Healthcare in Croatia: HZZO, the twelve-month back-charge and the dopunsko

In Croatia you are insured with HZZO, the Croatian health fund, and you get in through one of three routes: with a Dutch pension, with a Croatian job, or as a self-payer.

Your Dutch basic insurance ends on the day you deregister. Not on 31 December, and not "if you just let it run on for a bit". From that moment the Croatian system applies, and it works differently from what you're used to:

• There is one compulsory insurer.
• A registration clock of eight days runs.
• You pay co-payments per treatment.
• There is a supplementary policy that practically everyone has.

This article sets out the routes.

Route one: with a Dutch pension — the CAK and the S1

Croatia is an EU country and therefore a treaty country. Whoever brings a Dutch pension or a statutory benefit registers with the CAK as a treaty beneficiary: someone entitled to care through a treaty. The CAK sends an S1 form. With it you enrol with HZZO, the Croatian health fund, and you receive Croatian care at the expense of the Netherlands.

You pay the CAK a treaty contribution, which is usually deducted from your pension automatically. Apply for the S1 two to three months before departure. Issuing takes weeks, and without an S1 you stand at the Croatian counter as uninsured.

Route two: with a Croatian job

Whoever goes to work in Croatia is insured via the employer: the health contribution is 16.5% and runs through the payslip. You only have to supply your OIB yourself and check the enrolment.

Route three: self-payer — and the back-charge you can avoid

Whoever has no S1 and doesn't work, for example on early retirement or living off wealth, becomes a self-payer with HZZO. You then pay the contribution on the lowest contribution base yourself.

If you live on a pension from abroad, HZZO can register you on that basis. The contribution is then 16.5% of your pension, with the lowest contribution base as the floor and the average wage as the ceiling. Whether your Dutch early retirement pension is classed that way, HZZO and the Croatian tax administration decide when you register.

And here lies the trap that appears on no Dutch site, and that HZZO itself describes. Whoever insures on this basis only obtains their rights after paying in one go the contribution for the period since the end of their previous insurance, up to a maximum of twelve months. Insurance in another EU country that counts under the European coordination rules also counts as "previous insurance". So whoever can show they were insured in the Netherlands until the day of departure pays only for the gap between that day and the registration.

The solution is one letter: before departure, ask your Dutch health insurer for a certificate of cover up to and including your deregistration date, and register quickly. One sheet of A4, and the back-charge shrinks to the weeks you let run yourself.

If you came from a job in another EU country, a separate route applies: whoever reports to HZZO within thirty days of the end of that employment is treated as if the job ended in Croatia, provided the insurance in the previous country has stopped.