Healthcare in Bulgaria: from the CAK's S1 to the GP who opens everything
Bulgaria is a treaty country. With a Dutch statutory pension you apply for an S1 form at the CAK, have it registered at the regional office of the national health fund, and choose a GP on a form. That GP is the key to everything: without a referral no specialist. Per visit you pay a small user fee, and the public system is cheap, unevenly spread and often Bulgarian-speaking.
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Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
In Bulgaria you get healthcare through one national health fund, the NZOK, with a regional office in every province. So for you the question isn't which insurer you choose, but how you get into that fund. And then: which GP.
There are three routes in:
- Retired. You get in with an S1 form from the CAK.
- Employed. You are insured through your employer.
- Self-employed. You insure yourself through your own registration as a business.
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, the Dutch agency that arranges health cover for people living abroad. 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: the contribution you pay to the Netherlands as someone covered under the treaty. In most cases it 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. Bulgaria only provides the care.
Apply for the form well before your departure. The CAK's processing time is at most four weeks. 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 and reports it back to the Netherlands. 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 (literally: personal doctor). You do that 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 2026 that is € 1.48, for pensioners € 0.51. In 2025 it was 2.90 lev and 1 lev.
In hospital you pay a small charge per day, only for the first ten days a year. In 2025 that was 5.80 lev. For 2026 the European Commission states € 0.51 a day. Check the current amount with the health fund.
Exempt are, among others:
- children;
- pregnant women, up to 45 days after the birth;
- cancer patients;
- whoever is more than 71% incapacitated for work.
| What | Amount or period |
|---|---|
| user fee GP or dentist, per visit (2026) | € 1.48 |
| idem for pensioners | € 0.51 |
| user fee hospital, per day | small amount (2025: 5.80 lev), at most 10 days a year |
| European health insurance card | free, within 15 days |
| choosing or changing your GP | 1–30 June and 1–31 December |
| temporary GP after moving | 1 to 6 months |
| processing time of the S1 application at the CAK | at most 4 weeks |
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. There are good hospitals in Sofia, Plovdiv and Varna, but provision is thin in the countryside. 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. That is also the way you choose a GP. Your Dutch insurance ends on the day your Bulgarian one begins. 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 (the Dutch state pension), Anw, WAO, WIA or Wajong (Dutch benefits) will be admitted to the healthcare route for pensioners. The CAK reports that the European institutions have provisionally agreed to the amendment of Annex XI to Regulation 883/2004, the European rules on social security.
Whoever leaves on early retirement without AOW then falls outside it. They are 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.
In Vertrekklaar this is phase 1 of 5 of the journey, step 1.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Bulgaria or go straight to step 1.2 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- NederlandWereldwijd — the scheme for living abroad and the treaty countries — nederlandwereldwijd.nl
- NederlandWereldwijd — how do I arrange my health insurance through the CAK — nederlandwereldwijd.nl
- European Commission — your social security rights in Bulgaria, July 2026 edition — ec.europa.eu
- NZOK — the user fee (potrebitelska taksa) and who is exempt — nhif.bg
- CAK — emigrating on early retirement, the expected change from 1 November 2026 — hetcak.nl
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