Romanian Health Card: for foreigners What If You Don’t Have It?

The Romanian health card (Cardul Național de Asigurări de Sănătate) is mandatory for accessing most public healthcare services in Romania. However, many foreigners and long-term residents face a common problem: what happens if you don’t have the Romanian health card when a pharmacist or hospital receptionist asks for it?

In practice, you still have rights — and in certain situations, the public healthcare must grant medical services, even without presenting the physical Romanian Health Card.

👉 The public healthcare system must provide Emergency medical services to everyone, regardless of whether they possess the Romanian health card.

Separately, insured persons who cannot present the physical card (for example, because it was not issued, is defective, or was lost) are still entitled to covered services once the operator or doctor verifies their insured status electronically in the SIUI/PIAS system.

What Happens If You Don’t Have a Romanian Health Card?

The Romanian health card became mandatory on 1 May 2015 for insured adults. Although pilot distribution started earlier (2012–2014), nationwide enforcement began in 2015 under Government Emergency Ordinance (OUG) 133/2010 and subsequent implementing regulations. Nevertheless, significant misunderstandings still arise when dealing with pharmacies or hospital reception desks. In practice, confusion about the Romanian health card often affects foreigners, permanent residents, and even insured Romanian citizens.

What the law says (shortly):

OMS/CNAS no. 557/2015 – 246/2015 (joint order) modifies the framework contract regulations and explicitly provides that the public healthcare system must grant medical services/medicines/medical 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.)
CNAS confirms that healthcare operators (pharmacists, doctors) can carry out the verification of insured status online (PIAS/SIUI). There is, there, an official page for verification by Personal Numeric Code (CNP).
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 left without National Healthcare Card:

At the pharmacy, the clerk says that you must have a National Healthcare Card (Card Național de Sănătate) in order to receive your medicines. Less prepared personnel may ask for a substitutive certificate (adeverinţă, that, by the way, doesn’t exist) issued by CAS.
You have an accident, a doctor intervenes, or an ambulance or SMURD transports you to a hospital, and medical staff refuse to provide the necessary assistance because you do not present 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 Romanian Health Card

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 that you are insured under Romania’s public health system. Expats do not have a health card because the system does not issue one to foreign residents.
Ask them to check your insurance online in the SIUI/PIAS system using your CNP. Use this sentence “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”, explain that if you are registered in Romania’s public health insurance system. You do not need any “adeverință” to replace the Romanian health card.
Even if no health card has been issued in your name, you can still receive medical services and prescriptions based on your verified insured status. Doctors and pharmacies verify this online through the CNAS portal: https://cnas.ro/verificare-asigurati/.
If they still refuse: escalate to the pharmacy manager or file a complaint with CASMB/CNAS. For “life saver” drugs, you can also ask the intervention of the Police by calling 112.

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

Doctors, assistants or administrative personnel may tell you 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. Use:“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.”
(“The Romanian Public Health System guarantees medical care services 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 access a hospital in Romania, the reception staff may ask when your employment contract ends. This is not unusual.

For many employees, health insurance depends on having a valid work contract and paying social contributions (CASS).

When a work contract ends, health insurance usually ends too, unless the person qualifies under another insured category.

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 must treat insured persons under the same conditions, regardless of nationality. Lawfully insured foreign residents get to the same healthcare services as Romanian citizens within the public system.

⚖️ Bottom Line

Pharmacy → you must get services/medicines if insured, even without the Romanian health card.. Verification is online, or with an adeverință.
Emergency (ambulance/hospital) → public health operators, including doctors and pharmacists must provide treatment and cannot refuse under any circumstance. You don’t need to show a card required for emergency care. Healthcare System personnel can check status 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. It is 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. It performs the same role as CAS, but specifically for residents of Bucharest.

When Is the Romanian Health Card Actually Mandatory?

For routine consultations
For electronic validation
Not for emergencies
Some foreign categories and retired Romanians do not get it.

Costs for getting your Romanian Health Card or private 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.

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