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Every Bulgarian with health insurance is entitled to free preventive examinations. This guide will help you understand what examinations you are entitled to this year.

Main highlights:

Important reminders:

• Directions are valid for 30 days.
• A health insurance card is required.
• User fee: 2.90 BGN
• Some groups are exempt from fees

Basic preventive examinations

Every health-insured Bulgarian over the age of 18 is entitled to one free annual preventive examination. This examination is performed by a general practitioner and includes a detailed set of tests.

Basic research includes:

• Detailed medical history and complete medical status
• Calculating body mass index to assess overweight
• Assessment of mental status and emotional health
• Preliminary vision examination without determining diopters
• Blood pressure measurement
• Electrocardiogram (ECG) to assess cardiac activity
• Urine test with test strips for several indicators:
  • Protein
  • Glucose
  • Ketone bodies
  • Urobilinogen/bilirubin
  • pH

Additional research:

If risk factors are present, the GP may order a fasting blood sugar test. It is important to note that tests performed on other occasions within the last 12 months are not repeated during the preventive examination.

Formation of risk groups:

During the examination, the doctor assesses the risk of:

• Cardiovascular diseases
• Type 2 diabetes mellitus
• Malignant diseases
• Obesity
• Consequences of smoking

Statistics show that only 411% of Bulgarians with health insurance take advantage of their right to an annual preventive examination. This requires more active information to the population about the importance of prevention.

Studies by age group

From 20 to 65 years old

Preventive examinations in this age group are aimed at early detection of metabolic disorders and organ dysfunction.

Mandatory examinations every 5 years:

Complete blood count, which includes:

• Hemoglobin
• Erythrocytes
• Leukocytes
• Platelets
• Hematocrit
• SUE

Liver samples:

• AST (aspartate aminotransferase)
• ALT (alanine aminotransferase)
• GGT (gamma-glutamyl transferase)
• Total and direct bilirubin

Kidney function:

• Serum creatinine
• Urea
• Uric acid
• General urine with microscopic examination of sediment

After age 40

At this age, tests are added to assess cardiovascular risk.

Lipid profile:

Cardiovascular risk assessment includes:

• Blood pressure measurement
• ECG
• Calculating SCORE risk
• Family burden assessment

Specific examinations for women

From the age of 30:

• Annual clinical breast examination
• Breast ultrasound every 2 years
• Self-exploration training

Gynecological prophylaxis:

• Papanicolaou smear
• HPV typing if necessary
• Colposcopy in case of suspicious finding

Mammographic prophylaxis:

• 45-69 years: every 2 years
• After 70 years: every 3 years
• More common with family history

Specific examinations for men

After age 45:

• PSA test annually
• Digital rectal examination
• Prostate ultrasound in case of elevated PSA

Examinations for people over 65 years of age

Advanced research package:

• Complete blood count at 6 months
• Lipid profile at 5 years
• Cognitive function assessment
• Screening for osteoporosis
• Fall risk assessment

Additional recommendations:

• Flu vaccination
• Pneumococcal vaccination
• Vision and hearing assessment
• Depression screening

All tests are prescribed by the general practitioner according to the individual risk and health status of the patient.

Additional screening programs

Hepatitis screening

The National Program for the Prevention of Viral Hepatitis provides free testing for certain ages.

Research schedule:

• At 40: baseline study
• At 45, 50, 55 and 60 years: follow-up studies

Types of tests:

• HBsAg (hepatitis B surface antigen)
• Anti-HCV (antibodies against hepatitis C)
• Liver enzymes
• If necessary – viral load

Risk groups with more frequent checking:

• Medical staff
• Patients on hemodialysis
• Individuals with multiple blood transfusions
• Intravenous drug users

Practical information

How to get the reviews

Steps to enroll:

1. Call your doctor's office.
2. Choose a convenient time and date
3. Inform yourself about the necessary preparation

Required documents:

• Health insurance card
• ID card
• Previous studies (if any)

Financial aspects:

• User fee: 2.90 BGN
• Exempt from fee:
  
  • Children under 18 years old
  • Pregnant women
  • Chronically ill
  • Disabled veterans

Important deadlines

Validity of documents:

• Specialist referrals: 30 days
• Research directions: 14 days
• Secondary reviews: within 30 days after the first

Special cases:

• Emergencies: no time limit
• Chronic diseases: extended periods
• Pregnancy: special schedule

Rights and obligations

1. Patient rights

Access to information:

• Full access to electronic health record
• History of reviews and research
• Copies of medical records

Choice of medical care:

• Free choice of personal doctor
• Changing personal doctor twice a year
• Choosing a specialist with a referral

2. Patient Responsibilities

Health insurance:

• Regular monthly payments
• Current health insurance status
• Notification when status changes

Medical examinations:

• Respecting examination times
• Timely arrival
• Informing in case of inability to appear

Tips for effective prevention

1. Preparing for the exams

Documentation:

• Folder with previous research
• List of medications taken
• Allergies and intolerances

Questions for the doctor:

• Symptoms and complaints
• Family burden
• Risk factors

2. Tracking results

Organization of documents:

• Chronological order
• Digital archiving
• Sharing with your GP

Examination calendar:

• Save next dates
• Prevention reminders
• Schedule for specialized examinations

Special categories of preventive examinations

During pregnancy

• Schedule of mandatory examinations by trimester
• Free tests for pregnant women
• Genetic screening
• Ultrasound examinations

For children and adolescents

• Immunization calendar
• Preventive examinations by age
• Dental prophylaxis
• Physical development assessment

Prevention of chronic diseases

Diabetes

• Frequency of reviews
• Mandatory research
• Tracking complications
• Self-observation

Cardiovascular diseases

• Risk assessment
• Periodicity of control examinations
• Specialized research
• Preventive measures

Oncological prevention

Types of screening

• Colorectal carcinoma
• Lung cancer
• Skin cancer
• Other localizations

Risk groups

• Family burden
• Occupational risks
• Bad habits
• Age characteristics

Digital healthcare

Electronic health record

• System access
• Available information
• Data protection
• Sharing with doctors

Telemedicine

• Consultation opportunities
• Technical requirements
• Restrictions
• Payment

Financial aspects

Free services

• Scope of free reviews
• NHIF research
• Prevention programs
• Emergency assistance

Additional payments

• User fees
• Choosing a doctor/team
• Additional services
• Health insurance

Prevention at different ages

Young adults (18-30)

• Main risks
• Recommended tests
• Vaccinations
• Healthy lifestyle

Middle age (30-50)

• Specific risks
• Advanced research
• Occupational diseases
• Stress management

Advanced age (over 65)

• Comprehensive assessment
• Fall prevention
• Cognitive function
• Quality of life

Prevention in special conditions

Occupational risks

• Mandatory examinations
• Specific research
• Periodicity
• Documentation

Sports activity

• Previews
• Functional studies
• Load
• Recovery

Conclusion

Preventive examinations are a fundamental tool for disease prevention. Their regular implementation allows:

• Early detection of health problems
• Timely treatment
• Better health outcomes

Actively use your rights to free preventive examinations and tests. Maintain good communication with your GP and follow the recommended examination deadlines.

Frequently Asked Questions

Which examinations are free?

All preventive examinations at the GP once a year are free of charge for health insured persons. They include a general examination, basic tests and an ECG.

Do I have to pay a user fee?

Yes, a fee of 2.90 BGN is due. Children, pregnant women, chronically ill people, disabled veterans and some other categories of patients are exempt.

How long are directions valid?

Referrals for a specialist are valid for 30 days, and for tests - 14 days from their issuance.

What happens if I miss a preventive check-up?

You can do it later in the year. It is important to inform your GP and make a new appointment.

Can I change my personal doctor?

Yes, you have the right to change your GP twice a year – from June 1 to 30 and from December 1 to 31.

What tests are done every 5 years?

A complete blood count, liver function tests, lipid profile, and other basic blood tests are done every 5 years.

How do I prepare for blood tests?

You must fast for at least 8 hours before the test. Do not drink alcohol for 24 hours before the test and avoid strenuous exercise.

Is a referral for a preventive examination necessary?

No, a referral is not required for the annual preventive examination at the GP.

What documents should I bring?

Bring your health insurance card, ID card, and previous medical tests, if you have any.

Can I get a copy of the results?

Yes, you have the right to a copy of all your medical tests and documentation. You can also obtain them through your electronic health record.

When do preventive examinations for children begin?

Preventive checkups for children begin from birth and follow a special schedule according to the child's age.

What does chronic disease prevention include?

In the case of chronic diseases, more frequent examinations and specific tests are performed according to the disease, determined by the treating specialist.

Is there an age limit for free check-ups?

No, all health insured persons, regardless of age, are entitled to a free annual preventive examination.

How do I check my health insurance status?

You can check your status on the NRA website with an electronic signature or at an NRA office with an ID card.

What should I do if I don't have a personal doctor?

You must choose a personal doctor by visiting the district health insurance office or contacting your chosen doctor directly.

Sources

1. https://www.nhif.bg/bg/nzok-za-teb/useful/675
2. https://www.nhif.bg/bg/online/answers/50929
3. https://heraclinics.com/novini/pravo-na-profilaktichni-pregledi-po-liniya-na-nzok
4. https://www.segabg.com/category-zdrave/nzok-obyasni-kakvi-bezplatni-pregledi-ni-se-polagat
5. https://www.mh.government.bg/bg/informaciya-za-grazhdani/skriningovi%20kampanii/main/skrining-rak-jeni-2024
6. https://www.nhif.bg/bg/online/answers/48864