Ombudswoman Tena Šimonović Einwalter participated in the public consultation on the proposed amendments to the Mandatory Health Insurance Act, which was open until 5 April 2025.

The comments and proposals of the Ombudswoman relate to various issues raised by citizens and are aimed at strengthening the protection of the right to health in Croatia. Specifically, they address:

  • the obligation of in-person visits to the Croatian Health Insurance Fund (HZZO) every three months
  • issues faced by students studying in other EU Member States
  • the need to explicitly include homeless persons as a group eligible for mandatory health insurance, as they are currently excluded if they have no registered residence
  • the need to allow employed children, grandchildren, nephews/nieces, siblings to take sick leave to care for older and infirm family members
  • conditions for entitlement to and calculation of transport cost reimbursement

More on these comments can be found below.

The obligation of periodic In-Person attendance at the HZZO should be abolished

What is the problem?
Two years ago, a new obligation was introduced requiring certain insured persons to appear in person at the nearest HZZO office every three months in order to retain their mandatory health insurance. When the Ministry of Health proposed this obligation, the Ombudswoman warned of its adverse impact on citizens, but her comments were not taken into account.

Unfortunately, her concerns were confirmed. In the past year alone, 13,184 persons lost health insurance due to this requirement. Among them are many seriously ill individuals who, for various reasons, were unable to fulfill the obligation or were unaware of it.

Who lost their mandatory health insurance?
Citizens reported not knowing that the obligation applied to them or misunderstanding the deadline. Many, due to illness, disability, or other objective circumstances, simply could not comply. Some only found out they had lost insurance when visiting a doctor or attempting to obtain regular medication. Many women on maternity/parental leave also lost insurance and were simultaneously left without maternity benefits.

This obligation also negatively affects Croatian citizens studying abroad, who cannot return every three months to report to the HZZO and thus lose their insurance or must pay for it when returning to Croatia.

By the end of 2024, the Ombudswoman received complaints from 129 individuals affected by this issue – the highest number of complaints ever triggered by a single law.

In June 2023, the Ombudswoman submitted a request to the Constitutional Court for a review of the constitutionality of the Act’s provisions mandating this obligation. She argued it leads to discrimination based on health status, disability, and financial status, which is prohibited by the Anti-Discrimination Act, and violates the constitutional principle of equality before the law. The Court has not yet ruled.

What is the Ministry proposing in the new amendments?
The Ministry of Health now proposes to mitigate the negative consequences by introducing exceptions for some insured persons – those receiving maternity/parental benefits and those who cannot appear in person due to health or other justified reasons, provided they inform the HZZO.

Additionally, persons who lost regular student status and registered with the HZZO within 30 days would also be required to report in person every three months.

Are these amendments sufficient?
Introducing exceptions does not adequately address all the harmful effects of the obligation.

First, many have already lost insurance and cannot regain it through the proposed amendments, even though they still meet the key condition of being outside the labour system. Many now pay for it themselves despite being unemployed or on parental leave.

Second, the exceptions risk arbitrary application: it is unclear what proof is required to show inability to appear, or who determines whether a reason is justified – HZZO clerks, a HZZO committee, or someone else. The term “other justified reasons” is also vague.

Moreover, it is unclear whether insured persons will be informed about the exceptions and their applicability, risking continued deregistration despite eligibility.

Some insured persons without phone or internet access must appear in person, as that is their only communication channel with the HZZO – disadvantaging the financially vulnerable. This is especially problematic in geographically remote areas.

What must be done?
The obligation for in-person visits every three months should be completely abolished. Record-keeping and fraud prevention should be done via 21st-century methods – data exchange between the HZZO and other public bodies, such as the Ministry of the Interior (residence data) or the Tax Administration (tax residency data).

Everyone who lost insurance due to this obligation and meets the substantive criteria (e.g. unemployment) should regain insured status funded by the state budget. This requires introducing a new insurance basis – these amendments offer a timely opportunity to do so.

 

Students studying in the EU should not lose health insurance

What is the problem?
One can lose health insurance by reporting temporary departure from Croatia. This affects Croatian students studying regularly in other EU Member States, who have contacted the Ombudswoman.

They cannot access healthcare in the country of study via the European Health Insurance Card and also lack insurance upon return to Croatia. The Ombudswoman highlighted this to the Government, and the Chair of European Public Law at the Zagreb Faculty of Law supported her stance, stating this violates the EU right to free movement by discouraging its use.

What must be done?
To ensure Croatian students with residence in Croatia who study regularly in other EU Member States retain mandatory health insurance, an exception should be introduced so their insured status is not terminated upon temporary departure from Croatia.

 

Homeless persons without registered residence must be guaranteed health insurance

What is the problem?
Homeless persons are usually Croatian citizens without income, living in extreme poverty and social invisibility. Due to their financial situation, they often lack access to basic rights.

Nonetheless, the Act does not mention them as a group entitled to state-funded mandatory health insurance. Since they often lack registered residence, they are also uninsured and avoid visiting doctors. When they do, the cost is often covered by homeless shelter providers, as they are registered at the shelter’s address.

What must be done?
As one of the most vulnerable groups in society, homeless persons should receive free healthcare regardless of registered residence. The National Health Development Plan 2021–2027 also prioritizes improving access for vulnerable groups, including the homeless.

Therefore, the Act should be amended to explicitly include homeless persons as eligible for state-funded health insurance based on their specific status, regardless of registered residence.

 

Sick leave should be allowed for caring for older family members

What is the problem?
Currently, one cannot take paid sick leave to care for older and infirm parents. The Act only allows sick leave for caring for a sick child, spouse, or life partner.

However, the Croatian Constitution obliges citizens to care for their older and infirm parents. The Labour Act only allows up to five days of unpaid leave per year for such care – insufficient to fulfill this constitutional duty.

Some older persons also have no children, so it is necessary and justified for grandchildren, siblings, or nephews/nieces to be allowed to take sick leave in such cases.

What do citizens say?
The Ombudswoman has raised this issue for years, including in her 2024 Annual Report, which featured this appeal from a complainant:

“I urge you to take steps to help children care for their sick, infirm parents. Sick leave can be taken for a child or spouse, but not for a parent. How can children provide proper care without the right to sick leave when their parent is ill or bedridden?”

What must be done?
The Act should be amended to allow sick leave for persons caring for close family members.

“Close family” should be defined as in the Labour Act, including spouse, blood relatives in the direct line, their spouses, siblings, stepchildren, adopted children, children in foster care, stepparents, adoptive parents, and others whom the worker is legally obliged to support, as well as persons in informal or same-sex partnerships with the worker.

 

The distance threshold for transport cost reimbursement should be lowered, and calculation changed

What is the problem?
Under the Act, one may only claim reimbursement for transport costs for healthcare if the distance between residence and treatment facility is at least 50 kilometers.

This threshold should be reduced, as many citizens must travel outside their town for care. Without reimbursement, they may not be able to afford travel, making healthcare inaccessible. This was highlighted in the 2024 Annual Report.

The term “place” is defined restrictively in the relevant Ordinance, limiting rights guaranteed by the Act.

Reimbursement is also calculated based on the shortest route according to official public transport distance, which does not reflect the actual distance the patient must travel. Some places are not served by public transport, raising questions about which data are used.

What must be done?
To ensure equal access to healthcare as guaranteed by the Health Care Act, and independent of place of residence, the threshold should be lowered from 50 km to 30 km, as in the previous Act.

The term “place” should be replaced with “residence/temporary residence” and “health institution/clinic/orthopaedic aid provider.” Distance should be calculated from the insured person’s address to the address of the health facility or aid provider.

The reimbursement should reflect the actual distance traveled, not public transport ticket price.