The Romanian social health insurances offer access to a minimum and a basic package of services.
These include medical services for disease prevention, curative medical services, medicines and medical devices.
The service packages within the social health insurance system are established by Government Decision, at the proposal of CNAS in accordance with the aspects provided by the Parliament in the law governing the health system (Law no. 95/2006).
We specify that starting with July 1, 2021, the medical packages regulated by HG no. 696/2021 apply.
Also, the list of medicines benefited by the insured in a compensated or free system is approved by the Government, at the proposal of the Ministry of Health, with the approval of CNAS.
The last update was made by CNAS Order 734/2021, published on 30.07.2021, with applicability from August 1, 2021.
The contribution of social health insurance (CASS), as well as the amounts coming from other sources, such as interests, donations, subsidies from the state budget, constitute the Single National Health Insurance Fund (FNUASS).
It is managed by CNAS, together with the health insurance companies. It is useful to mention that the FNUASS budget, including the way in which the amounts are allocated on different assistance segments, is approved by the Parliament, at the proposal of the Government, and represents an annex to the state budget law.
The collection of the social health insurance contribution is the responsibility of the Ministry of Public Finance, through the National Agency for Fiscal Administration (ANAF).
The incomes for which the social health insurance contribution is due and the contribution quota are defined by the Fiscal Code.
Health insurance companies (not CNAS) conclude direct contracts with medical offices, clinics, hospitals, pharmacies, laboratories and other providers.
The medical services that are found in the packages settled from FNUASS are granted based on the contracts between the health insurance houses and providers. Thus, the health insurance houses:
- does not conclude contracts directly with the insured, but with the providers of medical services;
- does not reimburse to the insured the equivalent value of the medical services they benefited from, but to the providers with whom they are in contract
Medical service packages:
Within the social health insurance system, the insured persons, regardless of the form in which the quality of insured was acquired, benefit from medical services, medicines and medical devices, included in the basic package, provided by the family doctor or the specialist doctor, in outpatient or in hospital.
Uninsured persons benefit from services included in a minimum package of medical services, which refer especially to medical-surgical emergencies and diseases with endemo-epidemic potential, monitoring the evolution of pregnancy and childbirth, family planning services, prevention services.
In addition to the minimum package, the insured also benefit from paraclinical investigations, medical and palliative care at home, reimbursed medicines, medical devices, medical recovery services, physical medicine and rehabilitation.
The quality as assured person:
The Fiscal Code regulates the method of payment of the social health insurance contribution (CASS): “The share of the social health insurance contribution is 10% and is due by the natural persons who have the quality of employees or for whom there is the obligation to pay the social health insurance ”.
The data necessary for establishing the quality of the insured are transmitted to CNAS by the competent public authorities and institutions, based on protocols.
The quality of insured is granted from the moment of registering these data in the computer platform of the health insurances.
The categories of persons who receive insurance without paying the contribution include, but are not limited to:
- children up to the age of 18 and young people aged 18-26, if they are students, including high school graduates;
- students and doctoral students who carry out teaching activities;
- husband, wife and parents without their own income, who are dependent on an insured person;
- pregnant women and women;
- people with disabilities;
- patients with diseases included in the national health programs established by the Ministry of Health, until the cure of that disease.
Among the most important rights enjoyed by the insured persons within the social health insurance system are:
– choosing the providers of medical services, as well as the health insurance company to which they register;
– registration on the list of a family doctor you request;
– change of the chosen family doctor, only after the expiration of at least 6 months from the date of registration on its lists;
– the right to benefit from preventive health care and health promotion services, medical services in outpatient clinics and hospitals under contract with health insurance companies, emergency medical services, some dental care services, physiotherapy and recovery treatment , medical devices, technologies and assistive devices;
– guaranteeing the confidentiality regarding the data, especially regarding the diagnosis and the treatment;
– having the right to information in case of medical treatments;
– the right to benefit from holidays and social health insurance indemnities, in accordance with the law.
In order to benefit from the aforementioned rights, the insured have the following obligations:
- to register on the list of a family doctor;
- to notify the family doctor whenever there are changes in their health;
- to present at prophylactic and periodic controls;
- to notify within 15 days the family doctor and the health insurance company on the changes of the identity data or of the changes related when they are included in a certain category of insured persons;
- to respect the treatment and the indications of the doctor and to have a civilized conduct towards the medical-sanitary personnel;
- to pay the contribution due to the fund and the amount representing the co-payment / personal contribution, in accordance with the law.
We mention that all the rights and obligations of the insured can be studied by accessing the following link: http://cnas.ro/drepturi-obligatii-asigurati/
Accessing medical services abroad
Persons insured in the Romanian social health insurance system, located on the territory of the states with which Romania has concluded international agreements with provisions in the field of health, benefit from medical services on the territory of these states, under the conditions provided by the respective international documents.
Given that Romania is an EU member state, the quality of insured in the social health insurance system in Romania is recognized on the territory of any EU Member State / EEA / Swiss Confederation / United Kingdom of Great Britain and Northern Ireland.
Thus, depending on the forms issued by the health insurance company (European health insurance card or European forms / documents), the insured can benefit, as the case may be:
- medical services that have become necessary;
- planned treatment;
- all the medical services of any insured person in that Member State.
Thus, the European Health Insurance Card (CEASS) is a free card with which, if necessary, the insured can benefit from medical services in the public system, which become necessary during the temporary stay in any of the Member States of the European Union, the Economic Area European Union (Iceland, Liechtenstein, Norway), the Swiss Confederation and the United Kingdom of Great Britain and Northern Ireland, granted under the same conditions and at the same rates as insured persons in that country
We specify that by temporary stay is meant the movement of a person for tourist, professional, family or study reasons.
The European health card can be requested by any person who proves the quality of insured in the social health insurance system in Romania and is valid for 2 years.
CNAS representatives specify that the medical services provided on the basis of the card must not exceed what is medically necessary during the temporary stay in the Member State where the trip is made, being provided in accordance with the legislation of that Member State.
Covered benefits include, for example, services for chronic or existing diseases (example: dialysis), as well as for pregnancy / birth.
The European Health Insurance Card can be obtained from the health insurance company in which the person is registered. In order to obtain it, the insured submits an application in a standardized format, the model of which can be accessed on the website of CNAS or of the health insurance companies.
http://cas.cnas.ro/casmb/page/cardul-european.html
Attention!
For certain medical services it may be necessary to pay, which will be borne by the insured, even if in Romania the same services are fully settled.
The card does not cover the situation in which the trip aims to obtain the planned medical treatment.
If during the validity of the card, at the time of obtaining medical services, the person is no longer listed as insured, the health insurance company that issued the card, as payer of those medical services, will recover their value from that person.
It is possible to request, for a fee, the issuance of another card, whose validity period will not exceed the validity period of the initial card.
The card cannot be used in Romania.
The card can be refused by the medical service providers from the community space if the medical service provider does not carry out its activity within the public health system of the respective country, if the respective medical services are not settled in the public health system of that country or if the document was used in other situations than those for which it was issued (the medical services provided did not fall into the category of those that became necessary during the temporary stay).
The procedure for reimbursing cross-border healthcare is applicable only to the Member States of the European Union and to any provider of medical services who legally provide healthcare in the territory of a Member State of the European Union.
Detailed information on how the reimbursement procedure to which the insured is entitled is carried out can be requested directly from the health insurance company in the records on which he stands.
Portable document S1 (DP S1) – registration for medical insurance – is issued for employees or self-employed workers, who are insured in Romania and who work in another European state, in the following situations: seconded persons or in case of multi-activity, workers border guards, pensioners, civil servants and their family members.
DP S1 replaces the European forms E106, E109, E120 and E121 and represents a document certifying the right to healthcare for the categories of persons mentioned above, in their Member State of residence.
Based on DP S1, the insured person benefits from medical assistance in accordance with the social security legislation of the respective member state, as if the person were insured in the social security system of that state.
Detailed information on how to obtain DP S1 can be requested directly from the health insurance company in the records of the insured.
Portable document S2 (DP S2) – document opening rights to planned treatment: In the case of moving to another Member State in order to benefit from the planned medical treatment, the prior approval of the health insurance company is required.
The authorization involves the issuance by the health insurance company of DP S2, which replaces the European form E112.
Based on DP S2, the insured benefits in the Member State of residence of the planned medical assistance, granted in accordance with the social security legislation of the respective Member State, as if he were insured in the social security system of this state
Attention!
The authorization is granted if the respective treatment is included in the package of basic services regulated by the Romanian legislation and in the situation where the respective insured cannot be granted such treatment within a medically justified term, having – the state of health and the probable evolution of the disease are taken into account.
We mention that DP S2 does not cover the expenses related to transport, accommodation and possible co-payments existing in the Member State of treatment according to the legislation that it applies.
DP S2 can only be accepted by health units in the social security systems of the EU / EEA / Swiss Confederation / United Kingdom Member States in the United Kingdom and Northern Ireland.
Legal basis:
– HG 696/2021 for the approval of the service packages and of the Framework Contract that regulates the conditions for providing medical assistance, medicines and medical devices, technologies and assistive devices within the social health insurance system for the years 2021-2022;
– Emergency Ordinance 54/2021 for the amendment and completion of art. 230 and 349 of Law no. 95/2006 on health care reform;
– Law 95/2006 on health care reform – republished.