In Croatia, there is both public and private health insurance that can be used with both public and private healthcare providers. HZZO, the state health fund, offers two options for health insurance:
Since basic obavezno health insurance is required of all residents, it is important to understand what the costs and covers before moving here. Be forewarned, it might give you sticker shock.
In this post, we’ll cover how everything you need to know about Croatia’s required state health insurance called “obavezno” including:
- What is included in Croatia’s state health insurance
- Who must pay for state health insurance including what is costs for all work, citizenship and residence situations
- Who must pay the year of “back pay” when first signing up
- Basics of dopunsko supplemental state insurance
- Other health insurance options in Croatia
This guide can help you plan your personal healthcare costs in Croatia and it can also help future business owners plan for the cost of employees. Employers are required by law to cover the cost of their employee’s basic obavezno health insurance.
Obavezno health insurance is offered through the state agency HZZO. This health care coverage is made up of 2 parts:
- Zdravstvena zaštita (health care)
- Novčana naknada (financial compensation)
Zdravstvena zaštita (health care)
The health care side of obavezno refers to your ability to get subsidized healthcare treatment from doctors or facilities that are in the HZZO system.
Since it is subsidized, you will pay a small co-pay in most cases for doctor or hospital visits as well as for most medications. To eliminate this co-payment, you must sign up for dopunsko supplemental coverage.
With obavezno, you have a right to:
- Primarna zdravstvena zaštita (primary health care)
- Family doctor
- E-uputnica (electronic referrals for laboratory tests)
- Specijalističko-konzilijarna zdravstvena zaštita (specialist-consultative health care)
- Medical examinations by specialist doctors
- Uputnica (referral)
- Putni nalog (travel warrant)
- Bolnička zdravstvena zaštita (hospital health care)
- Hospital treatment
- Uputnica (referral)
- Putni nalog (travel warrant)
- Medicines from osnovna lista lijekova (basic list) and dopunska lista lijekova (additional list) as determined by the HZZO
- E-recept (electronic prescriptions for medicines that can be picked up at a pharmacy)
- Dental aids from osnovna lista (basic list) and dopunska lista (additional list) determined by the HZZO
- Orthopedic and other aids from osnovna lista (basic list) and dopunska lista (additional list) determined by the HZZO
- Urgent or necessary health care in other EU member states
- Urgent health care in Bosnia and Herzegovina, Macedonia, Serbia, Montenegro and Turkey per an international agreement on social insurance – A form is required prior to travel.
Novčana naknada (financial compensation)
In addition to standard health care, you also have a right to financial compensation related to medical issues.
The situations in which you may receive financial compensation from HZZO through your obavezno insurance include:
- Salary compensation during temporary inability to work
- Salary compensation due to inability to perform working activities that prevent earning other types of income
- Compensation for transport costs due to the use of health care from obavezno zdravstveno
- Compensation for accommodation costs to a parent or a person who’s caring for a child during child’s hospital treatment
Basic health coverage through HZZO is charged depending on your situation. These are the situations that affect the cost of your health insurance:
- If you are not employed by a Croatian company and do not collect unemployment
- If you are employed by a Croatian company
- If you are an EU citizen
- If you are unemployed and collect unemployment
- If you are unemployed and married to an employed person
- If you are working as a freelancer for a Croatian company
- If you are retired and earn a foreign pension
- If you are retired and earn a Croatian pension
- If you are under 18 years old and the child of a Croatian or EU citizen
- If you are under 18 years old and the child of third-country citizens
- If you are a college student and under 26 years old
- If you are considered “low income”
- You are in a protected group
Now, we’ll go over each individual situation and cover the health insurance premiums.
This situation covers a good chunk of the foreigners living in Croatia. Perhaps you live here, but you earn an income that comes from abroad or maybe you’re just financially independent.
In this case, you pay the standard rate of 570-580 kuna per month. The exact rate in 2021 is 575,65 kuna per month.
Depending on the basis for you residence permit, the police may only require some kind of travel insurance for your permit application. This is because it’s unclear if you’ll be approved for residency. Once you are approved, you will be required to register for state health insurance.
If you are an employee in Croatia, your company is required by law to pay for your obavezno health insurance as part of your salary. If you own a Croatian company, then you are required by law to pay yourself a salary, which will include pension and health insurance.
In this case, the cost of your health insurance is calculated based on your total salary. In terms of salary, there is neto and bruto. Neto salary is the net amount you get paid on your bank account each month. Bruto salary is the amount you receive on account, plus taxes and pension.
The health insurance premium is 16,5% of your bruto salary amount, then is added on top of bruto. For example, if your bruto salary is 6.000 kuna, then your health insurance cost is 990 kuna. This brings the total monthly employment amount that your employer must spend to employ you to 6.990 kuna.
You can use this calculator to play with the bruto salary to calculate health insurance costs as well as pension and taxes. Please note that if you’re using this calculator to also estimate taxes, keep in mind that the percentage charged for “porez i prirez” varies from city to city.
EU citizens can continue to use their existing state health care from their native country as long as they are paying into the system in their native country. However, they can only use their foreign state insurance in Croatia for urgent care. For regular, non-urgent health care, you must return to your home country. To get access to urgent care, you will need your EU health insurance card.
If you are an EU citizen that is no longer paying into the state health program in your home country after moving to Croatia, then you must start a new policy with HZZO. In this case, you will pay 570-580 kuna per month. The exact rate in 2021 is 575,65 kuna per month. HZZO may also request that you provide proof from the state health insurer in your home country that you no longer have a policy.
Unemployed people can request that their HZZO health insurance premium be covered by the state only if they notify HZZO within 30 days of losing their job (if they quit job or got fired). It should be noted this only applies to those that lose their job at a Croatian company. As part of this process, you’ll also have an interview with HZZ (a different agency) upon losing your job.
If you are unemployed and married to someone who is employed by a Croatian company, then you will be automatically covered through your spouse without any additional cost.
This is a rare case, yet still has its own unique rate for health insurance. It is a rare case because hiring a freelancer is, quite frankly, a pain in the ass for any Croatian company.
When hiring a freelancer, there must be a contract that defines the amount they will be paid and the term in which it will be paid. On top of this amount, the employer must pay for health insurance, taxes and pension. There are two pension funds, so the company must pay into the pension funds for which the freelancer is registered. Some are only in one, some are in both. For all of these reasons, freelancers are usually just paid in cash to avoid this whole mess.
In the case where a freelancer is hired properly and legally, the health insurance cost is calculated as 7,5% of their bruto payment and is paid for by the employer.
From the start, it is important to mention that HZZO will only know if you are collecting a foreign pension if you tell them. You are obligated to tell them. However, if you don’t know you are obligated to tell them, then it is possible nothing will ever come of it especially if you are not receiving your foreign pension on a Croatian bank account. Please also note that you may be obligated to pay income tax on your pension depending on the treaty Croatia has with your pension country.
If you notify HZZO of your foreign pension, you will be charged 16,5% of your pension payment for health insurance. If you are receiving a pension from a western nation with a higher cost of living, 16,5% can be quite a hefty chunk of money.
Side note: Depending on the treaties Croatia has with your country, you may also be required to pay income tax on your foreign pension. If you wish to consult with an attorney or accountant to find out if you are liable for income tax, contact me.
The amount you owe for health insurance is calculated based on the amount of your pension in comparison to the average Croatian salary for that year. If your pension is lower than the average salary, you pay 1% of your pension for health insurance. If your pension is higher than the average salary, you pay 3% of your pension.
Children under 18 years have a right to health insurance (given that their parents or foster parents are EU citizens). The cost of their obavezno policy is covered by the state.
Children under 18 years whose parents are third-country citizens and temporary residents are treated just like their parents. They must have their own health insurance policies with the monthly premium of 570-580 kuna. The exact rate in 2021 is 575,65 kuna per month. The 1-year of back pay of 6840-6960 kuna must also be paid for each child.
Only children of third-country citizens who are also permanent residents may be covered by their parent’s health insurance policy.
If a child goes on to college after high school and is under 26, they retain their right to health insurance through their parents or foster parents. The cost of their obavezno policy is covered by the state.
Citizens with low income are exempt from paying health care premiums for obavezno. The low income threshold is calculated based on the person’s total income in the previous calendar year, per family member, as it compares to the average national salary.
If it is a family, income must be lower than 1.516,32 kuna per family member per month or 45,59% of the average national salary. If it is a single person, income must be lower than 1.939,39 kuna per month or 58,31% of the average national salary.
There are certain groups that can get free basic insurance through HZZO including:
- Children of dependents that are incapable of living and working independently
- People with residency in Croatia that are incapable of independent life
- Family members of dead or missing Croatian armed forces members
- Disabled members of the Croatian armed forces
HZZO requires that certain people pay a year of premiums for the previous year when first signing up for state health insurance. This can be frustrating for some, but it is based on a pragmatic reason.
Once someone signs up for HZZO, they are completely insured. There is no waiting period until your health insurance kicks in. That means you can immediately get care or surgery or diagnostics, or whatever you need.
If you’ve just arrived to Croatia and immediately get surgery, you would not have paid enough into the system to cover that cost. The Croatian health care system cannot support that. To avoid a scenario where people cannot take advantage of the system, new insurance applicants must pay a year of health insurance premiums for the previous year when they were not in Croatia (in some scenarios).
We’ll go over those scenarios now.
- Any third-country national must pay 1 year of back pay.
- People who come from the EU as well as Croatian citizens must bring a written confirmation to HZZO proving the exact time period during the previous 12 months that they were insured outside Croatia. They will pay insurance only for those months when they weren’t insured in Croatia.
For example, let’s say a German citizen was insured abroad until December 2019, but arrived in Croatia 2020. This person will have to pay premiums for 10 previous months and not the whole year.
Dopunsko is an optional health insurance supplement that covers many co-payments that may be charged when visiting the doctor or filling prescriptions at the pharmacy. To learn more about what dopunsko is and why you should have it, read this post.
There are less variables when it comes to the cost of dopunsko. The cost varies depending on your age and from where you get the policy. You can get it directly from HZZO or you can get it from a bank or private insurance company.
The cost of dopunsko usually varies from 40 kuna to 80 kuna per month.
There are some groups of people who are entitled to free dopunsko. These groups include:
- Children under 18 years
- People with disabilities resulting in 100% body damage
- People with mental or physical diseases who can’t perform certain activities on their own
- War veterans with at least 30% body damage
- Parents with 3 or more children under 18 years
- Victims who experienced sexual violence during Domovinski Rat (Homeland War)
- Organ donors
- Blood donors – Women must give more than 25 times and men must give more than 35 times.
- Low income people – As defined by the thresholds defined earlier in this post.
EU citizens whom are using health insurance from their home country cannot get dopunsko because it is considered a supplement to the obavezno policy through HZZO. If you don’t have obavezno, you cannot get dopunsko.
There is a higher level supplemental insurance above dopunsko called “dodatno”, but the is a private-only policy so we won’t dive into the costs of this here since it isn’t public, but you can read about it on this post.