The Closed List That Decides Everything: Long-Term or Permanent Residence Gets You Insured, a One-Year Permit Does Not
Answer
The general rule applies to you
No exception is recorded for citizens of Malta on this topic. That is the answer, not a gap - everything below is the rule you get, unchanged.
172 exceptions recorded across 63 countries · none match Malta to Bulgaria · Access to healthcare
Article 33(1) of the Zakon za zdravnoto osiguryavane is a closed list of who is compulsorily insured with the National Health Insurance Fund, and for foreigners it turns on which residence status you hold rather than on how long you have been here. Point 3 covers foreign nationals and stateless persons who have been granted long-term or permanent residence - the five-year Union status and the national permanent status - unless an international treaty says otherwise. It does not cover the ordinary one-year continuing-residence permit on which almost every new arrival lives, and that gap is filled by three later additions rather than by a general rule: point 4b for holders of an EU Blue Card, added in 2023, and points 4v and 4g for holders of a Single Permit for residence and work and of a seasonal-work permit, both added by ДВ бр. 52 от 2025 г. A digital nomad, a pensioner, an investor on a one-year permit and a family member are in none of them, which is why the implementing regulation of the Aliens Act asks for private medical insurance where the person is not insured under the Health Insurance Act. The obligation starts on the day the long-term or permanent permit is received, under article 34(1)(2), and it is enforced by suspension: article 109(1) cuts off the rights of anyone who owes more than three monthly contributions over 36 months, and article 109(2) restores them only once every contribution due in the last 60 months has been paid.
At a glance
- Who is compulsorily insured
- Foreigners granted long-term or permanent residence
Article 33(1)(3) of the Health Insurance Act, subject to any international treaty.
- Holders of a one-year continuing-residence permit
- Not in article 33(1) of the Health Insurance Act, except for Blue Card, Single Permit and seasonal-work holders
Points 4b, 4v and 4g, added in 2023 and 2025. The implementing regulation of the Aliens Act asks everyone else for private medical insurance.
- When the obligation starts
- The date the long-term or permanent permit is received
Article 34(1)(2) of the Health Insurance Act.
- Arrears that suspend your rights
- More than 3 monthly contributions in 36 months
Article 109(1). While suspended, you pay for the care you receive.
- What it takes to get them back
- Every contribution due in the last 60 months
Article 109(2), and sums already paid for care are not refunded.
- Already insured in another member state
- Then not compulsorily insured here
Article 33(2), which gives way to the social security coordination rules.
Requirements
- Long-term or permanent residence, or a Blue Card, Single Permit or seasonal-work permit, for compulsory insurance
- Private medical insurance valid in Bulgaria, where you are not insured under the Health Insurance Act
- Contributions paid, because arrears suspend the right to use the system
Country-level policy
Bulgaria's currency is the euro. Article 4 of the Zakon za vavezhdane na evroto v Republika Balgariya says so in terms, and the Payment Services Act was amended with effect from 1 January 2026 so that a basic payment account provides its services in euro. None of that redenominated the statutes. The Aliens Act still asks for 600,000 leva of real estate, 250,000 leva in a disadvantaged region, 500,000 leva with ten jobs, 2,000,000 leva in listed securities and 6,000,000 leva in an unlisted company, because the Euro Introduction Act did not go through the statute book changing numbers. It did something else: article 11(1) says the introduction of the euro does not affect the operation of existing legal instruments that refer to the lev, and article 11(2) says amounts stated in leva in existing legal instruments are treated as amounts in euro at the official rate, with the conversion rule in article 12 and the rounding rule in article 13. So the lev figures in the Aliens Act are live law and are read as euro, and a reader converting them is doing what the statute tells them to do rather than correcting an oversight. Where an amendment does touch such a provision it is expected to carry the euro figure across: paragraph 5(2) of the transitional provisions requires that, for sums that came into Bulgarian law from a Union act which stated a euro amount.
What applies to you
Nothing changes for a citizen of Malta
We have no rule recorded that treats your citizenship differently here, so the general rule above is the one that applies to you. That is an answer, not a gap.
What the law says
«чуждите граждани или лицата без гражданство, на които е разрешено дългосрочно или постоянно пребиваване в Република България, освен ако е предвидено друго в международен договор, по който Република България е страна;»Our translation - not official
foreign nationals or stateless persons who have been granted long-term or permanent residence in the Republic of Bulgaria, unless otherwise provided in an international treaty to which the Republic of Bulgaria is a party;
The status test, and it does not reach the one-year permit.
Read it at the sourceAbout this source
The national health insurance fund, which runs compulsory health insurance and publishes the acts it applies under /bg/regulatory/laws. Its copy of the Закон за здравното осигуряване is consolidated to ДВ бр. 68 от 28 юли 2026 г. and is the most current Bulgarian statute text read for this country.
Standing: Applies the rule
Cannot be cited for: The fund publishes several copies of the same Act at different upload identifiers, with no index and nothing on the page to say which is newest except the number in the path. It is authoritative about insurance and about nothing else, and the contribution rates it operates on are set by annual budget acts that are published separately.
We re-read it every 60 days. More about this source
«чуждите граждани, на които е издадено разрешение за продължително пребиваване и работа тип "Единно разрешение за пребиваване и работа";»Our translation - not official
foreign nationals who have been issued a permit for continuing residence and work of the "Single Permit for residence and work" type;
Added by ДВ бр. 52 от 2025 г., with a parallel point for seasonal workers.
Read it at the sourceAbout this source
The national health insurance fund, which runs compulsory health insurance and publishes the acts it applies under /bg/regulatory/laws. Its copy of the Закон за здравното осигуряване is consolidated to ДВ бр. 68 от 28 юли 2026 г. and is the most current Bulgarian statute text read for this country.
Standing: Applies the rule
Cannot be cited for: The fund publishes several copies of the same Act at different upload identifiers, with no index and nothing on the page to say which is newest except the number in the path. It is authoritative about insurance and about nothing else, and the contribution rates it operates on are set by annual budget acts that are published separately.
We re-read it every 60 days. More about this source
«Не са задължително осигурени в НЗОК лицата, които съгласно правилата за координация на системите за социална сигурност подлежат на здравно осигуряване в друга държава членка.»Our translation - not official
Persons who, under the rules on the coordination of social security systems, are subject to health insurance in another member state are not compulsorily insured with the Fund.
About this source
The national health insurance fund, which runs compulsory health insurance and publishes the acts it applies under /bg/regulatory/laws. Its copy of the Закон за здравното осигуряване is consolidated to ДВ бр. 68 от 28 юли 2026 г. and is the most current Bulgarian statute text read for this country.
Standing: Applies the rule
Cannot be cited for: The fund publishes several copies of the same Act at different upload identifiers, with no index and nothing on the page to say which is newest except the number in the path. It is authoritative about insurance and about nothing else, and the contribution rates it operates on are set by annual budget acts that are published separately.
We re-read it every 60 days. More about this source
«по чл. 33, ал. 1, т. 3 - от датата на получаването на разрешение за дългосрочно или постоянно пребиваване;»Our translation - not official
under article 33(1)(3) - from the date of receipt of the long-term or permanent residence permit;
About this source
The national health insurance fund, which runs compulsory health insurance and publishes the acts it applies under /bg/regulatory/laws. Its copy of the Закон за здравното осигуряване is consolidated to ДВ бр. 68 от 28 юли 2026 г. and is the most current Bulgarian statute text read for this country.
Standing: Applies the rule
Cannot be cited for: The fund publishes several copies of the same Act at different upload identifiers, with no index and nothing on the page to say which is newest except the number in the path. It is authoritative about insurance and about nothing else, and the contribution rates it operates on are set by annual budget acts that are published separately.
We re-read it every 60 days. More about this source
«Здравноосигурителните права на лицата, които са длъжни да внасят осигурителни вноски за своя сметка, се прекъсват, в случай че лицата не са внесли повече от три дължими месечни осигурителни вноски за период от 36 месеца до началото на месеца, предхождащ месеца на оказаната медицинска помощ. Лицата с прекъснати здравноосигурителни права заплащат оказаната им медицинска помощ.»The enforcement mechanism, and it is self-executing.
Read it at the sourceAbout this source
The national health insurance fund, which runs compulsory health insurance and publishes the acts it applies under /bg/regulatory/laws. Its copy of the Закон за здравното осигуряване is consolidated to ДВ бр. 68 от 28 юли 2026 г. and is the most current Bulgarian statute text read for this country.
Standing: Applies the rule
Cannot be cited for: The fund publishes several copies of the same Act at different upload identifiers, with no index and nothing on the page to say which is newest except the number in the path. It is authoritative about insurance and about nothing else, and the contribution rates it operates on are set by annual budget acts that are published separately.
We re-read it every 60 days. More about this source
«Здравноосигурителните права на лицата по ал. 1 се възстановяват, при условие че лицето е заплатило всички дължими здравноосигурителни вноски през последните 60 месеца.»Our translation - not official
The health insurance rights of the persons under paragraph 1 are restored provided that the person has paid all health insurance contributions due over the last 60 months.
About this source
The national health insurance fund, which runs compulsory health insurance and publishes the acts it applies under /bg/regulatory/laws. Its copy of the Закон за здравното осигуряване is consolidated to ДВ бр. 68 от 28 юли 2026 г. and is the most current Bulgarian statute text read for this country.
Standing: Applies the rule
Cannot be cited for: The fund publishes several copies of the same Act at different upload identifiers, with no index and nothing on the page to say which is newest except the number in the path. It is authoritative about insurance and about nothing else, and the contribution rates it operates on are set by annual budget acts that are published separately.
We re-read it every 60 days. More about this source
«задължителна медицинска застраховка, валидна на територията на Република България, когато лицето не е осигурено по ЗЗО;»Our translation - not official
compulsory medical insurance valid on the territory of the Republic of Bulgaria, where the person is not insured under the Health Insurance Act;
What the gap in article 33(1) costs in practice.
Read it at the sourceAbout this source
The interior ministry's migration directorate, which decides every residence permit in Bulgaria and keeps a page of the legislation it applies at /migration/дирекцията/нормативна-уредба/bgzac. The files behind it are prints generated by the commercial system Сиела and are the most current texts of the Aliens Act, its implementing regulation and the Act on Union citizens that any Bulgarian public body publishes.
Standing: Applies the rule
Cannot be cited for: The files are vendor prints, not official texts, and the vendor's watermark is injected into the running text where it interrupts sentences mid-clause. Worse, the directorate's server returns 403 to a direct download, so the only way in is the extraction service, which reads these PDFs as two columns and interleaves the words of long paragraphs: article 23(5)-(6) of the Aliens Act and article 16(3) of the Act on Union citizens both come back scrambled. Nothing may be quoted from this publisher without reading the sentence back in Bulgarian first. Its own HTML service pages, which describe procedures, were unreachable by every tool.
We re-read it every 45 days. More about this source
Practical notes
No contribution rate or amount is published here. The rate is set annually by the budget acts, which were not read.
Emergency care and the care a hospital must give regardless of insurance are governed by the Health Act, which was not read.
- administersЗакон за здравното осигуряване, consolidated text to ДВ бр. 68 от 28 юли 2026 г.
Национална здравноосигурителна каса
About this source
The national health insurance fund, which runs compulsory health insurance and publishes the acts it applies under /bg/regulatory/laws. Its copy of the Закон за здравното осигуряване is consolidated to ДВ бр. 68 от 28 юли 2026 г. and is the most current Bulgarian statute text read for this country.
Standing: Applies the rule
Cannot be cited for: The fund publishes several copies of the same Act at different upload identifiers, with no index and nothing on the page to say which is newest except the number in the path. It is authoritative about insurance and about nothing else, and the contribution rates it operates on are set by annual budget acts that are published separately.
We re-read it every 60 days. More about this source
- administersПравилник за прилагане на Закона за чужденците в Република България, consolidated text to ДВ бр. 7 от 2026 г.
Министерство на вътрешните работи, дирекция "Миграция"
About this source
The interior ministry's migration directorate, which decides every residence permit in Bulgaria and keeps a page of the legislation it applies at /migration/дирекцията/нормативна-уредба/bgzac. The files behind it are prints generated by the commercial system Сиела and are the most current texts of the Aliens Act, its implementing regulation and the Act on Union citizens that any Bulgarian public body publishes.
Standing: Applies the rule
Cannot be cited for: The files are vendor prints, not official texts, and the vendor's watermark is injected into the running text where it interrupts sentences mid-clause. Worse, the directorate's server returns 403 to a direct download, so the only way in is the extraction service, which reads these PDFs as two columns and interleaves the words of long paragraphs: article 23(5)-(6) of the Aliens Act and article 16(3) of the Act on Union citizens both come back scrambled. Nothing may be quoted from this publisher without reading the sentence back in Bulgarian first. Its own HTML service pages, which describe procedures, were unreachable by every tool.
We re-read it every 45 days. More about this source