Health Insurance for Foreigners

Health insurance is one of the essential prerequisites for legal stay in North Macedonia. Article 18 of the Law on Foreigners requires every foreign national applying for a residence permit to demonstrate valid health insurance covering the duration of stay. МВР checks this at the initial application, at every renewal, and sometimes at intermediate moments.

The same requirement applies to family members joining a principal under family reunification — each member needs their own coverage. The practical question for most foreigners is which kind of insurance to start with: private travel insurance, private resident insurance, or the Macedonian public Health Insurance Fund (Фонд за здравствено осигурување, ФЗО). The answer depends on the foreigner's track and the timing.

Most foreigners begin with private insurance. At the residence-permit application stage, the foreigner usually has not yet started employment in North Macedonia and so cannot yet be enrolled in ФЗО as an employee. Private insurance — bought either in the country of origin (a Schengen-style travel policy that explicitly covers North Macedonia) or in North Macedonia from a domestic provider (Triglav, Sava Osiguruvanje, Eurolink, UNIQA, Croatia Osiguruvanje) — bridges the gap.

МВР accepts policies that cover the full duration of the requested permit, with a coverage ceiling typically of at least €30,000 for medical expenses including hospitalisation and medical evacuation. Schengen-style travel insurance from a foreign provider is acceptable as long as the policy explicitly names North Macedonia as a covered territory and the coverage period matches the permit duration.

Once the foreigner is employed by a Macedonian employer and the employment is registered with the Public Revenue Office (УЈП), ФЗО enrolment becomes available and is generally preferable to continued private insurance. The employer registers the foreigner as an employee with ФЗО, the employer pays health insurance contributions at the standard rate as part of the salary tax-and-contribution package, and the foreigner becomes entitled to the same public-system care as Macedonian employees.

The transition is quick — typically within two weeks of employment registration — and ФЗО issues a health insurance card (картичка за осигурување) printed in Macedonian. The foreigner uses this card at any public health facility and at most private clinics that have ФЗО agreements.

Self-employed foreigners — founders, owner-managers, and licensed independent professionals — pay their own ФЗО contributions through the company's payroll or directly through УЈП. The contribution rate is the same as for employees, calculated on the declared salary or income.

Self-employed foreigners often supplement public coverage with private insurance for faster access to specialists and higher-quality private hospital care, particularly in cardiology, oncology, and elective procedures. Private add-on policies in North Macedonia are inexpensive by Western European standards (€30–€100 per month) and substantially shorten waiting times.

Family members joining a principal under family reunification follow the principal's coverage logic: if the principal is enrolled in ФЗО as an employee, the spouse and minor children can usually be added as dependants under the family-coverage provision of the Law on Health Insurance, with the principal's contribution covering the additional family members at no extra cost beyond a small administrative fee. If the principal is on private insurance, family members each need their own private policies.

Switching from private to public coverage for family members happens when the principal's ФЗО enrolment activates — there is usually a 30-day window after the principal's enrolment to add the dependants.

Practical considerations when buying insurance: read the territorial scope carefully, because some travel insurance policies sold in the EU exclude North Macedonia or include it only as part of a wider 'Europe' definition that the issuing insurer may interpret narrowly; check the medical evacuation clause, because evacuation to a higher-tier hospital in Sofia, Athens, or Vienna can run into tens of thousands of euros and travel policies often cap evacuation at €15,000–€30,000; verify that the policy explicitly covers chronic conditions if relevant (many travel policies exclude pre-existing conditions); and keep both digital and printed copies of the policy and the official translation if requested by МВР at the counter — Macedonian-language summaries are sometimes required.