Before you start

CNP from the residence permit
Employment with Romanian payroll, or voluntary CASS registration if self-employed
Registration with a family doctor (medic de familie) near your address
Private subscription, if your employer provides one

Step-by-step

1
Confirm CASS is being deducted from your payslip
The 10% health contribution is withheld by the employer alongside the 25% pension contribution. Check it appears on your first payslip — enrolment is automatic but occasionally lags for a new foreign employee whose CNP arrived late.
Via employerWho: YouFirst payslip
2
Register with a family doctor
The medic de familie is the gateway to the state system: referrals to specialists, prescriptions, sick notes. You choose one and register with a form; practices near your address are the practical choice. Without a registered family doctor you have insurance but no route into the system.
In personWho: YouFirst month
3
Understand what the private subscription actually covers
Regina Maria, MedLife and Sanador run large clinic networks and sell corporate subscriptions that most Bucharest employers provide. These cover consultations, imaging and routine care quickly. They generally do not cover major surgery or intensive care, which still runs through the state hospitals.
Via employerWho: You
4
Register for voluntary CASS if you are self-employed
Freelancers and company directors pay CASS on a calculated base rather than through payroll, and the rules on the minimum base have been changed repeatedly in recent budgets. Get current advice — this is one of the most frequently amended parts of the Romanian fiscal code.
OnlineWho: You
5
Get the European Health Insurance Card once insured
Insured residents can request the EHIC from CASMB, which covers necessary treatment across the EU and EEA. It is free and takes a few weeks. Now that Romania is in Schengen the practical value of having it in your wallet has gone up.
OnlineWho: You
6
Know where the emergency route runs
112 dispatches both the county ambulance service and SMURD, the mobile emergency and rescue service run jointly with the fire brigade. Bucharest's university hospitals take the serious cases. Private clinics are not the route for an emergency — they will send you on.
In personWho: You

Documents you’ll need

CNP and residence permit
Health insurance evidence (adeverință de asigurat) or the payslip showing CASS
Family doctor registration form
Private subscription card, where provided
EHIC, once issued

Things most newcomers don’t know

The 10% health contribution is not the same thing as the 10% income tax, and people conflate them.

Romania has two separate 10% figures. One is the flat personal income tax. The other is CASS, the health contribution, charged on gross salary alongside a 25% pension contribution. Together the employee deductions come to roughly 35% of gross before the income tax is applied to what remains. Anyone comparing a Romanian offer to a Western European one on the strength of 'a 10% tax rate' is off by a very large margin.

Source: ANAF

A private subscription is normal here and is not a sign of a bad employer.

Nearly every professional employer in Bucharest provides a clinic subscription with Regina Maria, MedLife or Sanador, and employees use it for everything routine. This is not because the state system is unusable — it funds serious and emergency care effectively — but because outpatient waiting times are long and clinic conditions vary. Treat the absence of a private subscription in an offer as a real gap worth negotiating on.

Source: community-reported

Self-employed health contribution rules have changed almost every year, and old advice is dangerous.

The base on which freelancers, sole traders and company directors compute CASS has been rewritten repeatedly in successive Romanian budget laws, including significant changes for 2025 and 2026. Ceilings, floors and the treatment of dividend income have all moved. This is the single area where an accountant is worth the fee, and where a guide written even a year ago will give you a number that is no longer correct.

Source: ANAF

Without a registered family doctor you are insured but effectively locked out.

The medic de familie issues referrals, prescriptions and sick notes, and the state system routes almost everything through them. Foreign residents frequently pay CASS for a year without ever registering, then discover at the point of needing a specialist that they cannot get a referral. Registration is a short form at a practice near your address and should be done in the first month.

Source: CNAS