Health Insurance for Non-EU Workers in Romania 2026: CASS, CNAS and the Coverage Gap Employers Miss

Most employers hiring non-EU workers in Romania treat health insurance as a box ticked once, at the visa stage. In practice, a foreign employee passes through three different coverage regimes in their first months: private travel or medical insurance to obtain the long-stay visa, a transition period while the employment contract, CNP and payroll are set up, and finally full membership of the public system administered by the National Health Insurance House (CNAS).

Each handover carries risk. A worker who falls ill in week three, before payroll has run, may find that the visa-stage policy has lapsed and that CNAS does not yet show them as insured. Since September 2025, family members who relied on the old co-insured arrangement face a separate problem, because that status no longer exists automatically.

This guide sets out how coverage works for non-EU employees in 2026 and the points where HR teams most often lose track.

Stage One: Medical Insurance for the Long-Stay Visa

A non-EU national applying for the D/AM long-stay employment visa must submit proof of medical insurance valid for the duration of the visa, alongside the work permit, passport, proof of means and criminal record certificate. The policy is purchased privately, usually in the home country, and its only job is to cover the worker until they enter the Romanian system.

Employers should check three things before the visa application is filed:

• The policy covers the full visa period, not just the travel dates
• The territorial scope explicitly includes Romania
• The worker understands that the European Health Insurance Card does not apply to third-country nationals arriving from outside the EU

Stage Two: The Gap Between Arrival and Payroll

After arrival, the worker must apply to the General Inspectorate for Immigration (IGI) for a single residence permit. The IGI may ask for proof of health insurance at this point too, so the visa-stage policy needs to remain valid until the permit is issued.

The more practical constraint is the CNP, the personal numeric code. A Romanian employment contract cannot be registered in Revisal and a payslip cannot be generated without it, and CNAS registration and enrolment with a family doctor both depend on it. Until the CNP is issued and the first payroll has been processed, the employee is not reliably visible in the CNAS database.

The safest approach is to keep private cover in force for at least one full payroll cycle after the employment start date, and to confirm insured status before letting the private policy expire.

Stage Three: CASS Through Payroll

Once the employee is on Romanian payroll, health insurance becomes automatic. The employee contribution to social health insurance (CASS) is 10% of gross salary, withheld by the employer and declared monthly to ANAF through the D112 return. There is no ceiling on employment income for CASS purposes.

CASS sits alongside the 25% pension contribution (CAS) and 10% income tax, so the total employee-side burden on gross salary is significant. The employer itself pays only the 2.25% work insurance contribution (CAM). For budgeting purposes, the minimum gross salary rose from RON 4,050 to RON 4,325 per month from 1 July 2026, which sets the floor for many D/AM2 roles.

Paying CASS gives the employee the status of insured person, which entitles them to the basic package of medical services: family doctor registration, specialist referrals, hospital care and compensated prescription medicines, on the same terms as Romanian employees.

Confirming insured status

HR teams should not assume that withholding CASS automatically produces an active record. After the first D112 return has been processed, the employee can check their status through the CNAS online verification service or request an insured status certificate from the county health insurance house. If the record is missing, the usual causes are an incorrect CNP on the D112, a late filing, or a mismatch between the contract registered in Revisal and the payroll data.

Family Members After the End of Co-Insurance

Until 2025, a spouse or dependent parent without income could be covered as co-insured through the employee's contributions. Law 141/2025 removed that exemption from 1 August 2025, and the co-insured status ceased on 1 September 2025 for anyone who had not obtained insured status in their own right.

For non-EU workers bringing family under the family reunification route, this matters directly. A spouse who is not working in Romania must now be covered in one of two ways:

• The insured employee opts to pay CASS for them through the annual Single Declaration, calculated at the equivalent of six gross minimum salaries per year
• The family member buys private health insurance, which may also be required for their own residence permit

Children are treated differently and remain covered as dependants without a separate contribution, but they still need a CNP and registration with a family doctor to access services.

Employers who promise relocation support should make this explicit in offer letters and relocation briefings. A spouse arriving in Romania who assumes they are covered through the employee may only discover otherwise when they first need care.

Common Compliance Errors

The same problems recur across non-EU hiring cases:

• Allowing the visa-stage policy to expire before CNAS shows the employee as insured
• Delays in obtaining the CNP, which hold up payroll and therefore CASS
• Errors in the D112 that leave contributions unallocated to the employee
• Assuming spouses and parents are still co-insured
• Failing to brief workers on how to register with a family doctor, which is the entry point to most public services

None of these are penalised as a separate offence, but each one leaves a worker without effective coverage, and in renewal cases IGI may again ask for proof of health insurance.

How Nestlers Group Supports Health Insurance Compliance for Non-EU Hires

Nestlers Group's Work Permit and Visa Support team checks medical insurance documentation at the visa and residence permit stages, so that private cover is sized to bridge the full period until the worker enters the public system. The team also coordinates CNP issuance alongside the IGI residence permit application.

Our Payroll and HR Compliance team registers contracts in Revisal, processes monthly payroll with correct CASS withholding, files the D112 return and verifies that each new non-EU employee appears as insured with CNAS after the first payroll cycle. For clients without a Romanian entity, our Employer of Record service handles the same obligations as the legal employer.

For relocating families, our Global Mobility and Relocation team briefs employees and spouses on the end of co-insurance, the CASS option through the Single Declaration and family doctor registration, so that every family member has coverage in place from arrival.

Sources: Law No. 141/2025 on fiscal-budgetary measures (co-insured status and CASS exemption changes, effective 1 August and 1 September 2025); Law No. 95/2006 on healthcare reform, as amended; Romanian Fiscal Code (Law No. 227/2015), social contribution rates applicable in 2026; Government Decision on the national minimum gross salary from 1 July 2026; General Inspectorate for Immigration (IGI), long-stay visa for employment and residence permit guidance, 2026; PwC Worldwide Tax Summaries, Romania individual taxation, 2026.