Insurance coverage: pursuant to the Regulation on the general terms, the minimum insurance amount, minimum insurance premium, and the procedure for concluding the mandatory medical insurance of foreigners residing for a short or long period of time in the Republic of Bulgaria or passing through the country in transit /adopted by Decree of the Council of Ministers No. 80, from 2005; promulgated on May 13, 2005, amended and supplemented in the State Gazette, Issue 51, dated July 5, 2011):
• necessary expenses incurred by the Insured or a medical institution for treatment and hospitalization in case of a sudden, unexpected, unpredictable ailment, disease, or accident, which occurred during the term of the insurance contract;
• dental care, only for emergency unexpected conditions;
• the necessary and appropriate documented transportation expenses for admitting into or transferring the Insured individual to a hospital.
Insurance amount: 60,000 BGN, pursuant to the Regulation.
The insurance does not cover: organ transplants, tissues and cells; planned neurosurgical, cardiac, and eye surgeries; treatment of AIDS; treatment of alcoholism and drug addiction; mandatory immunizations; plastic cosmetic surgery and other cosmetic medical services; failure to comply with a prescribed regimen and/or treatment, simulating a disease by the Insured, as well as intentional damage to his health; preparation and participation in sports competitions; fights, attempted suicide, or suicide, committing general crime or another activity prohibited by law; damage to health due to excessive or chronic alcohol use, narcotics, intoxicating substances, or drug dependence; participation in military activities or exercises, or caused by radioactive or chemical materials in an uprising, riot, strike, lockout, or other similar activities, including emergency and disaster situations; health services necessitated by past diseases; home care which is not under a doctor's supervision, as well as measures for geriatric and rehabilitation treatment and treatment pedagogy; the following dental services: tooth implants, as well as measures and consequences which are in a causal relationship with them, insofar as they are not used to remove the consequences of an accident; orthopedics (dentures) and preparation for orthopedic activities; bolt-pin and pinless build-up of teeth; replants and implants; orthodontic work; teeth whitening; termination of pregnancy on request or for premature birth or complications due to air travel undertaken by an Insured individual whose pregnancy is at a stage after the 28th week; birth by optional caesarean section and its consequences; complications due to planned birth at home; surgery for correcting nearsightedness or farsightedness, or other eye defects, unless they are due to an accident or disease which has occurred during the term of the insurance;
Insurance compensation:
1.Upon the occurrence of an insured event, the Insured individual or the medical institution which provides the medical care, is obligated to notify the Insurer within 24 hours via a letter, telephone, fax, or another appropriate manner.
2.The compensation under the mandatory medical insurance is determined and paid by the Insurer within 15 days, after the Insured has presented all necessary documents related to the ascertainment of the event and the amount of the expenses for the provided treatment and hospitalization.
