When do pensioners have to pay a user fee?

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When do pensioners have to pay a user fee?
When do pensioners have to pay a user fee?

"I am interested in a few questions related to the user fee and hope to receive specific answers from you

Please clarify, firstly, is a user fee payable when there was no examination by the personal physician, but he issued a referral to another doctor - for example, a cardiologist, surgeon, eye doctor, for medical diagnostic work or for an appointment in hospital? Is there a separate user fee for each destination?"

Yanko Georgiev, Sofia

According to Art. 37 of the Law on He alth Insurance, for each visit to the doctor, the specialist in dental medicine or the medical facility, the he alth insured pay an amount determined by a Decree of the Council of Ministers, in the amount of BGN 2.90

It is indicated that lower amounts are set for people who have acquired the right to a pension for long-term insurance and age - in the amount of 1 BGN. A certain category of people, as well as patients with diseases specified in a list to the National Framework Agreement for Medical Activities 2020-2022, are exempted from paying these amounts.

For the amounts paid, the doctor, dentist or medical facility issues a financial document. The control over the issuance of a financial document (fiscal receipt/note) is carried out by the control bodies of the National Revenue Agency.

In order to pay a user fee when you visit the doctor, he must perform an examination. If he deems it necessary, he will issue you a referral for consultation with a specialist, for hospitalization or for a medical-diagnostic examination. For this provided medical assistance, according to the He alth Insurance Act, the he alth insured shall pay the doctor the amount specified above.

If you have been issued a "Direction for medical-diagnostic activity" (Bldg. MH-NHOC 4), you must pay the so-called price "biological material" in a laboratory that has signed a contract with the NHS.

For medical-diagnostic activities in the laboratory, the relevant contractor can set a "biological material" price, the amount being paid by he alth insurance. In case the patient pays the price of "biological material", the medical institution cannot demand from him for tests in the same laboratory a fee according to Article 37, paragraph 1 of the He alth Insurance Act, the so-called user fee.

In medical facilities performing medical-diagnostic activities, for which no "biological material" price is paid, the he alth insured pay the fee according to Art. 37 of the Law on He alth Insurance (i.e. user fee).

The laboratory fee is one, regardless of the number of tests. Only people without income, housed in homes for children and adolescents, homes for children of preschool age and homes for social care, are exempt from paying the "biological material" price.

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