The European Health Insurance Card (EHIC) allows Bulgarian citizens to receive emergency medical treatment free of charge while traveling within the European Union, as well as in countries like Norway, Iceland, Liechtenstein, Switzerland, the United Kingdom, North Macedonia, and Serbia. This document ensures that medical expenses are covered at the rates applicable to local residents, with Bulgaria’s National Health Insurance Fund (NHIF) reimbursing the costs. However, despite the benefits it offers, relatively few Bulgarians apply for it.

In 2024, Bulgarian citizens made approximately 8.8 million trips abroad, with about 5 million—over 56%—of those being to EU countries. The most visited destinations included Greece, Romania, Germany, Italy, and Austria. However, only around 160,000 to 170,000 EHICs are issued annually in Bulgaria, a small fraction of the number of travelers. Given that the card is valid for only one year, it is likely that a significant portion of applicants are repeat users who renew it annually.

Between 2018 and 2023, the NHIF received reimbursement claims for 184,900 cases, totaling 345.6 million leva. Preliminary data for 2024 indicates claims amounting to 24.3 million leva for 11,800 cases. Germany remains the country with the highest number of reimbursements, accounting for 45.6% of the total amount—157.5 million leva—due in large part to the sizable Bulgarian diaspora there. Over the years, Spain, Greece, and Belgium have also been among the leading countries in terms of medical expenses covered through the EHIC.

Until recently, obtaining the card was a cumbersome process, requiring individuals to visit one of approximately 120 branches of First Investment Bank, submit an application, and return two weeks later to collect the document. This requirement deterred many potential applicants, despite the card being free of charge. In 2016, the NHIF even attempted to shorten the validity period to six months to prevent abuse, though the proposal was not implemented.

A significant improvement came in 2022, when blogger Boyan Yurukov successfully pushed for an electronic application process. Initially, while applications could be submitted online, collection still required a physical visit. However, since the end of 2024, the entire process has been digitized. Now, applications can be submitted through the Ministry of Electronic Governance (MEG) website, with the option to receive the card by mail.

To apply, users must register on the MEG platform using a qualified electronic signature (QES), mobile QES from B-trust or Evrotrust (both 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 complete an electronic form. The form requires personal details, including names in both Cyrillic and Latin, contact information, and, if applying on behalf of another person, their relevant data.

Applicants then choose how to receive their EHIC. While in-person collection is still available at regional NHIF offices, most now opt for delivery via domestic or international courier services. The card itself remains free, though applicants must cover any courier costs. Once processed, the card arrives within two weeks, eliminating the need for physical visits to bank branches.

Despite its advantages, the EHIC is not universally accepted. In some Greek islands, for example, emergency procedures such as surgeries for injuries or fractures are often handled by private hospitals that do not recognize the card. Patients in such cases must either pay for treatment or seek care at state-run facilities, which may involve long waiting times.

For those who end up paying for medical services while traveling, reimbursement remains an option. Upon returning to Bulgaria, individuals can submit original invoices and payment receipts to their regional NHIF office, where they will be informed about the possibility and extent of cost recovery.