A Bulgarian National Television (BNT) story showed that foreigners from non-EU countries living in Bulgaria cannot be provided with free healthcare services from the Bulgarian state, even though they have paid their healthcare social securities.

On April 1, BNT featured the case of Ukrainian Elena Glushtuk, who married a Bulgarian citizen last August and currently lives in the city of Smolyan, in Rhodope Mountain. After marrying her husband, Glushtuk got the status of a long-term resident in Bulgaria. She even got an ID card for foreigners ("lichna karta" in Bulgarian).

Eight months ago, Glushtuk became pregnant and started paying her healthcare social security and started regular medical check-ups at her general practitioner, like any Bulgarian citizen. This routine changed dramatically after January 1 2007, the date when Bulgaria entered the European Union.

Kouzman Gelov, head of Regional Health Insurance Fund in Smolyan, told BNT that foreigners who paid their health contributions to the state before January 1 2007 could continue to do so, but if not, they would now have to pay their contributions to the National Revenue Agency (NRA).

Svetlana Stoyanova from the NRA presented a different picture. The EU membership of Bulgaria saw a change in the Healthcare Social Securities Act, which came into force on January 1 2007. According to these changes, foreigners living in Bulgaria are divided into two categories: permanent residents and long-term residents, Stoyanova told BNT.

"According to the changes, foreigners with long-term residency in Bulgaria are not eligible for healthcare social security," she said.
What foreigners could do is find a private health insurance fund and invest their money there. This means that even if a foreigner from a non-EU country with long-term residence is working legally for a Bulgarian company, his/her employer cannot pay the healthcare social security because the law simply does not provide a way to do so.

This, in theory, leaves foreigners such as nationals from the US, Russia, Canada, Arab and Asian countries working in Bulgaria without health insurance. In some cases, it may turn that even CEOs of international companies working in Bulgaria are not eligible for free healthcare.

The question of foreigners getting healthcare in Bulgaria might become a big problem for the country's tourist industry with the forthcoming summer season. The Black Sea annually attracts hundreds of thousands of foreign tourists and healthcare issues are in the spotlight each year.

On March 27, Iliyan Ivanov, chairman of the National Hotel Management Club, told journalists that hotel owners would no longer be required to use part of their profits to maintain doctors offices.

Ivanov talked to the Health Ministry about the nearing season. According to Deputy Health Minister Matei Mateev, there were enough doctors to take care of the projected four million foreign tourists who will visit Bulgaria over the summer. If necessary, additional medical staff could be sent to resort areas, but this would not be done at the expense of patients needing urgent treatment outside the resorts, Mateev said.

According to him, about 80 per cent of the total flow of visitors is expected to consist of EU nationals. Bulgaria's EU membership needed to bring about some change in the legislation, Mateev said.

To this purpose, the Regulation on Hhealthcare Services Access had to be amended by the beginning of the summer season. The amendment will follow EC's Directive 1408, which allows the free movement of people within the EU and guarantees their equal rights, including equality in healthcare services access.

EU nationals can get free healthcare in Bulgaria if they show their European Health Insurance Card. EU citizens visiting the country will be entitled to ambulance service and urgent medical treatment under the same terms as Bulgarians, Mateev said. The available health service package will not be any different for tourists. As for non-EU tourists, Mateev said they will receive free medical aid only if they have compulsory health insurance, which in most of the cases is part of the package the tourists buy from the tour operator.