Romanian Health Insurance (CAS) Registration for Non-EU Workers: What Employers Must Set Up

A non-EU employee who lands in Bucharest with an approved D/AM1 or D/AM2 visa is not automatically covered by Romania's public health system. Until that worker holds a residence permit, a CNP, and an active payroll record, they have no entitlement to CAS (Casa Nationala de Asigurari de Sanatate) treatment, and any medical costs incurred in the interim fall either on private travel insurance or on the worker directly. Employers who assume health cover starts the moment a visa is stamped are exposing new hires to a real coverage gap during the first weeks in Romania.

The sequencing matters because CAS registration is downstream of several other administrative steps that HR teams are often tracking separately: visa issuance, arrival, residence permit application, CNP allocation, and first payroll run. Getting the order wrong does not just create an administrative headache, it leaves an employee without a functioning family doctor registration or reimbursable prescriptions at exactly the point they are settling into a new country.

This guide sets out what employers actually need to arrange, in what order, for CAS registration of non-EU staff, how it differs from the European Health Insurance Card (EHIC) arrangement that EU nationals rely on, and what the employer's ongoing contribution obligations look like once the worker is on Romanian payroll.

Before the CNP: The Private Insurance Gap

Non-EU nationals applying for a Romanian long-stay (D-type) visa must generally show proof of medical insurance covering the visa validity period as part of the application file submitted to the consulate or, once in-country, to the General Inspectorate for Immigration (IGI). This cover is commercial travel or expat health insurance, not CAS, because CAS eligibility depends on a CNP that does not exist yet at the visa stage.

That private policy needs to stay valid through several distinct phases:

• The visa application and any consular processing time
• Travel to Romania and the initial settling-in period
• The residence permit application filed with IGI after arrival
• The waiting period until the residence permit is approved and a CNP is issued

Employers relocating staff should treat this private insurance as a fixed relocation cost, not an afterthought. A gap here is the single most common health-cover mistake HR teams make with new non-EU hires, because the assumption that "Romanian insurance kicks in on arrival" is incorrect.

Once the CNP Is Issued: CAS Registration Becomes Possible

The CNP, issued by IGI at the same time as residence permit approval, is the prerequisite for CAS registration. Without it, the local health insurance house (Casa de Asigurari de Sanatate, or CAS, organised regionally under CNAS) has no valid identifier to register the worker against.

Once the CNP exists, registration as an insured person typically requires:

• A valid identity document for foreign nationals: the temporary or permanent residence permit issued by IGI
• The CNP allocated with that permit
• Proof of an income source, most commonly an active employment contract registered in Revisal
• A completed insured-person request form submitted to the relevant county or Bucharest CAS office

For employed non-EU workers, the practical trigger for CAS coverage is the employer registering the individual's employment contract and processing them through payroll. Health insurance contributions withheld from salary are what establish and maintain insured status on an ongoing basis, so the registration step and the first payroll cycle are closely linked in practice.

Employer Obligations: CASS Withholding, Not a Separate Employer Contribution

Under the current Romanian system, the health insurance contribution (Contributia de Asigurari Sociale de Sanatate, or CASS) is withheld from the employee's gross salary rather than paid as a separate employer-side charge. Employers are responsible for calculating, withholding, and remitting this contribution correctly each month, alongside the separate work insurance contribution (CAM) that is paid by the employer itself on top of gross wages.

For a non-EU employee, this means the employer's compliance obligations include:

• Registering the employment contract in Revisal before or on the start date, using the CNP once available
• Applying the correct CASS withholding on the worker's gross salary each pay cycle
• Remitting the CAM contribution as the employer-side social charge
• Filing the monthly D112 statement that reports both salary income and social contributions to ANAF
• Keeping the worker's insured status current, since gaps in payroll processing can interrupt CAS coverage

Because CASS withholding depends on an active, correctly registered payroll relationship, any delay in Revisal registration or in receiving the CNP directly delays the point at which the employee is a fully contributing, and therefore covered, member of the public health system.

CAS vs EHIC: Why the Comparison Confuses HR Teams

EU, EEA, and Swiss nationals working temporarily in Romania typically rely on a European Health Insurance Card issued by their home-country health authority, which entitles them to medically necessary state-provided care in Romania on the same terms as a Romanian national, without needing to register separately with a Romanian CAS office. This is a coordination mechanism between EU social security systems, not a substitute for full local registration.

Non-EU workers have no equivalent card and no home-country coordination agreement with Romania in most cases. They must register directly and individually with CAS once they have a CNP and an active employment relationship, and their ongoing entitlement depends on continuous CASS contributions through Romanian payroll rather than a card issued abroad. HR teams that manage a mixed workforce of EU and non-EU staff need two distinct onboarding checklists rather than one, because treating a non-EU hire's health cover the way an EU secondment is handled will leave that person uninsured.

Family Doctor Enrollment

Once insured status is active, employees are entitled to register with a family doctor (medic de familie) of their choosing in their area of residence, which is the entry point for reimbursed consultations, referrals to specialists, and prescription cover under the public system. This step is separate from CAS registration itself and is not automatic. Newly arrived employees generally need support identifying a family doctor accepting new patients, particularly in Bucharest and other high-demand areas, and completing that registration promptly once their CNP and insured status are confirmed.

How Nestlers Group Supports CAS Registration for Non-EU Workers

Nestlers Group's Relocation and Destination Services team arranges compliant private medical insurance for the pre-CNP period, covering the visa application phase, travel, and the residence permit waiting window, and coordinates family doctor registration once an employee's insured status is confirmed. This closes the coverage gap that catches many employers off guard between visa approval and CAS eligibility.

The Payroll and HR Compliance team manages Revisal contract registration, correct CASS withholding, CAM remittance, and monthly D112 filings, ensuring that an employee's insured status activates as soon as the CNP and employment contract are in place, without administrative delay on the payroll side. For clients using the Employer of Record service, Nestlers Group takes on this entire chain directly as the legal employer in Romania, running payroll, contributions, and insured-status registration so the client company does not need a local entity or in-house payroll team to get it right. The Work Permit and Visa Support team, meanwhile, tracks the CNP issuance timeline against the residence permit approval so that HR and payroll can plan the CAS registration step without guessing at dates.

*Sources: CNAS (Casa Nationala de Asigurari de Sanatate) insured-status registration guidance; CASMB (Casa de Asigurari de Sanatate a Municipiului Bucuresti) foreign-citizen registration requirements; European Commission EU social security coordination guidance on the European Health Insurance Card; Romanian Fiscal Code provisions on CASS and CAM contributions (2026); General Inspectorate for Immigration (IGI) residence permit and CNP issuance procedures.*