Patient Pathway

Rights and obligations of health insured persons

If you have health insurance, you are entitled to:

• affordable and quality health care;
• information about your health condition and treatment methods;
• primary outpatient care
• specialized outpatient medical care;
• medical diagnostic tests;
• highly specialized medical activities;
• dental care;
• hospital aid;
• home remedies.

Any medical and dental activity related to your treatment is carried out after your informed consent.
Informed consent is the timely provision of medical information in an appropriate form and volume, which makes it possible to choose treatment. To obtain informed consent, the attending physician (dentist) notifies the patient, respectively his parent, guardian or guardian. In cases where there is a refusal of the parent, guardian or guardian and the patient's life is at risk, the head of the medical facility can make a decision to carry out life-saving treatment. If you are not satisfied with the quality of medical and dental care provided by a contracted partner of the NHIF/RHIF, you may submit a written report to the director of the regional health insurance fund at your place of residence or to the manager of the National Health Insurance Fund. In in the case of an illegally taken amount, you must also attach a copy of the financial document issued by the medical institution. The control authorities will carry out a check to clarify the facts and you will receive a written response to the report.

The attending physician must notify you of:

• diagnosis and nature of the disease;
• the goals, method and different treatment options, as well as expected results and prognosis;
• the risks associated with the proposed treatment, including side effects and adverse drug reactions, pain and other inconveniences;
• the likelihood of a beneficial effect or risk to health when applying other methods of treatment, as well as when refusing treatment;
• increased risk to life and health in surgical operations, anesthesia and other complex medical manipulations. (In these cases, informed consent is provided in writing.)

You freely choose your personal doctor

On the basis of Art. 5, Para. 4 of the Ordinance on implementing the right of access to medical care, the National Health Insurance Fund (NHIF) issues a health insurance card (HIC). You can get your card at the regional health insurance offices funds (ROZOK) in the country.
In the event of loss, theft or destruction of the originally issued health insurance card, you submit an application-declaration according to the model, according to appendix No. 1, to the director of the Health Insurance Agency, in whose territory the general practitioner (GP) chosen by me operates. You pay the value of the new ZOK in the amount of BGN 7.44, for which the ZOK issues the relevant document. After presenting the document certifying payment of the value of a new health insurance card, within 3 days you will receive the newly issued Health Insurance Card from the Health Insurance Agency, accompanied by a model protocol, according to Appendix No. 2. Then, within 3 days, you present the new health insurance card for certification and the protocol according to appendix #2 to the general practitioner of your choice.
You turn to your GP whenever you have a health problem and need advice, tests, home or hospital treatment, as well as prescription medication.
If you are not happy with your GP or you move, you have the right to choose a new GP. This happens twice a year - from June 1 to 30 and from December 1 to 31. You need a special form for the change, which you can buy from a medical record bookshop or download from the NHIF website. With the form, you must go to the newly selected personal physician and fill in your and the doctor's personal data on the spot. You must present the newly selected doctor with a health insurance card (or the third copy of the registration form if you do not have a health insurance card). You do not need to inform your previous GP about the change.

Do you have a health problem?

You visit your personal doctor. He examines you and prescribes treatment. In the doctor's office, information is displayed on which categories of citizens are exempt from user fees when receiving medical and dental services. If you do not fall into the listed categories, they pay a user fee a fee in the amount determined by a Decree of the Council of Ministers pursuant to Article 37 of the Law on Health Insurance.

Need research?

The general practitioner sends you with a referral for medical-diagnostic tests in a laboratory. The referral can be used up to 30 calendar days after it is issued. You pay a fee for taking biological material at the laboratory.

Do you need a consultation with a specialist doctor?

Your personal physician sends you with a referral voucher to a doctor with the relevant specialty. The referral can be used up to 30 calendar days from its issuance.
The specialist doctor examines you, and if you need additional tests, issues a referral for them. He prescribes treatment. The term for a secondary examination by a specialist outpatient medical care provider is up to 30 calendar days from the date of carrying out the primary examination. For each visit to the doctor, you pay a user fee, determined by a Decree of the Council of Ministers pursuant to Art. 37 of the Law on Health Insurance.

Should you treat yourself at home?

The treating doctor/dentist prescribes treatment. He can issue you a sick leave for a period of up to 14 days without a break, but for no more than 40 days (with a break) within a calendar year - for one or more illnesses. If my condition requires it, after the expiration of this period I can be referred to the LCC.

Does your home treatment require medication?

The doctor informs you which medications are fully or partially paid for by the NHIF. He issues you an electronic prescription and you receive them from a pharmacy that has a contract with the health insurance fund. If the health insurance fund does not fully cover the cost of the prescribed medications, you pay the necessary additional amount.
If the drugs for your treatment are not paid by the NHIF, the doctor issues a prescription and you can buy them at any pharmacy.

As citizens with health insurance, you also have obligations

• You must pay your health insurance premiums regularly;
• You must carry your personal health insurance card whenever you visit your GP or dentist;
• You must follow the doctor's prescriptions as well as disease prevention requirements;
• You must comply with the established internal order of the medical facility where you receive medical or dental care;
• You must respect the professional and human dignity of doctors;
• You must not intentionally harm your own health or the health of another person.

What are the main steps in the patient journey?

1. Initial Consultation

The journey begins when the patient becomes aware of a health problem and seeks medical attention. This may be a visit to a general practitioner who makes an initial assessment of symptoms and determines whether referral to a specialist or initiation of treatment is necessary.

2. Diagnostics

At this stage, the necessary medical tests are performed to establish the correct diagnosis. This may include laboratory tests, imaging studies (such as X-ray, ultrasound, MRI), biopsies and other specialized tests depending on the suspected disease.

3. Treatment planning

Once a diagnosis is made, the doctor develops a treatment plan, which may include medication, surgery, radiation therapy, chemotherapy, or a combination of these and other approaches. The plan is based on the latest medical standards and personal preferences and patient needs.

4. Execution of treatment

At this stage, the patient begins the treatment, which can be carried out in a hospital, on an outpatient basis or at home. The treatment process is under the strict supervision of a medical team that monitors the effectiveness of the therapy and possible side effects. In case of such, the medical team adapts the treatment by changing the used methods and drugs or changing the frequency, strength, power of the already applied treatment methods to limit side reactions.

5. Monitoring and Evaluation

Throughout the treatment period and after its completion, the patient continues to be regularly examined and monitored for any changes in condition, effectiveness of the treatment and possible recovery of the disease. Regular follow-ups are also included to prevent relapse , which are held every 3, 6, 12 months, and then once a year or according to another schedule according to the attending physician.

6. Rehabilitation and recovery

After completing active treatment, many patients go through a rehabilitation process that helps them regain physical fitness, social function, and psychological well-being. This stage may include physical therapy, vocational rehabilitation, dietary counseling, and psychological support. The goal is to improve patients' quality of life and facilitate their successful return to daily activities and a normal lifestyle.

What does the cancer patient journey involve?

Diagnosing cancer involves several steps that help determine whether symptoms are related to cancer, what type of cancer it is, and what stage it is in. Here is a detailed description of each step:

Preliminary Assessment

• Symptoms: People often seek medical attention for symptoms such as unexplained weight loss, persistent cough, changes in bowel or stomach regularity, lumps or skin changes, unusual bleeding, chronic pain, and more.
• Initial examination: The general practitioner (GP) conducts an initial examination and takes a medical history.

Referral to Specialists

• Specialists: Depending on the symptoms, patients may be referred to oncologists, gynecologists, urologists, gastroenterologists and other specialists for a more accurate assessment of the condition.

Diagnostic studies

• Imaging tests: Tests such as X-ray, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) are used to visualize the internal structures of the body.
• Lab tests: Blood tests may show abnormal values ​​that are characteristic of certain types of cancer.
• Biopsy: Taking a sample of suspicious tissue and examining it under a microscope is key to confirming a cancer diagnosis.
• Histopathological examination: is the examination of tissue material taken during biopsy or surgery under a microscope.

Cancer Staging

• Staging: Additional tests may be done to determine whether the cancer has spread, depending on the type of cancer.

Treatment Planning

• Based on the information gathered, the medical team develops a treatment plan, which may include surgery, radiation, chemotherapy, immunotherapy, or a combination of these methods.

Information from NHIF about the Patient Pathway

Next you will find information about what health insurance people can benefit from in hospital and outpatient care for a health problem.

What do you get for your health contributions from the NHIF in hospital care?

You can be treated in a hospital only if you have health insurance. The National Health Insurance Fund (NHIF) pays for the diagnosis and treatment of health-insured citizens in 267 clinical paths, including medical devices for hospital treatment in certain paths, such as: heart valve prosthesis, vascular prosthesis for thoracic and abdominal aorta and distal vessels, stents, joint prostheses for hip and knee joint, cochlear implants, permanent and temporary pacemaker.
The National Health Insurance Fund pays for them only if you are admitted for treatment on the relevant clinical pathway. The Regional Health Insurance Fund (RDHI) transfers the amounts for these items to the medical facilities for hospital care. In some clinical pathways, there are consumables that the National Health Insurance Fund does not pay. They are explicitly mentioned in the pathways, and you will find most of the clinical pathways published here. NHIF also pays for 6 clinical procedures and 47 outpatient procedures.
Your GP or the specialist you visited sends you with a referral voucher to a hospital of your choice, which has signed a contract with the NHIF for the treatment of the relevant disease on a clinical pathway. The referral for hospitalization is valid 30 days until the examination in the diagnostic-consultative unit of the hospital. The treatment on the clinical path includes up to two control examinations within 30 days after your discharge from the hospital doctor, after which he will continue to monitor your state of health.
Clinical pathways include activities – diagnostic and therapeutic, which are reflected in their cost. When the pre-hospitalization tests provided by you on the relevant clinical pathway are insufficient according to the receiving medical facility for inpatient care, the necessary tests are performed in the hospital .
The medical facility is obliged to announce in a prominent place the agreed clinical paths and the prices that the NHIF pays for them; as well as the types of medical devices and expensive consumables, and the prices up to which the NHIF pays for the same (in cases, when the medical device is included in the execution of the diagnostic-treatment algorithm in the CP)
If there is no capacity for planned hospitalization, the medical facility prepares a waiting list. The waiting list includes all patients who should receive treatment at the hospital, except for emergency cases. The health insured included in the list , receive a serial number and date of admission to hospital.

User Fee

You can be treated in a hospital only if you have health insurance. The National Health Insurance Fund (NHIF) pays for the diagnosis and treatment of health-insured citizens in 267 clinical paths, including medical devices for hospital treatment in certain paths, such as: heart valve prosthesis, vascular prosthesis for thoracic and abdominal aorta and distal vessels, stents, joint prostheses for hip and knee joint, cochlear implants, permanent and temporary pacemaker.
When admitted through a clinical pathway, the NHIF pays hospital care providers for all medical activities along the clinical pathway, including: examinations, pre-operative preparation, surgery, treatment in the hospital and the post-hospital regimen with the appointment of up to two follow-up examinations after the discharge of the patient.
The health-insured person owes (if not exempted from this) a user fee - BGN 5.80 - for each day of hospital treatment, but for no more than 10 days a year. There are also some expensive ones at the expense of the health-insured person consumables specifically mentioned in the relevant clinical pathways.
Beyond the scope of the basic package of health activities guaranteed by the NHIF budget, health insured persons have the right to additionally requested services related to the provision of medical assistance, as well as to a doctor or medical teams preferred by them, and the medical assistance is paid at prices determined by the relevant medical facilities.
However, this is a matter of personal choice and not a mandatory condition for admission to a medical facility for inpatient care. Forcing citizens to pay a team selection fee at a hospital is a violation of their constitutional right to access medical help.
Outside the activities paid by the NHIF, medical facilities must have a price list prepared, placed in a visible place, from which patients can be informed about the prices of the offered services and consumables.
The NHIF only pays for medical devices used in hospital medical care, if they are included in the so-called List of medical devices that the NHIF pays for in the conditions of hospital medical care.
The most suitable medical device is determined by the attending physician. Depending on the type/type of the inserted medical device, the value of which is paid by the NHIF outside the cost of the clinical pathway, the NHIF pays the medical institution the corresponding amount up to the value indicated against each item in the List (e.g. for knee joint - BGN 2,970, BGN 2,700)
If the patient requests to be fitted with a more expensive medical device, he pays an additional amount above that provided by the Health Insurance Fund. The hospital must issue financial documents that indicate what the payment is for. The amount that is paid by the NHIF, is transferred to the medical facility, not to the patient, after the inserted medical device is accounted for in a certain order.

What do you get for your health contributions from the NHIF in outpatient care?

Health insurance rights

In order to use medical assistance under the NHIF, you must have continuous health insurance rights. This means that you have regularly paid your health insurance contributions for the last 36 months, before the date of the examination. If you have gaps in your health insurance, you must pay the due contributions in order to receive insurance rights from the date of payment. Otherwise, you must pay for the medical care provided yourself - at prices announced by the medical facility.
If you had an irregular health insurance status and you recover the due health contributions, you should keep in mind that the information between the NRA, RZOK and personal doctors is updated within 1 calendar month. The doctor checks your health insurance status via the Internet If by the date of the examination the restoration of your health rights is not yet reflected in the NRA's electronic page, you must provide the doctor with a Certificate of continuous health insurance rights issued by the NRA to receive the medical care you need through the National Health Insurance Fund.
Amounts you paid for medical care while you were uninsured are not refundable.

Choosing a GP

In order to use medical assistance, as well as to receive medicines for home treatment, paid for by the health insurance fund, you must choose a general practitioner. Any general practitioner who has a contract with the NHIF in the territory can become your personal doctor A list of the names and addresses of the GPs is published on the official website of the NHS, in whose patient lists you can be included whenever you have a health problem and need a consultation. examinations, home or hospital treatment, as well as for prescribing medicines. An initial choice of GP can be made at any time of the year.
In order to choose a personal physician, you must fill out a Registration form for the initial selection of a general practitioner, which you can purchase or fill in printed samples from the official website of the National Health Insurance Fund (NHIF) - www.nhif.bg - menu For the citizens. You can also fill in and send to the GP of your choice a registration form for election by electronic means, free of charge, under the terms and conditions of the Electronic Document and Electronic Signature Act (ZEDEP) through an electronic service provided by the NHSOC .
For newborn children - until the EGN is given and a health insurance card is obtained, the number of the announcement of the child's birth, as well as the registration number of the medical institution from which the announcement originates, are entered in the registration form for selection.
For minors and minors, as well as for persons placed under full or limited guardianship, the choice is made by their parents and guardians, respectively - with the consent of their parents and guardians.
Each year, in the periods from 1 to 30 June and from 1 to 31 December, you can change your GP. To do this, you need to fill in a Registration form for a permanent choice of general practitioner. The form you can purchase or fill out printed forms from the official website of the National Health Insurance Fund (NHIF) - www.nhif.bg - For citizens menu time, free of charge, under the terms and conditions of the Electronic Document and Electronic Signature Act (ZEDEP) through an electronic service provided by the National Health Insurance Institute. your three names and the date of election.
In the case of permanent inability of the chosen doctor to provide primary outpatient care, the health insured person has the right to a new choice.
If you change your address, you also have the right to choose a new doctor without observing the specified annual deadlines. In this case, you fill in a registration form for the permanent choice of a general practitioner, which you obtain in the manner described above .
If you are staying in a populated place outside of your permanent residence for a period of up to 1 month and you need to receive medical assistance incidentally due to an acute condition, you can turn to any general practitioner for assistance. It is enough to give him provide your health insurance card. You will only pay the legally regulated user fee.
If you are in another settlement for more than 1 month, you must make a temporary choice of a general practitioner at the place outside your permanent place of residence. The temporary choice can be for a period of 1 to 5 months. It is carried out with a registration a form for temporary selection of a general practitioner, which you can obtain in the manner already described. When your temporary selection expires outside the health area in which you have made a permanent selection, the last permanent selection of a general practitioner is automatically restored.
The general practitioner examines you, prescribes you treatment, prescribes you medicines, carries out preventive examinations and immunizations, sends you for consultations with a specialist (with a referral for consultations), for laboratory tests (with a referral for medical-diagnostic tests ), directs you for an examination to a Medical Advisory Committee (MAC) (with an MAC voucher).
The general practitioner creates and stores for each of his patients a health file, which contains not only outpatient sheets of the examinations and activities he performed, but also outpatient sheets of specialists; results of performed medical-diagnostic activities and tests; a copy of medication protocols; a medical record (if you have been diagnosed with it) that contains the above-mentioned diseases; a pregnancy prevention card All citizens with health insurance, as well as those whose health insurance rights have been interrupted, have the possibility of quick and complete online access to the medical and dental care they use. For this purpose, they must have a unique access code (UKD ) to the Personalized Information System (PIS) of the NHIF, which is issued by the NHIF.

Preventive examinations

The preventive examinations paid by the NHIF for all citizens with health insurance are mandatory.
Citizens with health insurance over the age of 18 - regardless of whether they are medically examined or not, have the right to one mandatory preventive examination during the relevant calendar year. The personal physician cannot refuse to perform it. This is his duty.
Each general practitioner (private) doctor places in a generally accessible place in his office information about the type and frequency of preventive examinations and tests to which persons over the age of 18 are subject. In the general practitioner's outpatient clinic, on site, available to patients, the monthly schedule of the general practitioner is published, which also contains hours for promotional and preventive activities. research.
NHOC has developed a Child Health program, which includes preventive activities - various examinations, tests and immunizations. The monitoring is carried out by the child's personal physician. If his personal physician is not a pediatrician, at the request of parents, a doctor specializing in Pediatrics can be selected for monitoring under the Children's Health program. For this purpose, the general practitioner (personal) doctor must issue a Direction for consultation or joint treatment. Only the personal doctor can perform the immunizations of the child according to the immunization calendar, and the pediatrician monitors him only under the Children's Health program. Children up to the age of 18 have unlimited access to children's profile specialists. The GP cannot refuse a one-time consultation with a specialist doctor (when this is required).
Under the Child Health program, until the 28th day after birth, the child is visited by a doctor at home. Two examinations are performed until the child reaches the age of one month with a recommended interval of 7 to 14 days. The first examination is performed up to 24 hours after discharge from the medical facility if the child's parents have chosen a doctor (general practitioner or pediatric specialist).
The home visit made by the general practitioner is not paid for by the parents. Periodically, in accordance with the Children's Health program, the doctor performs the necessary examinations and tests, which are free of charge. They are tailored to the respective age of the child.
Up to 14 days after discharge, the newborn can be visited at home by a nurse, midwife or physician's assistant to provide health care if the GP has contracted to provide a Health Care package .
The Maternal Health program of the NHIF includes examinations and tests to monitor the pregnancy. Pregnant women with a normal pregnancy have the right to choose who will monitor their pregnancy. This can be either their general practitioner or a specialist Obstetrics and gynecology. The pregnancy is monitored by a specialist in obstetrics and gynecology, issued by the general practitioner (GP), once during the pregnancy and the first 42 days after the birth. If the pregnant woman requests to change the obstetrician, the general practitioner should issue a new referral to change the specialist at any time. In case the general practitioner monitors the pregnancy, consultations with a specialist in obstetrics and gynecology are provided for in the program.
All health-insured citizens over the age of 18 have the right to one preventive examination per year. It is carried out by the personal physician. The preventive examination includes: calculation of the body mass index, assessment of mental status, examination of the acuity of vision, blood pressure measurement, electrocardiogram, urine test with test strips in the office for: protein, glucose, ketone bodies, urobilinogen/bilirubin, pH, determination of blood sugar in the laboratory in the presence of risk factors the volume of the preventive examination depends on the age group in which the patient falls. For example, once every 2 years men who have reached the age of 50 are examined so-called prostate-specific antigen (PSA - total and free), and women (from 50 to 69 years of age) have a mammography of the mammary glands (for this purpose, the personal physician issues an MOH-NHOK form No. 4). If in the course of the year the insured have all these tests done on another occasion - for example due to illness, they are not done again.

Home Visits

It is the duty of the general practitioner to make home visits to the health insured registered in his patient list. The schedule for these visits is announced in a prominent place in front of his office. A contact phone number should also be indicated there. In the event of a home visit to the GP, patients should only pay a user fee for the medical assistance provided.

User Fee

According to the Law on Health Insurance in Bulgaria, for every visit to a doctor, dentist, laboratory or during treatment in a hospital, citizens with health insurance pay a user fee, which remains at their expense.
When tests are carried out on health insured persons (HIPs) in a laboratory appointed by the general practitioner, the specialist doctor or the dentist, and biological material is taken in the laboratory, a price for taking a biological sample is paid material (for one visit to the laboratory, regardless of the number of tests). For these medical-diagnostic activities, the relevant contractor can determine a price for taking biological material, and the amount is paid by the health insured person.
In the event that a health care provider pays a price for taking biological material, the laboratory cannot demand a fee from him for tests in the same laboratory according to Article 37 of the Health Care Act. In medical institutions performing medical-diagnostic activities, for for which no price is paid for the collection of biological material, the ZOL pays the fee according to Article 37 of the ZZO.
Persons without income, placed in homes for children and adolescents, homes for children of preschool age and homes for social care, are exempted from paying a price for the collection of biological material.
The physician, dentist, hospital or laboratory must issue to the health insured persons a receipt or receipt for each amount paid.
Children are exempt from paying a user fee for outpatient, hospital and dental care provided, but they pay the so-called fee for taking biological material in a laboratory.
User fees for outpatient and hospital medical and dental care are not paid and:

• persons with diseases defined by a list to the NRD;
• minors and minors;
• non-working family members;
• injured in or in connection with the defense of the country;
• war veterans, war disabled;
• persons detained;
• detained on the basis of Article 72 of the Law on the Ministry of Internal Affairs;
• detained on the basis of Article 125, paragraph 1 of the Law on the State Agency for National Security or deprived of liberty;
• socially weak, receiving benefits under the Regulations for the Implementation of the Law on Social Assistance;
• persons accommodated in homes under Article 36, Paragraph 3, Item 1 of the same regulation;
• medical professionals;
• patients with malignant neoplasms;
• pregnant and parturient women up to 45 days after birth;
• health-insured persons suffering from diseases with more than 71% reduced working capacity, according to the Ordinance on Medical Expertise.

Access to specialized outpatient care

The general practitioner assesses whether you need a consultation with a specialist doctor. He sends you with a referral slip to a doctor with the relevant specialty. The referral can be used up to 30 calendar days after it is issued. The specialist doctor performs an examination and if additional tests are necessary, he issues a referral for them. The specialist doctor can perform an examination without a new referral until 30 days after the date of the first examination. In this case, the personal physician does not need to issue a new referral.

Medical-diagnostic studies

In children:

Issuing a medical referral by the general practitioner (personal) doctor for consultation or for medical-diagnostic tests for a child is done at his discretion, according to the need and condition of the child.
All general practitioners may refer unlimited children up to the age of 18 for consultation by a doctor with acquired specialty in Pediatrics, Pediatric Gastroenterology; Pediatric Endocrinology and Metabolic Diseases; Pediatric Cardiology Pediatric Hematology and Oncology; Pediatric Pneumology and Pediatric Surgery.

For persons over 18:

The general practitioner issues a Direction for medical-diagnostic activity (Bl. MH-NHOC No. 4) for highly specialized medical-diagnostic examinations (VSMDI), in the cases of:
- written appointment by TELC or NELC;
- for VSMDI: Mammography of both mammary glands and Ultrasound of the mammary gland from the Imaging package, hormones: fT4, TSH, Tumor marker PSA - total and free and Urinalysis-microalbuminuria from the Clinical package laboratory.
- for VSMDI, which also appear as medical-diagnostic studies (MDI) in another package in another specialty.
The general practitioner issues a referral for highly specialized activities (bl. MH-NHOC No. 3A) for the activities included in the dispensary monitoring of health insured persons (HIP) according to annexes to the National Framework Agreement.
The general practitioner has: medical referrals for consultation or conducting joint treatment; medical referrals for highly specialized activities included in the dispensary monitoring of health-insured persons, according to the annexes to the NRD and VSMD from the package Anesthesiology and intensive care , and directions for medical-diagnostic activities.
Appendices are published on the website of the NHIF - in the menu National framework contract for medical activities.
Researches are carried out in a laboratory that has signed a contract with the National Health Insurance Fund. The direction can be used up to 30 calendar days from its issuance. The research can be carried out in a medical facility throughout the country.

Patient Rights and Obligations

Responsibilities of institutions under the Health Insurance Act (HILA)

Compulsory health insurance provides a package of health activities guaranteed by the NHIF budget.
Compulsory health insurance guarantees free access of insured persons to medical and dental care through a package of health activities defined in terms of type, scope and volume, as well as free choice of a contractor who has entered into a contract with a regional health insurance fund . The right to choose is valid for the entire territory of the country and cannot be limited on geographical and/or administrative grounds.

Compulsory health insurance is carried out on the principles of:

• mandatory participation in the collection of contributions;
• participation of the state, the insured and employers in the management of the NHIF;
• solidarity of the insured in the use of the collected funds;
• responsibility of the insured for their own health;
• autonomy in the use of medical assistance;
• equal status of medical care providers when concluding contracts with the Public Health Service;
• NHOC self-management
• negotiation of the relationship between the NHIF and the providers of medical care;
• package of health activities guaranteed by the NHIF budget;
• free choice of providers of medical assistance;
• publicity in the activity of the NHIF and public control over its expenses.

Compulsorily insured citizens have the right to:

• to receive medical assistance within the scope of the package of health activities guaranteed by the NHIF budget;
• to choose a medical care contractor who has signed a contract with the RHOC;
• to receive information from the Health Care Agency about the contracts concluded by it with the providers of medical care;
• to participate in the management of the NHIF through their representatives;
• to submit complaints to the director of the relevant RZOK when they are not satisfied with the medical activities related to the provided medical assistance (e.g. reported but not performed medical activity; denied access to medical documentation; received from a medical provider or dental aid sums without legal basis, etc.).

The National Health Insurance Fund plans, negotiates and purchases for the health insured persons the individual types of medical assistance according to Article 55, Paragraph 2, Item 2 of the Health Insurance Fund within the scope of the volumes agreed in the national framework contracts and in accordance with with the NHIF budget for the relevant year.
The Supervisory Board of the NHIF determines by its decision a list of diseases for the home treatment of which the NHIF fully or partially pays medicinal products, medical devices and dietary foods for special medical purposes, on the proposal of the manager of the NHIF, in accordance with the criteria , determined by the Minister of Health.
NHOK does not determine the medicinal products, their prices and the diseases for which it will pay, according to the Law on Medicinal Products in Human Medicine that entered into force and its amendments as of June 1, 2009. Medicinal products, the level of payment for all medicinal products, the restrictions in the way of prescribing for different indications, as well as the specific value that the NHIF pays, are determined by the National Council on Prices and Reimbursement of Medicinal Products to the Minister of Health.
NHOC negotiates discounts for the medicinal products included in Appendix No. 1 and No. 2 of the Positive Drug List with the holders of the authorization for use or with their authorized representatives on the territory of the Republic of Bulgaria, according to Ordinance No. 10 of 24.03.2009 on the terms and conditions for payment of medicinal products under Article 262, Paragraph 6, Item 1 of the Law on Medicinal Products in Human Medicine, of medical products and of dietary foods for special medical purposes, as well as of medicinal products for health activities under Article 82, Paragraph 2, Item 3 of the Health Act. Payment for the medical care provided to the insured person is made by the NHRI to the contractor who provided it. Medical care beyond the scope of what is agreed in the National Framework Agreement (NRD) is not paid by the NHRI. Uninsured persons under the NHRI pay for the care provided to them medical and dental care.

National Framework Agreement

A National Framework Agreement is signed for the implementation of the activities provided for in the PPE.
Representatives of the NHIF for signing the NRD are members of the supervisory board and the manager of the NHIF. The contract is re-signed by the Minister of Health.
The national framework contract is promulgated in the State Gazette and is binding for the NHIF, the RHIF and the contractors. The national framework contract contains:

• the conditions to which the providers of medical care must comply, as well as the procedure for concluding contracts with them;
• the separate types of medical assistance under Article 45 of the Health Insurance Act;
• the conditions and procedure for providing individual types of medical assistance;
• the volumes, prices and methodologies for valuation and purchase of types of medical assistance;
• criteria for quality and accessibility of contracted medical care;
• documentation and document flow;
• the obligations of the parties on the provision of information and the exchange of information;
• the conditions and procedure for monitoring the performance of contracts;
• sanctions for breach of contract;
• other questions relevant to health insurance.

When the National Framework Contract for medical and, respectively, dental activities are not adopted under the conditions and within the time limits defined in the Law on Health Insurance, the current NRD shall apply. In these cases, when changes in the current legislation impose an amendment or supplement to the requirements contained in the NSD (if the law on the budget of the National Health Insurance Fund for the next year foresees the financing of new medical activities, respectively dental activities, medicinal products and medical devices), they are determined by a decision of the supervisory board of the National Health Insurance Fund on the proposal of the manager of the NHIF.
In the sense of the Law on Health Insurance, providers of medical care are: medical institutions (under the Law on Medical Institutions) and national centers for public health problems (under the Law on Health).
Contracts for the provision of medical assistance under the Health Care Act and in accordance with the NRD are concluded between the director of the RZOK and the medical aid contractors. The contracts cannot be concluded under conditions more unfavorable than those adopted by the NRD. They are concluded in writing for the period of validity of the NRD and are valid until the adoption of a new contract or when the current NRD is changed.
Medical care providers are obliged to submit to the National Health Insurance Fund information about their activities according to the methodology and volume accepted by the National Revenue Agency. The National Revenue Agency (NAA) is obliged to provide information to the National Health Insurance Fund about the insured persons, as and for the amount of health insurance contributions collected for them.
The control over the implementation of the budget of the NHIF is carried out by the Audit Chamber. The overall financial control of the NHIF is carried out in accordance with the Law on State Internal Financial Control. The direct control is carried out by officials of the NHIF - financial inspectors and medical examiners.
The Minister of Health carries out specialized medical supervision on access to medical assistance and on the quality of the performed health activities and services related to the implementation of mandatory and voluntary health insurance.