14.10.2022

RIGHT TO FINANCIAL ASSISTANCE FOR PREVENTION AND REHABILITATION

In Bulgaria, there is the possibility of medical rehabilitation under two programs, in one of which the costs are fully covered by the state budget through the National Health Insurance Fund (rehabilitation with a clinical path), and in the second program a part of the costs are covered by the person and a part of the state budget (for rehabilitation under the National Social Security Institute).

The rehabilitation on the clinical path has a stay of 7 days, with the Health Insurance Fund taking over once a year rehabilitation on the relevant clinical path, and the rehabilitation on the program of the National Social Security Institute has a stay of 10 days and, unlike the rehabilitation on the clinical path, pays extra.

What are the conditions for using the right to financial aid for prevention and rehabilitation?

Persons insured for general illness, maternity and/or work accident and occupational disease are entitled to cash benefits for prevention and rehabilitation if insurance contributions have been paid or are due for them for these risks for a period of 6 calendar months preceding the month, during which prevention and rehabilitation are carried out.

The period of 6 calendar months also includes the time of paid and unpaid leave for raising a child, paid and unpaid leave for temporary incapacity for work and leave for pregnancy and childbirth, as well as leave for the adoption of a child up to the age of 5. Also, the time of unpaid leave up to 30 working days in a calendar year, as well as the time during which self-insured persons who are insured for general illness and maternity received cash benefits for temporary incapacity for work, pregnancy and childbirth, raising a child up to 2 years of age, adoption of a child up to 5 years of age and upbringing of a child up to 8 years of age by the father (adoptor), and periods of temporary incapacity, pregnancy and childbirth, upbringing of a child up to 2 years of age, adoption of a child up to the age of 5 and raising a child up to the age of 8 by the father (adoptive parent), during which they were not entitled to monetary compensation.

However, the requirement for paid or payable insurance contributions for a period of 6 calendar months does not apply to persons with disabilities resulting from an occupational accident or occupational disease. Persons receiving a personal disability pension are also entitled to the benefits if they have not reached the legal pension age.

The conditions for the use and payment of monetary benefits for the prevention and rehabilitation of persons, as well as the procedures for the selection of legal entities - executors of this activity, are determined by an ordinance of the supervisory board of the National Social Security Institute.

The right to monetary benefits for prevention and rehabilitation is used after the attending GP has assessed the need for prevention and rehabilitation, which is reflected in a medical referral.

The medical referral is issued in two copies and it documents the disease for which prevention and rehabilitation is necessary, the accompanying diseases, if any, the medical reasons for the rehabilitation, as well as the relevant medical tests. A direction is issued up to 30 calendar days before the date of admission to the relevant contractor of the prevention and rehabilitation activity.

Persons who wish to use their right to prevention and rehabilitation should prepare the following documents in advance:

Documents for admission to clinical paths:

1. Personal card;
2. Referral for hospitalization (form of the Ministry of Health-NHOF, No. 7) in two copies, issued by the GP;
3. A copy of the Epicrisis for treatment carried out in a hospital for active treatment (for certain clinical paths);
4. Staged epicrisis from the GP or specialist for treatment carried out in outpatient settings (if required by the relevant Regional Health Insurance Funds);
5. Reservation for the medical facility;
6. If the patient cannot take care of himself, a companion is required (the health insurance fund does not cover his expenses)

Documents for rehabilitation under NSSI:

1. Medical referral.
2. Identity document.
3. Model document certifying the person's insurance rights. It is not necessary for small people with TEMC.
4. Personal outpatient card and/or medical documentation certifying the person's current and past health status - tests, examinations, photographs, electrocardiograms and other documents, according to the specific case.
5. Expert decision of the Territorial Expert Medical Commission, respectively of the National Expert Medical Commission (for persons with permanently reduced working capacity of 50 and over 50 percent).
6. Expert decision on recognition of an occupational disease (for persons with an occupational disease).

Reference:

Art. 13c of the Social Security Code

Ordinance No. 1 of February 13, 2007 on the use and payment of cash benefits for prevention and rehabilitation