SOFIA, Bulgaria — The European Health Insurance Card (EHIC) provides Bulgarian citizens with a valuable safeguard, enabling them to access emergency medical care free of charge or at reduced costs while traveling within the European Union and select neighboring countries.
However, despite the card’s significant benefits, relatively few Bulgarians apply for it each year, a trend that persists even after recent efforts to simplify the application process.
In 2024, approximately 8.8 million Bulgarians traveled abroad, with over 56%—around 5 million—visiting EU member states. The most popular destinations included Greece, Romania, Germany, Italy, and Austria.
In contrast, the number of EHICs issued annually in Bulgaria remains notably low, ranging between 160,000 and 170,000. Given that the card is valid for only one year, it is likely that a substantial portion of applicants are repeat users renewing their cards annually.
The EHIC covers emergency medical treatments at rates applicable to local residents, with Bulgaria’s National Health Insurance Fund (NHIF) reimbursing the costs.
The financial scale of these reimbursements is substantial. Between 2018 and 2023, the NHIF processed reimbursement claims for 184,900 cases, totaling 345.6 million leva. Preliminary data for 2024 indicate claims amounting to 24.3 million leva for 11,800 cases.
Germany Tops Reimbursement Claims
Germany has consistently been the top country for reimbursement claims, accounting for 45.6% of the total amount—approximately 157.5 million leva. This is largely attributed to the significant Bulgarian diaspora residing in Germany.
Spain, Greece, and Belgium also rank high in terms of medical expenses covered through the EHIC, highlighting the card’s importance for Bulgarian citizens residing or traveling frequently within these nations.
Despite these figures, the relatively low issuance rate of EHICs suggests a disconnect between the card’s potential benefits and public awareness or willingness to apply for it.
Health experts attribute this to a combination of factors, including lack of information, the cumbersome application process that existed until recently, and skepticism about the card’s acceptance in certain countries.
From Bureaucracy to Convenience: Digitalization Efforts
Until recently, obtaining the EHIC in Bulgaria involved a cumbersome process. Applicants were required to visit one of approximately 120 branches of First Investment Bank to submit an application in person and return two weeks later to collect the document.
This bureaucratic process deterred many potential users, despite the card being free of charge. The situation began to improve significantly in 2022, largely due to the advocacy of Bulgarian blogger Boyan Yurukov.
His successful campaign led to the introduction of an electronic application process. Initially, while applications could be submitted online, collection still necessitated a physical visit to a bank branch. However, since late 2024, the entire process has been fully digitized.
Now, applications can be submitted via the Ministry of Electronic Governance (MEG) website, with the option to receive the card by mail. This modernization is part of a broader government initiative to streamline public services and encourage digital adoption among citizens.
Simplified Application Process
To apply for the EHIC online, users must register on the MEG platform using a qualified electronic signature (QES), a mobile QES from B-trust or Evrotrust—both offered free for MEG services—or a personal identification code (PIC) from the National Revenue Agency (NRA) or the National Social Security Institute (NSSI).
Once logged in, applicants navigate to the NHIF section under “Service Providers,” select “Issue of a European Health Insurance Card,” and fill out an electronic form requiring personal details, including names in both Cyrillic and Latin, contact information, and, if applicable, the details of the person they are applying on behalf of.
Applicants can choose to collect their EHIC in person at regional NHIF offices or opt for delivery via domestic or international courier services.
While the card itself remains free, applicants must cover any courier costs. The digitization has notably eliminated the need for physical visits to bank branches, significantly simplifying the process.
Challenges to Acceptance Abroad
Despite the enhanced convenience in obtaining the card, some challenges remain regarding its acceptance abroad.
In certain Greek islands, for example, emergency procedures such as surgeries for injuries or fractures are often handled by private hospitals that do not recognize the EHIC.
Patients in these cases must either pay for treatment out of pocket or seek care at state-run facilities, which may involve long waiting times.
This inconsistency in the card’s acceptance is a significant deterrent for potential applicants, as many prefer to rely on private travel insurance to avoid the risk of unexpected medical expenses.
Additionally, misinformation about the EHIC’s coverage scope contributes to its underutilization. While the card covers emergency care, it does not extend to planned treatments or private healthcare services.
Reimbursement Options for Out-of-Pocket Expenses
For those who end up paying for medical services while abroad, reimbursement remains an option. Upon returning to Bulgaria, individuals can submit original invoices and payment receipts to their regional NHIF office.
NHIF staff assess the documentation and inform applicants about the possibility and extent of cost recovery. However, the process can be time-consuming and often involves extensive paperwork, further discouraging travelers from relying on the EHIC.
Looking Ahead: Increasing Awareness and Adoption
Experts suggest that a targeted awareness campaign highlighting the EHIC’s benefits could significantly boost its adoption rates.
Informing citizens about the simplified online application process and clarifying the scope of the card’s coverage might encourage more Bulgarians to apply.
“The EHIC is an essential tool for ensuring medical security while traveling in the EU, yet its low adoption in Bulgaria indicates a need for better public information,” says Dr. Petar Stoyanov, a healthcare policy expert.
“Enhancing awareness and addressing misconceptions about the card’s acceptance abroad could greatly improve its usage.”
As more Bulgarians travel within the EU each year, ensuring that they have adequate medical coverage remains a priority.
The digitalization of the EHIC application process is a step forward, but bridging the information gap and addressing challenges to its acceptance abroad will be crucial to maximizing the card’s potential benefits.