The European Health Insurance Card and Romania's Public Health System: What Employers Need to Know

Employers moving staff into Romania often treat health cover as a single line item, something that either exists or doesn't. In practice, Romania runs two related but distinct mechanisms: the European Health Insurance Card, which gives a person already insured in an EU or EEA member state temporary access to Romania's public healthcare network, and full enrolment in Romania's own public health insurance system, administered by the Casa Nationala de Asigurari de Sanatate, CNAS. Confusing the two is one of the more common gaps HR teams run into when a cross-border assignment turns into a longer stay.

What the EHIC actually does

The EHIC is not Romanian insurance. It is a reciprocal-access document: an employee who is already insured under the public system of another EU or EEA country can present it in Romania and receive care from providers that hold a contract with a local CNAS health insurance house, on the same basis as a person insured in Romania. It covers medically necessary care during a temporary stay, not a pre-planned treatment and not an open-ended residence.

Covered care, when delivered by a contracted provider, includes family doctor and specialist consultations, emergency dental treatment, hospital care for genuine emergencies, life-threatening conditions, contagious diseases requiring isolation, and childbirth, along with day-hospital procedures such as emergency surgery and monitored chemotherapy sessions. Prescribed medicines are reimbursed at different rates depending on the drug sublist, with some categories reimbursed close to fully and others only partially. Diagnostic and treatment services tied to specific national health programmes, including dialysis, radiotherapy, oxygen therapy during hospitalisation, and certain genetic and haematological testing, are also accessible through the same network.

The card does not make care free in every respect. Holders pay out of pocket for anything outside the covered package, treatment from a provider without a CNAS contract, upgraded hospital accommodation or meals, the portion of a medicine's price above the reimbursed share, and the hospitalisation co-payment that individual hospitals set, typically in the range of five to ten lei per episode. Emergency admissions are exempt from that co-payment.

Where the EHIC stops applying

The EHIC is only valid for someone who remains insured in their home EU or EEA country. Once an employee becomes a Romanian tax resident, takes up local employment with a Romanian employer, or otherwise falls under Romania's own social insurance system, the basis for their healthcare access changes. At that point the relevant document is no longer the EHIC from the sending state but registration as an insured person directly with CNAS through contributions paid in Romania, typically the health insurance contribution withheld from salary.

This is the point where non-EU hires in particular need a different starting assumption altogether. A non-EU national taking up employment in Romania does not carry an EHIC at all, since the card is issued only by EU and EEA national systems. Their path to public health cover runs through Romanian payroll registration from day one: once an employer registers the employment relationship and begins withholding the health insurance contribution, the employee becomes an insured person under CNAS and can access the same contracted network, this time on the strength of Romanian registration rather than a reciprocal card.

Employers posting staff the other direction, sending a Romania-based employee on a temporary assignment into another EU or EEA state, face the mirror image of this question. That employee should apply to their local CNAS health insurance house for their own EHIC before departure, so that temporary care abroad is accessible without the posting itself creating a coverage gap.

Where HR teams get this wrong

The recurring mistake is treating the EHIC as a general-purpose health insurance card rather than what it actually is: a bridge for people who remain insured elsewhere. A company that relocates an EU national employee to Romania and assumes the EHIC covers them for the length of a multi-year assignment is relying on a document meant for temporary stays, not settled residence. Once the assignment's character shifts from temporary to ongoing, local CNAS registration should follow, both to keep the employee properly covered and because continued reliance on an EHIC alone does not substitute for the contribution-based registration Romanian authorities expect for a resident employee.

A second common gap involves assuming the EHIC extends to dependants automatically carried on a family member's card from the home country, without checking that each person named actually appears on the card and that its validity period matches the length of the assignment. The card itself is issued within a matter of working days once an application is registered with the relevant national health insurance house, so renewing it ahead of a known assignment extension is usually straightforward, but it has to be done before the existing card lapses, not after a gap in coverage is discovered at a clinic.

How Nestlers Group supports employers on this

Nestlers Group's tax team manages public health system insured-status validation for employees moving into and out of Romania, confirming whether an employee's coverage runs through a home-country EHIC, Romania's CNAS registration, or a combination of the two across a single assignment, and coordinates the European Health Insurance Card support needed when a Romania-based employee is posted elsewhere in the EU. For non-EU hires, our immigration and payroll teams align the employment registration, health insurance contribution withholding, and CNAS insured status so that cover begins with the employment relationship rather than lagging behind it. Employers managing a mixed workforce of EU postings and non-EU hires into Romania can have both tracks run through the same case team, so a change in an employee's status, from a temporary EHIC-based stay to a locally insured employment relationship, gets picked up and acted on rather than left to surface at the point someone needs care.

Sources: European Commission, Employment, Social Affairs and Inclusion, "Romania - European Health Insurance Card" guidance page; Casa Nationala de Asigurari de Sanatate (CNAS), EHIC issuance and contracted-provider guidance, including the CNAS President's Order no. 180/2022 on radiotherapy provider lists, as subsequently amended.