Moving to Croatia

How to Croatia - Navigating The World of Croatian Health Insurance

By 2 November 2022

November the 2nd, 2022 - For foreigners and even those with Croatian citizenship who are moving here, the stress of navigating the sometimes needlessly complicated world of Croatian health insurance tends to come as a surprise...

Nobody wants to think of themselves becoming unwell, developing a hernia or breaking a bone, but it happens. You might eat one too many oysters and need to be in extremely close proximity to a very well functioning toilet, you could jump off a rugged Adriatic cliff and land in a less than ideal position in the sea below, or you might step on the notorious ‘jež’. The jež, or sea hedgehog, isn’t some sort of mythical Croatian monster from times gone by, it is a mere black sea urchin, there are loads of them and they do nothing but sit around all day, but they don’t half pack a punch (or stab, which is more accurate) if you accidentally step on one. 

Health insurance in Croatia is regulated by HZZO, or in English, the Croatian Health Insurance Fund. Much like the rest of Europe, Croatia has a universal healthcare system with private options available too. This doesn’t mean that healthcare is free in Croatia, it isn’t, we all need to do our bit and pay into it to ensure we can all be cared for should we need to be.

Health insurance in Croatia is compulsory, which means everyone resident on the territory of Croatia should have a regulated compulsory health insurance status. That isn’t saying that we all do, many of us don’t, and much like many other ‘mandatory’ things in Croatia… well… the use of the term is a little skewed. That said, you should have it, if for no other reason than for your own peace of mind. 

So, who technically needs to be insured in Croatia?

Long story short - Everyone. Short story long - There are more complications to this than there needs to be, and there are 59 different categories of insured persons!

Let’s start with the basics. In Croatia, there are three types of healthcare coverage. One is obvezno (mandatory), the others are dodatno and dopunsko, which act as additional coverage on top of your obvezno insurance. Think of it in levels; 1) Obvezno 2) Dopunsko 3) Dodatno.

Universal healthcare coverage is the norm all over Europe, with the British NHS being a not perfect but absolutely enviable tax-based model where nothing is paid at all at the point of use regardless of what needs to be done. Croatia’s socialised health insurance system is similar in the sense that it is based entirely on the principles of solidarity, meaning that all residents of Croatia, be they foreign or Croatian, are expected to contribute to the fund according to their respective abilities to pay for it. Everyone is paying for everyone else, and for the system to exist, and in turn they receive healthcare services according to their needs, from the prescribing of antibiotics for that pesky trachea infection that makes you sound like a chain smoker to open heart surgery that you need because you quite literally are a chain smoker.

You don’t need to pay if you’re under 18 years of age, you’re incapable of living an independent life, if you’re a disabled member of the Croatian Armed Forces, or if you’re the direct family member of a missing or dead member of the Croatian Armed Forces.

There are some other exceptions with more detailed explanations, but assuming you’re a foreign resident, you’re highly unlikely to be any of the above, so I’ll move on and offer a brief look at what the different types of Croatian health insurance mean and include.

Obvezno zdravstveno osiguranje is the most basic of the basic must-haves in Croatia. It’s the one everyone living in Croatia is meant to have from HZZO. You don’t need it if you’re an EEA citizen or permanent EEA resident who is covered by national health insurance in another EEA member state. This goes back to what I mentioned previously about not being allowed to be insured in two EEA member states at the same time.

Dopunsko zdravstveno osiguranje is a bit like a beefed up version of obvezno. It’s supplemental and totally optional, and you can take out a policy either as a public or private health insurance policy. You can get it from either HZZO or even from a bank or independent insurer. It eliminates most copayments for medication prescriptions, visits to the doctor, diagnostic workups, tests, and hospital stays should you need hospitalisation for any reason. If you’re someone who is, for example, diabetic, or suffers from some other sort of chronic condition such as hypertension which needs constant medication and frequent monitoring, this would be a good option. Copayments in Croatia are small, but why pay them if you can avoid it?

Dodatno zdravstveno osiguranje is the top of the range when it comes to Croatian health insurance. It covers absolutely everything and isn’t on offer from HZZO but from independent insurers and banks. This policy covers preventive care, visits (as many as you need) to all kinds of specialists, additional treatments, any laboratory test you can imagine, and extended hospital visits should you (God forbid) need that. You won’t need to pay anything out of pocket whatsoever if this is your policy of choice, and once again, it’s great if you’re someone who does suffer from some sort of chronic ailment that needs medicating and/or a watchful eye kept on it.

Now we’ve covered that, you might be wondering how you enrol into HZZO

First, you need to find the HZZO office for your area of residence, a full list can be obtained by accessing hzzo.hr and selecting ‘English’ in the top right corner. Alternatively, you can ask at MUP during your residence procedure.

Once there, you’ll need to explain that you’re a resident in Croatia and you’d like to enrol for obvezno health insurance.

If you’re a citizen or permanent resident of the EEA and as such you have an EHIC, you technically do not need to enrol in HZZO because you shouldn’t be publicly insured in two EEA member states at the same time. You absolutely can enrol in HZZO should you so wish, but you’ll need to provide proof that you’re no longer insured by the other EEA country in question. This is where things can get tricky.

When Britain was part of the EEA, many, many British residents of Croatia had endless issues trying to enrol into the Croatian healthcare system because the NHS is not health insurance but a right automatically afforded to people born and living in the UK, and because the document HZZO wants (proof of no longer being insured in the UK) seems to be as elusive as the abominable snowman. Many people have never heard of such a document and have absolutely no idea what is being sought. Now the UK is no longer an EEA member state, that awkward problem is hopefully a thing of the past.

It’s technically HZZO which needs to seek this document, not you. If they ask you for it, let them know that you're not the one who needs to be chasing it, they are.

If you manage to bypass this requirement, or you’re simply not asked, and you’re an EEA citizen or permanent resident, you can be enrolled into the Croatian health insurance system. Your first step is filling in the form to sign up which will be given to you or be made readily available at the office. 

A back payment, for a year in which you weren’t even in Croatia…

This might sound utterly preposterous, and to many people it does appear quite ridiculous, but there’s logic here, so hear me out. Some people (such as those who aren’t being signed up to HZZO) by their employers, need to pay ‘back pay’ to HZZO for the previous year. So this is 12 months of premiums, all in one go. But I wasn’t even here?! I hear you cry. I know, it seems like a complete con, but the reason behind it is this: what if you turned up, enrolled for free, got hit by a bus on your way home and then needed major surgery? What if you have a chronic health condition you failed to mention and started eating the system out of house and home as it were? Insulin, blood thinners, inhalers, statins, the works! That wouldn’t be fair on the people paying into the system, while you’ve paid nothing and yet you’re reaping the rewards of a socialised medical system.

Of course, one sincerely hopes that they will never be hit by a bus, struck by lightning, attacked by a shark, be knocked unconscious by a falling brick or anything else of the sort, but these are things we unfortunately cannot predict, and nor can HZZO. If you have a chronic health condition which will require the use of the system for prescription medication and therapies, you should also be paying your part into the system in order to be on a level playing field with everyone else paying their contributions.

I truly understand that it might seem like an absolute con and a half to be asked for a document that nobody seems to have ever heard of, such as ‘release from health insurance in another EEA country’, and then once you’ve fought that battle, be asked to pay for the health insurance you would have needed to pay for had you been here over the past 12 months, but you didn’t and couldn’t have, because you were not here… Yeah, I’ll give you that, it seems a bit like someone is taking the Michael, as they say in England, but hopefully the above explanation makes it seem a bit more rational.

I’ve been hired by a Croatian company, do I need to go and enrol at HZZO?

No. Your employer is obliged by law to do this for you using what’s known as a T-2 application form. You don’t have anything to do with this process.

Getting a health insurance card

As soon as you finish enrolling at the HZZO office, or as soon as your employer is finished enrolling you, you’re insured. You’ll be given paper confirmation of that fact by the clerk, and you can use this if you do need medical help as proof of you being insured by HZZO. You will get a proper plastic card attesting to that fact in the mail eventually, this can take weeks to months to arrive, so don’t panic if it doesn’t turn up for a while, you’re insured regardless and it will.

How do I find a GP?

Got a cough that just won’t go? Eaten one too many seafood platters and become best mates with the toilet? Found a weird rash you can’t leave alone? Your GP needs to be your first port of call unless it is an emergency, in which case, well, the emergency room needs to be your first port of call. 

From ear infections to ingrown toenails and everything in between, GPs, or as they’re called in Croatia ‘family doctors’ (doktor opće medicine/obiteljski liječnik) are the ones who will prescribe the antibiotics, sprays, prescription ointments and so on. 

Most people have a GP, a paediatrician for their kids if they have them, a gynaecologist if you’re a woman, and of course, the one who tells you off for eating too many sweets - a dentist. 

Let’s not get ahead of ourselves with all of the different doctors. Here’s how to find and get registered as a new patient with a GP

HZZO’s website (hzzo.hr) has a list of GPs. You’ll need to go through the list of those in your area and call them to ask them if they’re taking on new patients. Alternatively, you can use word of mouth, which is worth its weight in gold in Croatia for just about everything. GPs can’t turn you down if they are taking on patients, which is good news. But be aware, they might not pick up the phone when you call, and the GPs with a great reputation among the local bakas (grandmothers) will likely not be able to take you on.

Once you find a GP and are accepted as a new patient, you’ll fill in a form which you’ll get from the doctor’s office, and then you’ll need to give it to the doctor. They then fill in their part, and send it off to HZZO. That’s it, you’re done.

Your GP will be the one you visit first with your health complaints which aren’t medical emergencies. They are qualified to run certain tests, and also to make a decision as to whether you need to be referred for more tests, scans, and/or to a specialist at a polyclinic or a hospital. If you do need to see a specialist for further diagnostics and tests, you’ll be given what’s called an uputnica (a referral). This used to be a slip of paper and it’s now digital (yes, Croatia is actually catching up, believe it or not), and is called an e-Uputnica.

How do I find an English speaking doctor?

English is very widely spoken in Croatia, and most educated people speak it excellently. Most doctors speak some degree of English, some with complete fluency. In smaller areas, especially down on the coast or in the Dalmatian hinterland, you might come across doctors who speak very little to no English, however. The British Government’s website (GOV.UK) and its Croatia page has a handy tool you can use to find the names of English speaking doctors, as does the US Embassy’s website.

In case of emergency

As stated, if you’re experiencing a medical emergency, go straight to the nearest hospital with your health insurance card or the piece of paper HZZO gave to you after you enrolled, don’t wait on your GP. If you’re a mere tourist with no intention of becoming a resident, take your passport and your EHIC. This is now a GHIC if you’re British.

Things to be aware of

Everyone resident in Croatia is supposed to have a GP. Does everyone have one? No. Can everyone get hold of theirs on the phone or via email if they do? Also no. 

Obvezno (mandatory health insurance) does not cover birth control, cosmetic surgery, abortion, or the expenses of medical treatment sought because of some sort of religious conviction or personal preference that isn’t deemed medically necessary.

Unless you have dodatno health insurance (or dopunsko, in a wide array of cases), you may need to pay a small copayment for certain medications, procedures or hospital stays. This is usually a symbolic sum.

Contraception and abortion in Croatia

Contraceptives

Condoms are available in all kinds of stores, from Lidl to newsagents, and even in Tisak kiosks. There are various brands on offer just like all over the world.

I mentioned above that contraceptives aren’t covered by obvezno health insurance in Croatia. Some brands of contraceptive pills, however, are covered if you have taken out a dopunsko policy, but generally you need to pay out of pocket for them and you’ll also need a gynaecologist to give you the green light (and a prescription) following a pelvic examination and a few general health questions to check all is well. The gynaecologist can be a state healthcare provider or a private one, it doesn’t matter at all.

When it comes to intrauterine devices (IUD), you also need to pay. You can get certain types at certain pharmacies and gynaecology practices. Following the purchase, a gynaecologist needs to perform the procedure and insert the IUD into your uterus following the ‘green light examination’ I mentioned above. They may want to examine you again and ask some questions before beginning the procedure to double check.

Plan B and C

Levonorgestrel, more commonly referred to as the morning after pill (Plan B) is available to purchase at all pharmacies (a pharmacy is called a ljekarna in Croatian). Health insurance doesn’t come into this. You can just go and purchase it. It prevents pregnancy in an impressive 95% of cases if taken within 24 hours, and you don’t need to speak to a doctor, nor do you need a prescription.

Mifepristone is a drug often used in combination with another drug called misoprostol to induce a medical abortion and manage early miscarriage. This is known as Plan C, you need a prescription and it can be used until the 10th week of pregnancy in Croatia. Once the prescription is taken to a pharmacy, they aim to have it within one to two days, after which you must take it for a period of four days. After that, you’ll need to go back to the gynaecologist who will perform another pelvic examination to make sure the termination is complete.

Abortion

This is still a touchy subject in Croatia, but abortion is legal and has been for a very long time. If you’re determined to have an abortion and you’ve passed the 10 weeks of pregnancy mark, you need to be absolutely certain of your decision, and while you don’t need any counselling like you do in certain other countries, even the more liberal ones, you do need to convince your doctor you’re 100% sure, as well. 

Once you’ve made your intentions clear, you’ll be spoken to about something called the Commission of First Instance, consisting of a gynaecologist, another doctor, and a social worker or registered nurse. The commission then either chooses to approve the abortion if it is medically necessary to save the woman's life or preserve her state of health, whether that threat to her health is present during the pregnancy, or during the delivery itself.

What does that mean?

An abortion after 10 weeks will likely be approved if what will become a baby is likely to, or will definitely be born with a congenital defect or if the unwanted pregnancy is the result of a crime such as incest or rape. The Commission's decision may be appealed to a Commission of Second Instance, whose decision is final. This sounds daunting, but it doesn’t even come into it in situations where the woman's life or health is in immediate danger or the abortion procedure has already begun. 

Once you’ve been given the green light, you’ll be referred for the procedure, which typically lasts around 40 minutes as long as there are no complications or bumps in the road, and is typically carried out at a hospital. The facility set to carry out the abortion must have a obstetrics and gynaecology department.

Abortions aren’t free, and they are typically not covered by HZZO. You’ll need to fork out a few thousand kuna for the gynaecological exam, blood tests, and the procedure itself.

Things to note

Certain types of IUD are free of charge and covered by HZZO entirely if the woman in question suffers from anaemia as a result of blood loss during abnormally heavy periods.

There are numerous types of contraceptive pills available in Croatia, ask the gynaecologist which one is right for you based on your own medical history, possible medical issues, and potential hormonal issues. If you have had issues with a particular brand in the past, make sure to mention it.

Some pharmacies can refuse to sell Plan B (the morning after pill) on religious grounds. It sounds absolutely beyond comprehension, but it can and does unfortunately happen. If this happens to you, go to another pharmacy.

There is something called ‘conscientious objection’ in Croatia, and much like the above case with Plan B and some pharmacists, some doctors use it to refuse to agree to refer a patient for an abortion, or to carry out the procedure. If this does happen to you, don’t waste your time pleading your case, save yourself the energy and seek out another doctor.

The tide appears to be turning when it comes to the issue of abortion in Croatia. Back in the pandemic-dominated year of 2020, the Ipsos Puls agency conducted a poll in which 81% of respondents agreed with the statement that a woman should have a right to choose regarding pregnancies, giving birth or abortions, of which 68% completely agreed and 13% mostly agreed.

On a much lighter note, you can get free tests for sexually transmitted infections (STIs) through HZZO.

If you’re prescribed some medication, you’ll pay a very small copayment when picking it up from the pharmacy. The amount is symbolic.

Additional information in more specific cases, such as cross-border healthcare, can be accessed by visiting HZZO’s National Contact Point page, or emailing them at [email protected]

Alright, I’ve found a doctor, how do I go about finding a dentist?

Dentists are those kinds of people you just don’t even think about until you can’t stop thinking about them, either because your tooth has suspiciously just started hurting or because you’ve parted with your hard earned cash, all for a tiny filling you won’t even be able to see and what feels like a smack in the face.

They don’t evoke pleasant thoughts, nor do their whirring tools, but they’re very necessary. 

If you’re a tourist in Croatia, you just quite literally need to find one, see if they have an appointment free for you, pay out of pocket for what you need to be done and then be on your merry way, hopefully never to return again. In all honesty, the same can be done as a resident who has Croatian health insurance. If you’re willing to pay out of pocket, you can’t be bothered to go flicking through the dentists which have contracts with HZZO and you need help right now, you’re free to do as you like and go to whoever will treat you. 

Dental care in Croatia is typically of a very high standard, and the prices are very favourable compared to what many people are used to paying elsewhere. This has become such a trend that Croatian dental (and health in general) tourism has been blossoming, with some polyclinics having earned stellar reputations among locals and foreigners alike, be they coming for necessary work or cosmetic procedures.

Finding a dentist who has a contract with HZZO

If you want to find a dentist who has a contract with HZZO and it isn’t cosmetic work you’re after, you’ll be able to be treated for free, although you might need to pay a very small contribution in participation costs.

Cosmetic dentistry

Croatia is making quite the name for itself in this regard, and there are, as I mentioned a little while ago, numerous polyclinics springing up offering excellent services for very favourable prices. Dentists in Croatia study at the School of Dental Medicine in Croatia, which is the only one of its kind in the country, and the care they provide is of high quality. Foreigners from all over the world come to Croatia to get their dental work done, enjoying stays in hotels, sightseeing and the gastronomic scene (as long as they can eat, of course!) all while completing their treatments. 

Croatian dentistry has an absolutely brilliant reputation internationally, and with very good reason.

 

For more on navigating the practicalities of life in Croatia, make sure to keep up with our How to Croatia articles each week by following our lifestyle section.

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