What is the NHIF
The National Health Insurance Fund is an independent public institution established to provide compulsory health insurance to the citizens of Bulgaria. It works towards the continuous improvement of health services and ensuring equal access to them for all Bulgarians.
The NHIF works with self-insured individuals and those whose health insurance is provided by their employer. They require mandatory health insurance and free and equal access to medical care.
The Fund gives you a choice of specialists working with it, from whom to receive the necessary services in inpatient and outpatient care and in the field of dentistry.
Dentist who works with the NHIF
This is a dental specialist who has a valid contract with the health insurance fund for services for which he receives a certain payment according to the adopted National Framework Agreement.
Every health-insured person with permanent rights can choose and visit any dentist working with the Fund, regardless of his/her address registration, and cannot be refused to perform the procedures covered by the insurances.
What is the procedure when using the NHIF
The patient is required to bring his or her health insurance book with him or her to each visit to the office of a dental specialist who works with the NHIF. The results of the examinations and procedures are recorded in the book. When the blank pages in the booklet are finished, a gadget is added. This is accomplished through address registration at the Regional Health Insurance Fund's office.
On the official website of the National Health Insurance Fund, you can find a list of all dentists in Bulgaria who have signed a contract and provide services covered in whole or in part by the Fund.
When visiting a dental specialist, the patient carries his/her personal health insurance book, in which the dentist enters the performed activities.
When the pages in the health insurance book are exhausted, an additional sheet supplement to it is used according to a model approved by the Bulgarian Dental Association (BDA) and the National Health Insurance Fund (NHIF). Insured persons receive this document at the Regional Health Insurance Fund (RHIF).
The data of the attending dentist must be entered in the health insurance book. A signature and seal are also required. The codes of the performed activities and those of the teeth on which they were performed, as mentioned in the National Health Insurance Fund regulations, shall also be entered. The date on which the treatment was performed is also added.
Which services are covered by the NHIF
Every person with a health insurance policy has the right to use a package of services within the calendar year (from January to December). The services included in this package, which are paid in full or in part, are agreed upon annually by the NHIF and are specified in the National Framework Agreement.
The right of the insured persons is to be informed about the volumes and values of the agreed activities before they are provided with dental services.
1. Dental activities for persons under 18 years of age who are fully or partially paid by the NHIF:
- Detailed examination and recording of dental status once for the respective calendar year with a surcharge of BGN 1.80.
Up to four treatment activities for the respective calendar year, including:
- Obturation (seal) - free of charge;
- Extraction (extraction of a tooth) of a temporary tooth - free of charge;
- Extraction of a permanent tooth - free of charge;
- Treatment of pulpitis or periodontitis of a temporary tooth - additional payment of BGN 4.70;
- Up to two treatments for pulpitis or periodontitis of a permanent tooth - additional payment of BGN 12.30.
- Specialized surgical thorough examination (additional payment BGN 1.80); incision in connective tissue lodges, incl. anesthesia (surcharge BGN 3.00); extraction of a deeply fractured or deeply destroyed tooth, incl. anesthesia (surcharge BGN 5.00); control examination after one of the above two activities (surcharge BGN 0.80).
For mentally ill persons up to 18 years of age, the above procedures are fully covered by the NHIF, without limiting the volume of dental activities. All of them must be performed under general anesthesia.
2. Dental activities for health insured persons over 18 years of age, which are fully or partially covered by the NHIF:
- Detailed examination with removal of dental status once for the respective calendar year with additional payment of BGN 1.80.
Up to three treatment activities for the respective calendar year, including:
- Fillings with amalgam or chemical composite - surcharge BGN 4.00;
- Extraction of a permanent tooth (tooth extraction) with anesthesia - surcharge BGN 4.00
- Restoration of the function of the masticatory apparatus in case of completely edentulous lower or upper jaw with a whole plaque denture, incl. and control examinations for 4 years for persons aged 65 to 69 years. This does not include the work of dental technicians and the necessary materials for the manufacture of the prosthesis, but only the work of the dental specialist.
- Specialized surgical thorough examination (surcharge BGN 1.80); incision in connective tissue lodges, incl. anesthesia (surcharge BGN 7.50); extraction of a deeply fractured or deeply destroyed tooth, incl. anesthesia (surcharge BGN 13.50); control examination after one of the above two activities (surcharge BGN 0.80)
Health insured persons aged 65 to 69 inclusive are entitled to the volume of activities (thorough examination with withdrawal of oral status once for the respective calendar year and up to 3 medical activities for the respective calendar year), and up to two activities are added to them to restore the function of the masticatory apparatus in edentulousness (respectively one for the upper and lower jaw), incl. and control examinations due for 4 years.
Pregnant women are also entitled to an additional thorough examination with the removal of dental status, which is also covered by the Fund.
What happens if the NHIF does not cover certain treatments or medications
In many cases, the treatment you need is not fully covered by the NHIF. Then your dental specialist must inform you what part of it is not included in the package, what amount you will have to pay extra, and exactly what it is for.
It is most often paid for photopolymer fillings, because the Fund does not cover this type of material. The additional payment depends on how big the obturation is, whether it is on two surfaces, etc.
In addition, the NHIF does not cover any services offered by dental technicians - making crowns, bridges, dentures. The patient pays the medical and technical activity for their production. This also applies to the materials used to make them. When it comes to plaque dentures, patients sign a declaration that they are aware of the need to pay extra to the part that is covered by the Fund.
The anesthesia is also not covered by the package of services for health-insured persons. If you want them to be used during the treatment, you will pay extra. Every dental specialist should be able to provide you with a price list of their services, which you should get acquainted with before proceeding to perform manipulations.
