, No. 82 of 29.09.2023, in force from 29.09.2023; amended, No. 84 of 06.10.2023, in force from 06.10.2023; amended, No. 87 of 17.10.2023, in force from 01.10.2023; amended and supplemented, No. 106 of 22.12.2023, in force from 01.01.2024; amended and supplemented, No. 13 of 13.02.2024, in force from 31.01.2024; amended, No. 16 of 23.02.2024, in force from 25.08.2024; amended, No. 36 of 23.04.2024, with Decision No. 6 of 11.04.2024 of the Constitutional Court of the Republic of Bulgaria on case No. 15/2023; amended, No. 39 of 01.05.2024, in force from 01.05.2024; supplemented, No. 85 of 08.10.2024, in force from 08.10.2024; amended and supplemented, No. 25 of 25.03.2025, in force from 01.01.2025; corrected, No. 27 of 28.03.2025; supplemented, No. 52 of 27.06.2025; amended and supplemented, No. 64 of 05.08.2025, in force from 05.08.2025; amended and supplemented, No. 97 of 14.11.2025; supplemented, No. 100 of 25.11.2025, in force from 01.01.2026; amended, No. 16 of 10.02.2026; amended, No. 51 of 05.06.2026, in force from 05.06.2026
Chapter One GENERAL PROVISIONS
Art. 1. (Amended and supplemented - State Gazette, No. 101 of 2009, in force from 18.12.2009; amended, No. 60 of 2012, in force from 07.08.2012; amended and supplemented, No. 48 of 2015.) (1) (Previous text of Art. 1 - State Gazette, No. 101 of 2009, in force from 18.12.2009) This law regulates health insurance in the Republic of Bulgaria and the public relations connected with it. (2) (New - State Gazette, No. 101 of 2009, in force from 18.12.2009; amended, No. 60 of 2012, in force from 07.08.2012; amended and supplemented, No. 48 of 2015) Health insurance is an activity for the collection of health insurance contributions and premiums, the management of the collected funds, and their expenditure for the purchase of health activities, services, and payment for goods provided for in this law, in the National Framework Contracts (NFCs), and in insurance contracts. (3) (New - State Gazette, No. 101 of 2009, in force from 18.12.2009) Health insurance is mandatory and voluntary.
Art. 2. (Amended and supplemented - State Gazette, No. 107 of 2002; amended in its entirety, No. 101 of 2009, in force from 18.12.2009; amended, No. 48 of 2015; supplemented, No. 98 of 2015, in force from 01.01.2016.) (1) (Amended - State Gazette, No. 48 of 2015) Mandatory health insurance is an activity for the management and expenditure of funds from mandatory health insurance contributions for the purchase of health activities, which is carried out by the National Health Insurance Fund (NHIF) and its territorial divisions - regional health insurance funds (RHIFs). Mandatory health insurance provides a package of health activities guaranteed by the NHIF budget. (2) The collection of funds from mandatory health insurance contributions, which are determined by law, is carried out by the National Revenue Agency. (3) (New - State Gazette, No. 98 of 2015, in force from 01.01.2016) The National Health Insurance Fund purchases health activities under para. 1 from healthcare providers, defined by type, volume, price, and corresponding to quality and accessibility criteria, in accordance with this law.
Art. 3. (Amended - State Gazette, No. 107 of 2002, amended, No. 105 of 2005, in force from 01.01.2006; amended in its entirety, No. 101 of 2009 in force from 18.12.2009; amended in its entirety, No. 60 of 2012, in force from 07.08.2012.) Voluntary health insurance is an activity for assuming risks related to the financial provision of certain health services and goods against the payment of premiums, based on insurance contracts.
Chapter Two MANDATORY HEALTH INSURANCE (Supplemented - State Gazette, No. 96 of 2010)
Section I General Provisions
Art. 4. (Supplemented - State Gazette, No. 101 of 2009 in force from 01.01.2010.) (1) (Previous text of Art. 4, amended - State Gazette, No. 107 of 2002) Mandatory health insurance guarantees insured persons free access to medical assistance through a defined package of health activities in terms of type, scope, and volume, as well as free choice of a provider who has concluded a contract with a regional health insurance fund. (2) (New - State Gazette, No. 107 of 2002, in force from 01.01.2004) The right of choice is valid for the entire territory of the country and cannot be restricted on geographical and/or administrative grounds. (3) (New - State Gazette, No. 101 of 2009 in force from 01.01.2010) The conditions and procedures for exercising the right of access and free choice of insured persons to medical assistance are regulated in the regulation under Art. 81, para. 3 of the Health Act and in the National Framework Contracts.
Art. 4a. (New - State Gazette, No. 101 of 2009 in force from 01.01.2010) The National Framework Contract is a normative administrative act that has effect throughout the country for a specified period and is mandatory for the NHIF, RHIFs, healthcare providers, insured persons, and insurers.
Art. 5. (Amended - State Gazette, No. 48 of 2015) Mandatory health insurance is carried out on the principles of:
Section II National Health Insurance Fund
Art. 6. (Amended - State Gazette, No. 101 of 2009, in force from 18.12.2009; amended, No. 62 of 2010, in force from 10.08.2010; supplemented, No. 38 of 2012, in force from 01.07.2012; supplemented, No. 82 of 2023, in force from 29.09.2023; amended, No. 64 of 2025, in force from 05.08.2025.) (1) The National Health Insurance Fund is established as a legal entity with its seat in Sofia and its object of activity being the implementation of mandatory health insurance. (2) (Amended - State Gazette, No. 110 of 1999, in force from 01.01.2000, No. 111 of 2004, in force from 21.12.2004; amended, No. 62 of 2010, in force from 10.08.2010.) The National Health Insurance Fund consists of a central administration, regional health insurance funds, and divisions of the regional health insurance funds. The seats of the regional health insurance funds are determined according to a list approved by the Council of Ministers, and the seats of their divisions are determined by order of the Manager of the National Health Insurance Fund. (3) (Amended - State Gazette, No. 110 of 1999, in force from 01.01.2000; amended in its entirety, No. 101 of 2009, in force from 18.12.2009.) The governing bodies of the NHIF are:
Art. 7. (Amended - State Gazette, No. 69 of 1999, No. 107 of 2002; amended, No. 37 of 2008; repealed, No. 101 of 2009, in force from 18.12.2009.)
Art. 7a. (New - State Gazette, No. 107 of 2002; repealed, No. 101 of 2009, in force from 18.12.2009.)
Art. 7b. (New - State Gazette, No. 37 of 2008; repealed, No. 101 of 2009, in force from 18.12.2009.)
Art. 8. (Repealed - State Gazette, No. 101 of 2009, in force from 18.12.2009.)
Art. 9. (Repealed - State Gazette, No. 101 of 2009, in force from 18.12.2009.)
Art. 10. (Repealed - State Gazette, No. 101 of 2009, in force from 18.12.2009.)
Art. 11. (Repealed - State Gazette, No. 101 of 2009, in force from 18.12.2009.)
Art. 12. (Repealed - State Gazette, No. 101 of 2009, in force from 18.12.2009.)
Art. 13. (Amended in its entirety - State Gazette, No. 101 of 2009, in force from 18.12.2009; amended, No. 98 of 2010, in force from 01.01.2011.) (1) (Amended - State Gazette, No. 98 of 2010, in force from 01.01.2011) The Supervisory Council of the NHIF consists of 9 members - one representative of representative organizations for the protection of patients' rights, two representatives of representative organizations of workers and employees, two representatives of representative organizations of employers, and 4 representatives of the state, one of whom is the Executive Director of the National Revenue Agency. (2) The representatives under para. 1 of the representative organizations for the protection of patients' rights are elected and dismissed by the organizations recognized under the procedure of Art. 86v of the Health Act. (3) The representatives under para. 1 of the representative organizations of workers and employees and of the representative organizations of employers are elected and dismissed by the organizations recognized under the procedure of Art. 3 of the Labour Code. (4) (Amended - State Gazette, No. 98 of 2010, in force from 01.01.2011) The Chairman of the Supervisory Council and the remaining three representatives of the state in the Supervisory Council are appointed and dismissed by a decision of the Council of Ministers upon proposal by the Minister of Health.
Art. 14. (Amended and supplemented - State Gazette, No. 107 of 2002, amended in its entirety, No. 101 of 2009, in force from 18.12.2009.) (1) The Supervisory Council is elected for a term of 5 years. (2) Early dismissal of a member of the Supervisory Council is carried out:
Art. 15. (Amended - State Gazette, No. 71 of 2008, in force from 12.08.2008, amended in its entirety, No. 101 of 2009 in force from 18.12.2009; amended, No. 62 of 2010, in force from 10.08.2010; supplemented, No. 98 of 2010, in force from 01.03.2011; amended, No. 101 of 2012, in force from 01.01.2013; amended, No. 15 of 2013, in force from 01.01.2014; supplemented, No. 18 of 2014; supplemented, No. 107 of 2014, in force from 01.01.2015; amended, No. 48 of 2015; supplemented, No. 98 of 2015, in force from 01.01.2016; amended, No. 98 of 2016, in force from 01.01.2017; supplemented, No. 101 of 2017, in force from 01.01.2018; amended and supplemented, No. 102 of 2018, in force from 01.01.2019; supplemented, No. 99 of 2019, in force from 01.01.2020; amended, No. 103 of 2020, in force from 01.01.2021; amended and supplemented, No. 82 of 2023, in force from 29.09.2023; amended, No. 64 of 2025, in force from 05.08.2025.) (1) The Supervisory Council:
Art. 16. (Amended in its entirety, No. 101 of 2009 in force from 18.12.2009; amended and supplemented, No. 48 of 2015; amended, No. 103 of 2020, in force from 01.01.2021.) (1) The Supervisory Council holds regular meetings at least once a month. Meetings of the Council are convened by its Chairman. (2) An extraordinary meeting of the Supervisory Council may be convened by its Chairman, by one third of its members, by the Manager of the NHIF, and by the Minister of Health according to an agenda proposed by them. (3) The Supervisory Council takes decisions in the presence of at least two thirds of its members, but with no fewer than 5 votes "for", except for the cases under Art. 15, para. 1, items 1, 2, and 5, in which decisions are taken by a simple majority. (4) The Manager of the NHIF participates in the meetings of the Supervisory Council without the right to vote. (5) (New - State Gazette, No. 48 of 2015; amended, No. 103 of 2020, in force from 01.01.2021) Verbatim records are drawn up for the meetings of the Supervisory Council. Decisions of the Supervisory Council and records of its meetings are published on the NHIF website. Decisions are published no later than the day following the day they are taken, and records - within 7 days from the date of the meeting. (6) (Previous para. 5 - State Gazette, No. 48 of 2015) The organization of work of the Supervisory Council is regulated in accordance with the applicable legislation in the regulation on the organization and activities of the NHIF.
Art. 17. (Amended - State Gazette, No. 107 of 2002; repealed, No. 101 of 2009, in force from 18.12.2009.)
Art. 18. (Amended and supplemented - State Gazette, No. 37 of 2008; amended and supplemented, No. 42 of 2009; amended, No. 101 of 2009, in force from 18.12.2009; supplemented, No. 98 of 2010, in force from 01.01.2011; amended, No. 60 of 2012, in force from 07.08.2012; supplemented, No. 103 of 2017.)