2025 Guide: How to Become Insured under the Romanian Public Health System

If you are currently not enrolled in Romania’s public health insurance system, there are several ways to become eligible for coverage.

1. Employment or Receiving Taxed Income

The most straightforward option is to become employed. For salaried employees, the health insurance contribution (CASS) is automatically withheld monthly and paid by the employer to the state. The same applies if you receive a pension or unemployment benefits — these are automatically insured categories under Romanian law.

2. Income from Independent Activities

If you are self-employed or earn income from freelance work, royalties, rent, or investments, you must contribute to health insurance if your total annual income exceeds a certain threshold: six times the national gross minimum wage per year (updated annually). In this case, you are required to file a Single Tax Declaration (Form 212), stating your income and contributions.

If your income is below this threshold, you are not obliged to pay the health contribution, but you may choose to do so voluntarily to gain insured status — just like someone without any income. The process is the same: you file the Single Declaration and pay the contribution.

3. Voluntary Health Contribution for Individuals Without Income

This is the main option for former dependents (co-insured persons) who no longer qualify under any other category. Romanian fiscal law allows individuals without taxable income to voluntarily enroll in the public health insurance system by filing the Single Declaration and paying the full annual contribution directly to the tax authority (ANAF).

Once the contribution is paid, you gain insured status for 12 months from the date the declaration is submitted.

4. Belonging to an Exempted Category

Some categories are automatically covered by law without paying CASS. These include:

• Children under 18
• Pupils and students (under certain conditions, up to age 26)
• Pregnant women and new mothers
• Individuals with disabilities
• Patients with conditions included in national health programs
• Pensioners
• Unemployed persons receiving benefits
• Parents on childcare leave

If you belong to one of these groups, no payment is required.

How Voluntary Health Contribution Works for People Without Income

For people with no income (or with income below the legal threshold), the Romanian Fiscal Code (Art. 180 of Law 227/2015) offers a specific way to access health coverage. You can voluntarily pay a fixed health insurance contribution calculated on a notional income equal to six times the national gross minimum wage.

For the year 2025, the gross minimum wage is 4,050 RON/month (as per Government Decision no. 1505/2024).
The taxable base is therefore: 6 × 4,050 = 24,300 RON
The health contribution rate is 10%, so the total annual amount to pay is: 2,430 RON

Once this fixed amount is paid through the Single Declaration, you are covered for 12 months, regardless of when you submit it during the year.

Example

Let’s say you are currently unemployed or have no taxable income. To ensure access to public medical services in 2025, you file the Single Declaration and pay 2,430 RON. This gives you 12 months of health insurance starting from the submission date. The contribution is not prorated — the full amount is always required, whether you enroll in January or September.

Why Six Minimum Wages?

This legal mechanism is based on the idea that a 6-month minimum contribution period is sufficient to secure 12 months of coverage. In the past, people could retroactively pay for the last 6 months to gain access to care. Now, that option has been replaced by the Single Declaration system — a more predictable and flexible method for voluntary health insurance.