Adopted with a Decree of the Council of Ministers No. 80 of 03.05.2005
Prom. State Gazette No.41 of 13 May 2005, amended with State Gazette No. 57 of 13 July 2007, amended with State Gazette No. 51 of 5 July 2011.
Section One.
GENERAL PROVISIONS
Art. 1. (1) (Former text of art. 1 – State Gazette, No. 57 of 2007, as amended – State Gazette, No. 51 of 2011, effective as of 05.07.2011) This ordinance regulates the general conditions, minimum sum insured, minimum insurance premium and the order for conclusion of compulsory medical insurance for foreigners staying for a short or long term in the Republic of Bulgaria or transiting through the country, for the time of their stay in the country.
(2) (New – State Gazette, No. 57 of 2007) This ordinance does not apply to people who temporarily stay in the Republic of Bulgaria or transit through the country and for whom the rules for coordination of the social security systems under the meaning of § 1, p. 22 of the final provision of the Health Insurance Act apply.
Art. 2. (1) (Supplemented – State Gazette, No. 51 of 2011, effective as of 05.07.2011 ) Upon entry or transit through the territory of the Republic of Bulgaria, foreigners under art. 1 shall have valid health insurance or medical insurance, unless any international treaty under which the Republic of Bulgaria is a party, law of regulation of the European Union, provides else.
(2) Provided that upon entry in the country foreigners do not have valid health insurance or medical insurance, they are obliged to conclude a medical insurance valid for the territory of the country and for the time of their stay, which shall satisfy the requirements of this ordinance.
Art. 3. (Amended – State Gazette, No. 51 of 2011, effective as of 05.07.2011) (1) The contracts for the compulsory medical insurances for foreigners staying for a short or long term in the Republic of Bulgaria or transiting through the country, shall be concluded upon entry into the territory of the country with insurers who have the relevant permit or license to carry out a business with such types of insurances.
(2) The contracts for the compulsory medical insurances for foreigners staying for a long term in the Republic of Bulgaria, may be signed also after they have entered the territory of the country.
Art. 4. (1) (Supplemented – State Gazette, No. 51 of 2011, effective as of 05.07.2011) A party under the contract for compulsory medical insurance may be any foreigner staying for a short or long term in the Republic of Bulgaria or transiting through the country.
(2) (Supplemented – State Gazette, No. 51 of 2011, effective as of 05.07.2011) People staying for a short or long term in the Republic of Bulgaria or transiting through the country who have concluded abroad and have health insurance or medical insurance valid for the territory of the Republic of Bulgaria are not obliged to sign compulsory medical insurance.
(3) When the term of the medical insurance expires during their stay in the country, the people who are subject to compulsory medical insurance shall conclude a new insurance before the expiry of the old one and the term of the new insurance shall cover the period till the end of their stay in the country.
Art. 5. (1) (Supplemented – State Gazette, No. 51 of 2011, effective as of 05.07.2011) Subject to insurance under the compulsory medical insurance are all costs and expenses for medical treatment and hospital stay for all foreigners staying for a short or long term in the Republic of Bulgaria or transiting through the country for the time of their stay in the country.
(2) (Amended – State Gazette, No. 57 of 2007) Costs and expenses for medical treatment and hospital stay for the foreigners under par. 1, are all costs and expenses for medical assistance and aid in emergency situations, as well as costs and expenses made for outpatient and clinical medical aid, dental services under the applicable provisions of this ordinance.
Section Two.
GENERAL CONDITIONS, MINIMUM SUM INSURED, MINIMUM PREMIUM AND ORDER FOR CONCLUSION OF COMPULSORY MEDICAL INSURANCE
Art. 6. (1) The scope of insurance liability shall include all necessary costs and expenses made by the insured person or the medical centre for the medical treatment and hospital stay in case of unexpected, unforeseeable malaise, disease or accident which may occur during the time of effect of the insurance contract .
(2) (Amended – State Gazette, No. 57 of 2007) The scope of insurance liability shall include dental health but the coverage includes only urgent situations and conditions that have occurred suddenly within the following dental services:
- incision of abscess and phlegmones in the oral cavity;
- extraction of suddenly broken or heavily damaged tooth, including anaesthesia;
- follow-up examination after the services under p. 1 and 2;
- (Amended – State Gazette, No. 57 of 2007) urgent conditions after the applied dental procedures.
Art. 7. The scope of the compulsory medical insurance shall include also all recorded necessary and expedient transport costs and expenses for accommodation or transfer of the insured person to the medical centre.
Art. 8. The compulsory medical insurance does not cover costs and expenses of the insured persons for:
- medical treatment and hospitalization for existing chronic diseases of the insured;
- haemodialysis and blood transfusion;
- transplantation of organs, tissue and cells;
- planned neurosurgical, cardiological and eye operations;
- in vitro fertilization (IVF);
- AIDS treatment;
- hospitalization of people with oncology diseases and people with mental disorders;
- alcoholism and drug addiction therapies;
- compulsory immunizations;
- plastic cosmetic surgery and other cosmetic medical services;
- application of unconventional methods for favourable impact on personal health.
Art. 9. The insurance coverage under the compulsory medical insurance does not include and the insurer does not owe insurance compensation for bodily injury or death of the insured caused as a result of:
- failure to follow prescribed regime and/or therapy, simulation of a disease by the insured, as well as any act of wilfully causing damage on his/her health;
- preparation and participation in sports competitions;
- fight, attempt to commit suicide or suicide, committing a general crime or performing any other act forbidden by law;
- damage on health, which has occurred within the procedure of arresting the insured by the law enforcement bodies or at a detention centre;
- earthquake and nuclear explosions, radioactive products and contamination from them, radioactive (ionizing) radiation;
- damage on health resulting from overdose or chronic use of alcohol, narcotic, psychotropic substances or drug addiction;
- act of terror or terrorism;
- participation in war or military exercises or caused by radioactive or chemical materials during revolution, riot, strike, lockout or other similar acts, including disaster and emergency situations.
Art. 10. The insurer will not pay medical services to the insured, which have been provided as a result of his/her participation in scientific research or clinical tests of drugs and medical products.
Art. 11. The insurer will not cover medical services, the need of which has occurred as a result of previous diseases.
Art. 12. (Amended – State Gazette, No. 57 of 2007, supplemented – State Gazette, No. 51 of 2011, effective as of 05.07.2011) As of 1 July 2007, the minimum sum insured upon the compulsory medical insurance for foreigners staying for a short or long term in the Republic of Bulgaria or transiting through the country is fixed to the amount of BGN 60,000.
Art. 13. (1) Insurers may offer voluntary medical insurance for sums insured, which are higher than those indicated in art. 12 above.
(2) When the voluntary medical insurance is concluded under the conditions of the ordinance for sums insured, which are higher than those fixed in art. 12 , then it will be considered that the compulsory medical insurance is included in it.
Art. 14. (Amended – State Gazette, No. 57 of 2007) The minimum insurance premium, which the foreigner pays under the contract for compulsory medical insurance shall be determined under the provisions of art. 65 of the Insurance Code.
Art. 15. The insurance premium shall be paid as a lump sum with the conclusion of the insurance contract.
Art. 16. The availability of a valid insurance contract shall be verified with the relevant insurance policy.
Art. 17. (Amended – State Gazette, No. 51 of 2011, effective as of 05.07.2011) (1) The insurance contract of foreigners staying for a short term in the Republic of Bulgaria or transiting through the country may not be concluded for a term longer than 90 days.
(2) The insurance contract of foreigners staying for a long term in the Republic of Bulgaria , may not be concluded for a term longer than one year.
Art. 18. (Amended – State Gazette, No. 57 of 2007) Persons who have concluded compulsory medical insurance shall have the right to use personally the agreed coverage and freely choose their doctor, doctor of dental medicine or medical centre within the territory of the Republic of Bulgaria.
Art. 19. The insured person shall benefit from all rights of the compulsory medical insurance provided he/she has not created conditions for unlawful and fake use of medical services.
Art. 20. (1) Upon the occurrence of an insurance event, the insured person or medical centre providing medical service shall within 24 hours notify the insurer with a letter, by phone, fax or any other proper means of communication.
(2) The occurrence of an insurance event under the compulsory medical insurance shall be proved with the relevant documents. To be able to determine the amount of the compensation, the insurer shall be provided with:
- document, which verifies the occurrence of the event;
- sick leave certificates;
- medical reports;
- report from the doctors consultation committee or the territorial committee of medical experts;
- any other written evidence and explanation which the insurer may request.
Art. 21. The insurer shall pay all costs and expenses for medical services and hospitalization provided to foreigners insured under the provisions of this ordinance as follows:
- to the providers of medical services – at the price list of the relevant medical centre;
- to the insured person – provided he/she has paid the price for the rendered medical services of the medical centre.
Art. 22. Payments upon the compulsory medical insurance shall be effected by the insurer who has issued the policy upon the compulsory medical insurance, or by any representative duly authorized by the latter.
Art. 23. (1) The compensation under the compulsory medical insurance shall be determined and paid only after the insured person has presented all necessary documents referring to the identification of the event and the amount of the costs and expenses related to the provided medical treatment and stay in the hospital.
(2) If the agreed compensation is to be transferred abroad, the amount due and payable will be converted into the relevant currency under the central exchange rate of the Bulgarian National Bank at the date of the bank transfer.
Art. 24. The rights under the contract for the compulsory medical insurance shall be deemed settled and expire with the expiry of the relevant terms under the applicable Bulgarian legislation.
Final provisions
The only paragraph. (Amended – State Gazette, No. 57 of 2007) This ordinance is adopted on the grounds of the provisions of art. 83, par. 6 of the Health Act.
Final provisions
TO DECREE No. № 157 OF 5 JULY 2007 FOR AMENDMENT AND SUPPLEMENT OF THE ORDINANCE ON EXERCISING THE RIGHT OF ACCESS TO MEDICAL HELP ADOPTED WITH DECREE No. 119 OF 2006
(Updated – State Gazette, No. 57 of 2007)
- 8. The ordinance on the general conditions, minimum sum insured, minimum premium and order for conclusion of compulsory medical insurance for foreigners staying for a short or long term in the republic of bulgaria or transiting through the country, adopted with Decree No. 80 of the Council of Ministers of 2005 (State Gazette, No. 41 of 2005 ) shall be amended and supplemented as follows:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
- Everywhere in the ordinance the words “stomatology”, “stomatological” and “stomatologist” shall be replaced accordingly with “dentistry”, “dental” and “doctor of dental medicine”.
Final provisions
TO DECREE No. 179 OF 29 JUNE 2011 FOR THE ADOPTION OF THE RULES FOR THE APPLICATION OF THE FOREIGNERS IN THE REPUBLIC OF BULGARIA ACT
(AMENDED – STATE GAZETTE, No. 51 OF 2011, EFFECTIVE AS OF 05.07.2011)
- 7. This decree shall become effective as of the date of its publication in the State Gazette.
Appendix to art. 14
(Revoked – State Gazette, No. 57 of 2007)
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