Romanian Health Card: What If You Don’t Have It? Your Rights Explained

Contents of this Article

The pharmacist or the hospital receptionist ask for your Health Card (the romanian “Card de Sanatate” and you don’t have it. A guide to your rights.

The “Card Național de Asigurări de Sănătate” (“card de sănătate”) was officially introduced in Romania in 2015.

1 May 2015 → The use of the health card became mandatory for all insured persons over 18, for access to medical services, medicines, and medical devices.
Pilot phase → Distribution and testing had started earlier (2012–2014), but the nationwide rollout with legal obligation began in 2015.
Legal basis → Government Emergency Ordinance (OUG) nr. 133/2010 and subsequent implementing orders by CNAS/Ministry of Health set the framework, but the mandatory enforcement date was 1 May 2015.

👉 Children under 18 and certain exceptional cases (e.g., emergency situations, people without a card issued) can still access services without it, based on verification in the SIUI system.

Unfortunately, after all these years, there are still big misunderstandings when you have to face a pharmacist to have your medicines, or even getting help in a hospital.

What the law says (shortly):

OMS/CNAS no. 557/2015 – 246/2015 (joint order) modifies the framework contract regulations and explicitly provides that medical services/medicines/medical devices may also be granted without the health insurance card “in situations where the insured persons cannot present/use the card.” (See Annex 47, point 13 of the joint order.) (lexmed.ro)
CNAS confirms that the verification of insured status is carried out online (PIAS/SIUI). There is an official page for verification by Personal Numeric Code (CNP). (CNAS, SIUI)
The Ministry of Health also directs the public to the CNAS page for “Verification of insured status” (therefore the physical card is not mandatory if you can be verified in the system). (ms.ro)

Frequent misunderstandings due to the fact that foreigners are one of the categories for which the National Healthcare Card is not emitted:

At the pharmacy, the clerk says that you must have a National Healthcare Card (Card Național de Sănătate) in order to receive your medicines. Sometimes, as an alternative, they may ask for a substitutive certificate (adeverinţă) issued by CAS.
You had an accident, a doctor intervened or you have been transported to a hospital by an ambulance or SMURD and one of these actors tells you that they cannot provide you the necessary assistance without a valid National Healthcare Card.

Do you need National Health Card to request your residence?

It is important to distinguish between Romania’s National Health Insurance system (CNAS), a private health insurance policy, and a private medical subscription (abonament medical) with providers such as Regina Maria or MedLife. The National Health Insurance system is public and financed through mandatory social contributions (CASS). It grants access to state hospitals and reimbursed services within the public healthcare network. A private health insurance policy, on the other hand, is an insurance contract issued by an insurer that covers medical costs according to the policy terms, often including private hospitals and additional services. A medical subscription (such as those offered by Regina Maria or MedLife) is not insurance: it is a prepaid package of services provided within that specific private network and typically covers consultations and basic investigations, but not major hospitalization or complex treatments unless explicitly included.
This distinction becomes crucial in immigration matters. For obtaining or renewing a Romanian residence card (especially for non-EU citizens), authorities generally require proof of valid health insurance coverage. A simple medical subscription is usually not sufficient, because it is not legally classified as insurance and may not cover hospitalization risks. EU citizens registering their residence must also demonstrate comprehensive health insurance if they are not employed or contributing to CNAS. Therefore, when dealing with residency procedures, you must verify whether your coverage qualifies as legally recognized health insurance, not merely as a private healthcare subscription.

✅ Guide for Foreigners: What to Do If Asked for a National Healthcare Card in Romania

1. At the Pharmacy

The clerk may say you must have a National Healthcare Card (Card Național de Sănătate) to get your medicines. Sometimes they will ask for a substitutive certificate (adeverință).

What to do:

Politely explain you are insured but do not have the physical card, as it is not issued to foreign citizens residing in Romania .
Ask them to check your insurance online in the SIUI/PIAS system using your CNP: “Vă rog să verificați calitatea mea de asigurat în SIUI după CNP. Conform OMS/CNAS 557/2015–246/2015, serviciile se pot acorda și fără card.”
(“Please check my insured status in SIUI using my CNP. According to OMS/CNAS 557/2015–246/2015, services may be provided even without the card.”)
If they insist on an “adeverință“, just mention that if you are registered as insured in Romania’s health insurance system, you do not need any “adeverință” to replace the Card de sănătate. Even if no health card has been printed for you, you can still receive medical services and prescriptions on the basis of your insured status. Doctors and pharmacies verify this online through the CNAS portal: http://www.cnas.ro/casmb/page/verificare-asigurat.html. I have filed a petition to CASMB and published the answer in this article.
If they still refuse: escalate to the pharmacy manager or file a complaint with CASMB/CNAS. If the medicines you need are “life saver” drugs, you can also ask the intervention of the Police by calling 112.

2. In an Emergency (Accident, Ambulance, SMURD, Hospital)

You may be told that treatment cannot be given without a valid health card.

What the law says:

According to Law no. 95/2006, art. 223–225, emergency medical care must be provided to every person, insured or not.
According to OMS/CNAS 557/2015–246/2015, services can also be provided without a card if the insured person cannot present or use it.
Insured status can be verified online in SIUI/PIAS using your CNP.

What to do:

Calmly insist that in emergencies, care cannot be denied: “Asistența medicală de urgență este garantată prin lege, indiferent dacă am card de sănătate sau nu. Vă rog să verificați calitatea mea de asigurat în SIUI după CNP.”
(“Emergency medical care is guaranteed by law, regardless of whether I have a health card. Please check my insured status in SIUI using my CNP.”)
If the staff still insists on the card:
- Remind them that refusing treatment in an emergency is against Law 95/2006 and exposes the provider to liability.
- If possible, ask a family member to record or note the refusal.

An important note:

If you are admitted to a hospital in Romania, the reception staff may ask when your employment contract ends. This is not unusual. In many cases, health insurance coverage for employees is linked to the validity of their work contract and the payment of social contributions (CASS).

When an employment contract terminates, health insurance coverage may also cease, unless the person qualifies under another insured category (for example, as a pensioner, dependent family member, self-employed contributor, or permanent resident with continued contribution status).

However, if you hold permanent residence in Romania and continue to meet the legal conditions for health insurance coverage — including payment of contributions where required — your right to access healthcare does not automatically expire when a specific work contract ends.

In such cases, you should clearly explain your legal status and provide documentation proving your continued insured status. Romanian healthcare providers are required to treat insured persons under the same conditions, regardless of nationality. Lawfully insured foreign residents are entitled to the same healthcare services as Romanian citizens within the public system.

⚖️ Bottom Line

Pharmacy → services/medicines must be given if you are insured, even without the card. Verification is online, or with an adeverință.
Emergency (ambulance/hospital) → treatment cannot be refused under any circumstance. Card is not required for emergency care. Insurance status can be checked online afterwards.

Here’s a short statement to use with the Romanian personnel:

„Sunt asigurat(ă) CASMB**. Conform OMS/CNAS nr. 557/2015 – 246/2015, Anexa 47, pct. 13, serviciile se pot acorda și fără card, dacă nu îl pot prezenta. Vă rog să îmi verificați calitatea de asigurat în SIUI/PIAS după CNP.” (lexmed.ro, SIUI)

*CAS (Casa de Asigurări de Sănătate) – the County Health Insurance House, responsible for managing the public healthcare system in each county of Romania (e.g., CAS Cluj, CAS Iași, etc.).

**CASMB (Casa de Asigurări de Sănătate a Municipiului București) – the Health Insurance House of Bucharest Municipality, which performs the same role as CAS, but specifically for residents of Bucharest.

Costs for getting your insurance

To obtain access to Romania’s National Health Insurance system (CNAS) and receive a National Health Card (“Card de Sănătate”), you must qualify as an insured person. The most common route is through employment, where the employer withholds and pays the mandatory health contribution (CASS), currently 10% of gross income. Once contributions are properly declared, insured status is registered automatically and the health card is issued without a separate fee.
If you do not have employment income, you may still become insured by opting for voluntary health insurance through the tax authority (ANAF). In practice, this is done by submitting the Single Tax Declaration (Declarația Unică) and declaring that you will pay the health contribution calculated at the minimum threshold. In many cases, this involves paying CASS at the level of six minimum gross salaries, which currently results in a lump-sum contribution of approximately 2,500–3,000 RON (depending on the minimum salary applicable in that fiscal year). Once this contribution is declared and paid, you acquire insured status for the relevant period and become entitled to public healthcare services under the same conditions as other insured persons.
By contrast, private health insurance is obtained by purchasing a policy from an insurance company, with costs varying depending on age, coverage level, and medical history. Basic policies may start from around €20–40 per month, while comprehensive plans covering hospitalization and major treatments can exceed €70–100 per month. Unlike the public system, private insurance requires a formal contract and premium payments, and coverage begins according to the policy terms rather than automatically through tax registration.

Legal Disclaimer
This article is not intended as legal advice. I am simply sharing my personal experience, supported by the best information available at the time — including explanations generated with the help of AI tools like ChatGPT.
Please be aware that immigration laws and procedures may change over time, and mistakes can happen. I strongly recommend verifying any legal or administrative detail directly with the Romanian authorities or a qualified immigration lawyer.
I am committed to keeping my articles up to date and accurate. If you spot an error or have constructive feedback, your comments are not only welcome — they are appreciated.

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Romanian Health Card – What If You Don’t Have It?