Croatia’s state health care obvezno insurance, what it costs and what is included: Guide for 2022

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UPDATED: 27/09/2022

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:

  • Obvezno – Mandatory coverage for all residents
  • Dopunsko – Optional supplemental coverage

Since basic obvezno health insurance is required of all residents, it is important to understand what the costs and covers are before moving here. Be forewarned, it might give you sticker shock.

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 obvezno health insurance.

In this post, we cover:

The facts are these…

What does obvezno state health insurance include

Obvezno 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 obvezno 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 the doctor or hospital visits as well as for most medications. To eliminate this co-payment, you must sign up for dopunsko supplemental coverage.

With obvezno, you have a right to:

  • Primarna zdravstvena zaštita (primary health care)
    • Family doctor
    • Gynecologist
    • Pediatrician
    • Dentist
    • 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, also called “List A”) and dopunska lista lijekova (additional list also called “List B”) 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 obvezno insurance include:

  • Salary compensation during temporary inability to work
  • Salary compensation due to the inability to perform work activities that prevent earning other types of income
  • Compensation for transport costs due to the use of health care from obvezno zdravstveno
  • Compensation for accommodation costs to a parent or a person who’s caring for a child during the child’s hospital treatment

Cost of basic obvezno state health insurance and who must pay for it

Basic health coverage through HZZO is charged depending on your situation. These are the situations that affect the cost of your health insurance:

Now, we’ll go over each individual situation and cover the health insurance premiums.

[Read: How to sign up for state health insurance in Croatia]

You are not employed in Croatia, but don’t collect unemployment in Croatia either

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, the rate you will pay is ~596 kuna per month.

Depending on the basis of your 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.

You are employed by a Croatian company

If you are an employee in Croatia, your company is required by law to pay for your obvezno 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.

You are an EU citizen

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 (EHIC).

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, the rate you will pay is ~596 kuna per month. HZZO will request that you provide proof from the state health insurer in your home country that you no longer have a policy.

If you are a UK citizen, we’ve outlined how health insurance will work specifically for you post-Brexit here.

You are unemployed AND collect unemployment from Croatia

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 their 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.

You are unemployed AND married to an employed person

In certain scenarios, the spouse of an employed person can get health insurance at no additional cost based on their spouse’s employment. There are two scenarios within this case.

Scenario #1 – If you are a Croatian citizen, then you can be covered by your employed spouse’s health insurance.

Scenario #2 – If you are an EU/EEA citizen, then you must have a temporary OR permanent residence to be covered by your spouse’s health insurance. The application procedure is standard. Go to HZZO and apply for health insurance.

Scenario #3 – If you are a third-country national, you can’t be covered by your employed spouse’s health insurance regardless of your spouse’s nationality or your residence status.

You are working as a freelancer for a Croatian company

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 butt 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 (which is not legal, for the record).

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.

You can learn more about hiring freelancers (or working as a freelancer in Croatia) here.

You are a digital nomad

To qualify for residence in Croatia as a digital nomad, you must have private health insurance coverage for the entire term of your permit (up to 1 year). However, digital nomads are exempt from mandatory obvezno state health insurance in Croatia.

This means that you have the option to sign up for state health insurance after you are approved for residence, but it is not required as it is with other types of residence.

We wrote a detailed guide on how to apply for the digital nomad residence permit in Croatia. You can find it here.

You are retired AND earn a foreign pension

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, since people with foreign pension with prebivalište or permanent residence in Croatia are charged 16,5%. 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.

Tax administration calculates the exact amount for each individual. So, the percentage of health insurance is 16,5% of your pension. Tax administration will calculate the exact amount on the basis of your pension, but the basis for calculation can’t be lower than the lowest monthly base and higher than the average salary. The lowest amount you may pay is ~596 kuna and the highest amount is ~1.570 kuna.

Contributions for people with a foreign pension are defined in Articles 130-134 of the Law on contributions (Zakon o doprinosima) which is available here.

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.

You are retired AND earn a Croatian pension

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.

You are under 18 years of age AND the child of a Croatian or EU citizen

Children under 18 years have a right to health insurance (given that their parents or foster parents are EU citizens). The cost of their obvezno policy is covered by the state.

You are under 18 years of age AND the child of a third-country citizen

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 a monthly premium of ~596 kuna per month. The 1-year of back pay of ~7.000 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.

You are under 26 years of age AND a student

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 if those parents are EU or Croatian citizens, or third-country nationals with permanent residence. The cost of their obvezno policy is covered by the state.

You earn less than the “low-income” threshold

Citizens with low income are exempt from paying health care premiums for obvezno. 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.

You are in a protected group

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

What to do after you are granted a permanent residence

Once you are granted permanent residence in Croatia, you have the same rights to health insurance in Croatia as Croatian nationals. This means that you are no longer treated as a foreigner in Croatia, and you must change the status of your obvezno health insurance. However, you don’t have to change your status if you are insured through the company where you work, i.e. your job.

[Read: Rights of permanent residents in Croatia]

To change the status of your obvezno health insurance, you must contact the HZZO and sign up for the obvezno health insurance on another basis. If you don’t notify the HZZO, HZZO will send you the Rješenje, i.e. a notification explaining you are signed off from health insurance and that you must change your status (sign up on another basis/category).

There are 59 categories on which people can sign up for the obvezno health insurance in Croatia. They are defined in the rulebook called “Basics of insurance in compulsory health insurance” (Osnove osiguranja u obveznom zdravstvenom osiguranju) which is available here.

[Read: How to sign up for state health insurance in Croatia]

How to check the status of your state health insurance

If you are unsure of the status of your obvezno or dopunsko state health insurance, you can always check your policy on the HZZO web site here.

All you need is your OIB number. This page will tell you if your policy is valid or not.

Who must pay the first year of “back pay” when first signing up

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 in 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).

Everyone who registers for Croatian state health insurance for the first time must pay 12 months of back pay. However, EU/EEA and Croatian citizens who have had an EU state health insurance policy for the previous 12 months can get out of this back pay.

In this case, you must bring a written confirmation to HZZO proving the exact time period during the previous 12 months that you were insured outside Croatia. If you were covered only a portion of the previous 12 months, then the back pay will be prorated.

For example, let’s say a German citizen was insured by German state insurance for 10 of the previous 12 months before signing up for HZZO. This person will have to back pay premiums for 2 previous months and not the whole year.

What if you neglect to sign up for obvezno

Having obvezno health insurance in Croatia is required, but there is no fine or a penalty for not having health insurance.

For example, if an adult person signs up for obvezno health insurance for the first time and they have never been employed and signed up for health insurance, they would have to pay it retroactive for one year or less, depending on the situation.

Cost of supplemental “dopunsko” public health insurance

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 fewer 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 who are using health insurance from their home country cannot get dopunsko because it is considered a supplement to the obvezno policy through HZZO. If you don’t have obvezno, you cannot get dopunsko.

Other health insurance options

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 in this post.

View other health insurance posts


Sources:
Doprinosi – Mirovina
Zakon o doprinosima

Please note: All information provided by Expat in Croatia is only for the purposes of guidance. It does not constitute legal or financial advice in any form. For legal advice, you must consult with a licensed Croatian lawyer. For financial advice, you must consult with a licensed Croatian tax advisor or accountant. We can recommend one if you contact us.

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