Major Healthcare Reform in Romania: What Co-Insured Individuals Must Do Before September 1

As of September 1, 2025, Romania enacted a major overhaul of its public health insurance system. The concept of being co-insured, where spouses or parents without their own taxable income are covered through a family member, was phased out. From that date, individuals who previously depended on this arrangement needed to either start paying the healthcare contribution (CASS) themselves or risk losing insured status.

Who was affected

Until this change, individuals such as a spouse or parent without taxable income could benefit from free health insurance as a co-insured person under a principal insured family member. Starting September 1, 2025, this arrangement ended.

More than 650,000 Romanians were reported as co-insured in 2023. Without taking action, these individuals lost their insured status and access to most medical services, with only minimal coverage remaining.

How to stay insured after September 1

To retain access to public healthcare benefits, those affected needed to opt into voluntary health insurance by submitting the Declaratia Unica (Unique Tax Declaration, form D212) to ANAF. The insurance becomes valid for 12 months from the date of submission.

The required contribution (CASS) equals 10 percent of six times the national gross minimum wage, which came to roughly 2,430 lei for 2025. Payment is split:

• 25 percent at the time of submitting the declaration
• 75 percent by May 25 of the following year

Why this change was made

This policy shift is part of a broader fiscal reform aimed at strengthening the health insurance fund by expanding the pool of contributors. Authorities have said this supports better budget allocation for medical supplies and improved access to care.

Some categories remain exempt, including individuals undergoing treatment for cancer, those in national health programs for chronic conditions, and people with disabilities.

What affected individuals needed to do

Anyone covered as a co-insured needed to act before September 1 to avoid losing access to reimbursed healthcare services. That generally meant:

• Understanding whether co-insured status would end under the new rules
• Completing and submitting the Declaratia Unica (D212) accurately
• Ensuring correct payment of both installments within the deadlines
• Confirming ANAF reception and CNAS activation of the insurance
• Setting reminders for the annual renewal to stay covered going forward

Summary at a glance

• Previously: co-insured status applied to a spouse or parent without income, with no CASS payment required, and full basic medical coverage included
• From September 1, 2025: co-insured status ended, requiring voluntary insurance and CASS payment of around 2,430 lei in two installments to keep comprehensive CNAS coverage

This reform changed healthcare access for a large number of Romanians who relied on co-insured status, making it important for affected families to plan ahead for the new contribution requirements.

Sources: ANAF, CNAS