NZOK and autism in Bulgaria: what health insurance covers

NZOK, the Bulgarian health insurance fund, covers preventive check-ups, specialist consultations with a referral and diagnostics for children on the autism spectrum, but, by open data, it does not pay for regular speech therapy or psychological therapy. This article is about the insurance fund. We wrote about disability status and social benefits separately, in the piece on TELK and benefits: that is a different system with different rules.

What NZOK already covers

According to NZOK's own information, all children up to 18 (or until they finish school) are insured from the state budget regardless of their parents' income. The package includes mandatory preventive check-ups with the family doctor (height, weight, hearing, vision and general development under the "Child Healthcare" program), vaccinations, consultations with a pediatrician and specialists by referral, and tests ordered by a doctor. The referral to a specialist is issued by the family doctor on form MZ-NZOK No. 3.

For a family this means that the route to a diagnosis through the family doctor and a child psychiatrist or neurologist exists within the fund's system. How it looks in practice is in our piece on autism diagnosis in Bulgaria.

What NZOK does not cover

The most quoted assessment comes from child psychiatrist Dr. Nikolay Popov. In a Nova TV report of June 27, 2023, retold by the portal Roditeli BG, he said that NZOK pays for one child psychiatrist exam and does not cover therapeutic activities that are essentially non-medical, meaning psychotherapy and speech rehabilitation. In the same piece a mother names a therapy hour at 35 leva (about 18 euro at the official rate) and another family estimates costs at 600 to 700 leva a month (roughly 307 to 358 euro). These are 2023 figures and parents' own words, not a price list.

We also checked the current document. NZOK publishes the National Framework Agreement for 2026-2028. In the text of its Appendix 18 "Outpatient procedures" (460 pages), a search finds neither an outpatient procedure for neurodevelopmental disorders nor the words "speech therapist" or "psychologist". That is the result of our text search, not a legal opinion, so the exact answer for your case is best obtained from your regional office.

The issue has also been raised at budget level. In July 2023, according to Clinica.bg, parliament's budget committee approved a proposal to direct 6.6 million leva to an "outpatient procedure for diagnosis and assessment of neurodevelopmental disorders" for children on the autism spectrum. Whether such a procedure works today we could not confirm.

What changes from 2027 and what it does not change

The news of a "2027 reform" is easy to misread. According to GP News, from the start of 2027 NZOK will begin paying for some children's treatments that used to be funded through the charity "Bulgarian Christmas". The mechanism is a targeted transfer from the Ministry of Health budget. The named list of outpatient therapies includes growth hormone deficiency and copper metabolism disorders (Wilson disease). Autism is not mentioned, so it does not follow from this news that the fund will pay for speech or psychological therapy in autism from 2027.

Where to get the missing part of the help

• The State Speech Therapy Center and speech cabinets in kindergartens and schools: free, details in the piece on speech therapists in Bulgaria.
• A resource teacher in kindergarten and school: how the system works in Bulgaria.
• Parent organizations and day centers: communities and NGOs for parents.
• A remote behavioral program as a base that in-person services plug into: ABA therapy in Bulgaria.

What to do today: call or write to your regional health insurance office (RZOK) and ask in writing which services are paid now for your child's diagnosis. NZOK's helpline for citizens is 0800 14 800.

How Sense Behavior helps families in Bulgaria

We do not depend on what the fund pays: your child's program is built on a skills assessment and sessions are online. The budget is covered in what ABA therapy costs. You can start with a free thirty-minute consultation.