On 15 July 2025, the last day of the session before the constitutional recess, the Croatian Parliament voted on amendments to the Compulsory Health Insurance Act.

These amendments were an opportunity to protect the right to health of a large number of citizens, which is why the Ombudswoman Tena Šimonović Einwalter provided several comments and recommendations in the public consultation and in the parliamentary procedure. They concerned students, persons living in homelessness, employees caring for elderly or infirm family members, citizens who must travel outside their place of residence to access medical care, and others.

Since these proposals were not accepted, the problems remain and the Ombudswoman will continue to advocate for the proposed solutions, described below.

The obligation to periodically visit the Croatian Health Insurance Fund in person should be abolished

What is the problem

Two years ago, a new rule required certain insured persons to personally visit the nearest Croatian Health Insurance Fund (HZZO) office every three months to avoid losing their health insurance coverage. When the Ministry of Health proposed this obligation, the Ombudswoman warned of the consequences it would have on citizens, but her comments were not taken into account.

Unfortunately, these warnings proved correct: last year alone, 13,184 people lost their health insurance because of this rule, including many seriously ill who, for various reasons, could not meet the requirement or were unaware of it.

Who was left without compulsory health insurance

Citizens say in their complaints that they did not know that this obligation applied to them or did not understand by when they had to report, and that due to illness, disability and other objective circumstances they simply could not do so. Many found out that they had lost health insurance only when they went to the doctor or wanted to collect their regular medication, and many women on maternity/parental leave were left without both health insurance and maternity benefit.

This obligation has also had a negative impact on Croatian citizens studying abroad, who have not been able to return periodically to report to the Croatian Health Insurance Institute, and therefore many are in a situation where they do not have health insurance when they come to Croatia, or have to pay for it.

Considering all the examples, it is not surprising that by the end of 2024, 129 people in this situation had complained to the Ombudswoman, which is the highest number of complaints ever prompted by a single law.

In June 2023, the Ombudswoman submitted a request to the Constitutional Court for a review of the constitutionality of the provisions of the Compulsory Health Insurance Act that prescribe this obligation. She pointed out that this obligation leads to discrimination on the basis of health status, disability and socio-economic status, which is prohibited by the Anti-Discrimination Act and violates the constitutional principle of equality before the law. However, the Constitutional Court has not yet decided on her request.

What do the amendments to the Compulsory Health Insurance Act bring

The amendments to the Compulsory Health Insurance Act, which have been in force since 1 August 2025, after almost two years, mitigate the negative consequences that the obligation to appear in person has had and continues to have for certain groups of citizens. Exceptions have been introduced for insured persons who, for valid reasons, are unable to appear in person, for as long as those reasons persist and provided they have notified the Institute.

Are these changes sufficient

The introduction of an exception is not an adequate solution to all the negative effects that the obligation of periodic personal access has had and continues to have.

First of all, a large number of people have already lost compulsory health insurance due to this obligation, and will not receive it under these changes, although they still meet the key and substantial condition for it, which is that they are outside the labor system. Many of them now pay for it themselves, although they are still unemployed or on maternity/parental leave.

In addition, the introduction of an exception opens up room for arbitrary action because the law does not specify what evidence is required to prove that a person is unable to appear in person before the Croatian Health Insurance Institute, nor who decides whether the reason is justified: the institute officials who work directly with the parties, the Institute Commission or a third party. It is not even clearly defined what is meant by “other justified reasons”.

Furthermore, the question is whether insured persons will be informed that there is an exception and that it can be appplied to them, or whether they will still be deregistered from compulsory health insurance due to the lack of this information, even though they could have kept it.

Namely, such exceptions are already made in the practice of the Institute, when it comes to health status, but complaints show that some persons do not have such information. Also, persons who do not have a telephone or computer/internet will have to approach in person because for them this is the only way of communicating with the Institute, which means that some persons, living with lower income, are excluded from the possibility of being exempted from the obligation to approach in person.

Situations like this certainly do not fall under the average life circumstances, but they are very possible, especially when we are talking about areas that are geographically and in terms of traffic distant/isolated from cities.

What actually needs to be done

For all these reasons, it is necessary to completely abolish the obligation to regularly visit the Croatian Health Insurance Institute in person once every three months, and to update the records and prevent abuse in accordance with the possibilities of the 21st century – by exchanging data between the Croatian Health Insurance Institute and other public law bodies, such as the Ministry of the Interior (for records of residence) or the Tax Administration (for records of tax residency).

It is also necessary to enable all those who, due to the introduction of this obligation, were left without compulsory health insurance, but who meet the key and substantial condition of being unemployed, to regain the status of an insured person at the expense of the State Budget. For this, it is necessary to introduce a new insurance basis, and these amendments were precisely the opportunity for this.

Students studying in the EU should be prevented from losing health insurance

What is the problem

One of the reasons why someone can be left without health insurance is if they report a temporary departure from Croatia. This also happens to Croatian students who study regularly in other EU member states, who have also contacted the Ombudswoman.

They cannot access health care based on the European Health Insurance Card in their place of study, and they do not have compulsory health insurance even when they return to Croatia. The Ombudswoman has also warned the Government of the Republic of Croatia about this problem, and the Department of European Public Law at the Faculty of Law in Zagreb has confirmed her position that this is a violation of the freedom of movement as a right of EU citizens because it deters students from using it.

What needs to be done

In order to ensure that Croatian students who are regularly educated in other Member States and have their residence in Croatia also retain their compulsory health insurance, it is necessary to introduce an exception for those insured persons who report a temporary departure from Croatia if they are regularly educated in another EU Member State.

Health insurance should also be provided to homeless people who do not have a permanent residence

What is the problem

Homeless people are mostly Croatian citizens without income, they live in extreme poverty, are mostly invisible in society, and are often denied access to basic rights, among other things.

Despite this, the Compulsory Health Insurance Act does not mention them in the list of groups that acquire compulsory health insurance at the expense of budget funds. Because people living in homelessness often lack a permanent residence address, they cannot obtain health insurance and therefore avoid seeking medical help when ill. Later when they do, the costs of treatment are covered by the providers of accommodation services for the homeless because they are registered at their address.

What needs to be done

Homeless people, as the most vulnerable group in society, should have free health care, regardless of whether they have a registered residence. After all, the new National Health Development Plan 2021-2027 also prioritizes improving health care for vulnerable groups, which the homeless certainly are.

Therefore, it is necessary to list the homeless in the Compulsory Health Insurance Act as a group that acquires compulsory health insurance at the expense of budget funds based on their specific situation, regardless of whether they have a registered residence or not.

Sick leave should also be provided for the care of an older family member

What is the problem

Children of older and infirm parents who need care cannot obtain sick leave, or the right to salary compensation due to temporary incapacity for work. Namely, according to the Compulsory Health Insurance Act, sick leave can only be obtained for the care of a sick child, spouse or life partner.

On the other hand, citizens are obliged by the Constitution of the Republic of Croatia to care for their older and infirm parents, but currently for such needs they can only use unpaid leave and only five days during the year, which is prescribed by the Labour Act. Therefore, the conditions for fulfilling the constitutional obligation to care for parents have not been created.

Likewise, some older persons never had children or do not have them anymore, so it is vitally necessary and justified to provide sick leave, in addition to children, to grandchildren who care for their grandparents, in situations when their parents are unable to do so, for example because they are no longer alive, as well as to brothers/sisters and nephews, for those who did not have children.

What citizens say

The Ombudswoman has been warning about this problem for several years, including in the Ombudswoman’s Report for 2024. In it, she also highlighted the example of a complainant who addressed her on this very topic, with this message:

“I would appeal to you who can take certain steps to make it easier for children to care for and take care of sick and infirm parents. A person capable of working can take sick leave for immediate family members; the law includes children and spouses (marital, extramarital, life partner or informal life partner), but not parents. Given such a legal definition, a person cannot exercise the right to sick leave to care for a sick parent. The law was passed; the duty of children is primarily moral, and then legally to take care of their sick and infirm parents. How? How will they care if they cannot take sick leave to provide adequate care. So for a spouse of a marriage, extramarital, informal YES… but for a mother/father who has cared for and loved their child unconditionally their entire life, that same child cannot take sick leave when the mother/father is sick at the end of their life and often immobile?”

What needs to be done

The Compulsory Health Insurance Act should also provide sick leave to persons who care for members of their immediate family.

In this case, the immediate family should be defined as in the Labor Act, which states that the immediate family includes a spouse, blood relatives in the direct line and their spouses, brothers and sisters, stepchildren and adopted children, children entrusted for care and upbringing or children in care outside their own family, stepfather and stepmother, adoptive parent and a person whom the worker is legally obliged to support, and a person who lives with the worker in an extramarital relationship, in a life partnership or informal life partnership.

The number of kilometers for obtaining compensation for travel expenses should be reduced and the method of calculation should be changed

What is the problem

According to the Compulsory Health Insurance Act, the right to reimbursement of travel expenses related to accessing health care under compulsory insurance can be exercised if, among other things, the distance from the place of residence to the place of referral for treatment is at least 50 kilometers.

This number should be reduced because it is a common situation that citizens have to go for examination or therapy outside the place where they live, and if they cannot receive compensation, they may not be able to afford the cost of transportation, so health care becomes inaccessible to them. The Ombudswoman also reported this to the Croatian Parliament in the Report of the Ombudswoman for 2024.

The definition of “place”, which is determined by the Ordinance on the conditions and manner of exercising rights from compulsory health insurance, is also a problem, in a way that narrows the right guaranteed to citizens by the Act.

What needs to be done

In order to ensure equality in the entire process of obtaining health care guaranteed by the Health Care Act, and for citizens to have access to the necessary health care regardless of where they live, it is necessary to reduce the mileage requirement from 50 to 30 kilometers, as was stipulated in the previous Compulsory Health Insurance Act.

It is also necessary to stop using the term “place” in the Act, and instead use the “residence” of the insured person and “health care institution/clinic/supplier of orthopedic aids”. In this way, the distance would be determined from the address of residence to the address of the health care institution/clinic to which the person is referred for treatment, i.e. the address of the supplier of the aids.