Healthcare in Bulgaria: from the CAK's S1 to the GP who opens everything

Bulgaria has one national health fund, the NZOK, with a regional office in every province. For you the question isn't which insurer, but how you get into that fund — and then which GP.

Retired: the S1 route through the CAK

Bulgaria is on the list of treaty countries. If you have a Dutch statutory pension or benefit, you report to the CAK. You get an S1 form, and with that you're entitled to care in Bulgaria at the expense of the Netherlands.

For that you no longer pay a Dutch health premium but a treaty contribution, which in most cases is withheld automatically from your pension. Bulgaria charges you no premium of its own on top: you don't fall under the Bulgarian insurance but under the Dutch, and Bulgaria only provides the care.

Apply for the form well before your departure — count on six weeks — and only cancel your Dutch policy once it's settled. A gap between two systems is the most expensive thing that can happen to you in this journey.

Registering at the regional health fund office

With your S1 and your residence certificate you go to the regional office of the health fund, the RZOK, of your place of residence. It registers your cover, reports it back to the Netherlands, and from that moment you're known in the Bulgarian system. The form in your drawer is no insurance; only after this registration can you take the next step.

The GP is the key

To use your rights, you have to choose a GP, the личен лекар, on the registration form for the permanent choice. That GP is the first step in every treatment and refers you to a specialist; without a referral you don't get there.

Changing is possible twice a year, from 1 to 30 June and from 1 to 31 December. Whoever moves may choose temporarily in between, for one to six months. Choose the GP in your first weeks, and when choosing ask about English: in Sofia and on the coast that can be found, beyond that Bulgarian is the language of the consulting room.

The user fees

Per visit to the GP or the dentist you pay a small user fee: in 2025 that was 2.90 lev, for pensioners 1 lev — converted around one and a half euros and half a euro. In hospital you pay 5.80 lev a day, only for the first ten days. Since 2026 those amounts have been converted into euros at the fixed rate.

What the system is, and what it isn't

Your right is a right to the care from the Bulgarian system: the same care as for Bulgarian insured persons, with the same waiting times and the same co-payments for medicines. The public system is cheap and unevenly spread: good hospitals in Sofia, Plovdiv and Varna, thin in the countryside, and many Bulgarians pay privately on top for specialists and diagnostics. Count that into your budget, even with an S1: the registration gives you access, not speed.

If you work in Bulgaria: the route through the employer

Whoever takes up employment is insured with the health fund through the employer, with the Bulgarian premium, and chooses a GP that way. Your Dutch insurance ends on the day your Bulgarian one begins, and the CAK doesn't come into it. Whoever is self-employed insures themselves through their own registration as a business.

The deadline for early retirement

As expected, from 1 November 2026 only new applicants with AOW or a disability benefit will be admitted to the healthcare route for pensioners. Whoever leaves on early retirement without AOW then falls outside it and is dependent on a private policy or, when working, on the Bulgarian system through the employer.

Whoever is already a client keeps their rights. Whoever is on the edge has an interest in being registered before that date.