One national fund, run through county health insurance houses

Romania uses social health insurance. Contributions flow into a single national fund, FNUASS, which the national health insurance house (Casa Națională de Asigurări de Sănătate, CNAS) manages together with local houses. In the insured person’s guide CNAS published in March 2024, there are 43 of them: 41 county houses, one for Bucharest and a separate house for defence, public order, national security and judicial staff.

The local houses, not CNAS itself, contract with family doctors, clinics, hospitals, pharmacies and laboratories, and they pay those providers directly, so an insured patient is not usually sending in claims. Insured people get the basic package, which runs from the family doctor and outpatient specialists to hospital care, tests, subsidised medicines, medical devices and rehabilitation. Someone uninsured gets only a minimal package, centred on emergencies, epidemic-risk diseases, pregnancy monitoring and prevention.

What the Romanian payroll withholds and pays

The health contribution, CASS, is set by the Fiscal Code at 10% of salary for employees, as stated in the CNAS guide in 2024; check the current figure before you budget. The employer calculates, declares and pays it, and the tax agency ANAF collects it. No income level lets an employee step out of the system, because CASS is due on salary.

The employer also owes its own work insurance contribution, CAM, which funds sick leave and similar benefits. Fiscal Code text published by the Ministry of Finance gives it as 2.25% of gross salaries in 2026, so check the current figure too. CNAS ties an employee’s right to sick pay to CAM being paid.

Sick pay is partly an employer cost. For ordinary illness, the employer pays days one to five itself; from day six it keeps paying and recovers the amount from the health insurance house. To claim sick leave, an employee normally needs six months of insurance record in the last twelve, a condition waived for emergencies and some serious illnesses.

Family members and groups insured without paying

Children under 18 are insured without contributions, and so are young people aged 18 to 26 who are pupils, recent high-school graduates or students. The 2024 CNAS guide also lists pregnant women and new mothers, people with disabilities and patients in national health programmes among the groups covered without paying.

Adult relatives work differently. A spouse or parents with no income of their own have been able to join an insured person’s cover as co-insured. A 2025 law (Law 141/2025) tightened that from 1 August 2025, and a CNAS notice describes an extra contribution the insured person now pays for co-insured relatives to keep their status. Confirm how the change applies to a particular family before relying on it.

EU citizens moving to Romania may have their insured status recognised under EU rules, for example with a European Health Insurance Card, according to law-firm guidance on remote work there.

Medical subscriptions as an employee benefit

Romanian employers often fund voluntary health insurance or medical subscriptions (abonamente medicale) for staff, and the Fiscal Code names both as a benefit an employer can give. A limited amount of that employer-paid cover receives favourable tax and contribution treatment, while anything above the limit is taxed as salary. Confirm the current limits before you design the benefit, since Romanian fiscal rules on staff benefits are revised from time to time.

Employees who pay for a voluntary policy or subscription themselves can get similar tax relief, and such a policy may include their dependants. For a US employer, a subscription or plan of this kind sits alongside CASS rather than in place of it.

Where an international plan fits, and who may sell in Romania

Because CASS is compulsory on salary, a global health plan cannot take the place of public cover for a Romanian employee. It can add to it, with the extra cover set by the plan the insurer offers.

The insurer’s home base matters. Romania’s Financial Supervisory Authority, the ASF, oversees insurers. Under Law 237/2015, an insurer from another EU state can operate in Romania through a branch or under freedom to provide services once its home supervisor has notified the ASF. An insurer from outside the EU needs ASF authorisation to operate through a branch. Whether a plan bought by a US employer can lawfully cover a Romania-based employee is a point for the insurer to confirm.

Hiring setup: your own entity, a licensed agency or a contractor

Law-firm guidance describes Romania as having no separate employer of record licence, with staffing through a third party lawful only through a licensed temporary work agency (agent de muncă temporară) under the Labour Code, and only for a temporary, specific assignment. A long-term hire therefore usually points towards your own Romanian entity, with any agency route limited to work that genuinely fits those rules. Check the structure, the time limits and the tax on any medical benefit with a local adviser or tax professional before the hire.

Whichever Romanian employer runs payroll, it withholds CASS, and that withholding is what makes the employee insured. A self-employed contractor is in a different position, because CASS is also owed on some other kinds of income, so a contractor handles their own contribution where it applies. Our guide to health coverage for EOR staff and contractors abroad compares the arrangements.

Asking for a benefits partner introduction

We do not arrange health cover ourselves. When you want international cover that adds to CASS for someone in Romania, we can introduce you to a benefits partner that works on health coverage for international and remote teams. Use the quote form on this page to tell us the city where the person lives, how many people you employ abroad, whether relatives would be included and whether the hire is through your own entity, an agency or a contract, and we will pass the details on. Decisions on eligibility, plan options and price belong to the partner and the insurer, not to us.

Comparing several European countries? Read the Europe overview, our pages on Poland and Ukraine, the general guide to international health insurance for remote employees, or the employee benefits hub.

A few useful answers

Common questions

How does an employee become insured in Romania?

Through payroll. The employer withholds and pays the CASS health contribution on salary, which makes the employee insured with the public system.

What does a Romanian employer pay on top of salary for health and sickness?

Its own work insurance contribution, CAM, stated at 2.25% of gross salaries as of 2026, plus sick pay for the first five days of ordinary illness. Check the current figure before budgeting.

Can an international plan replace public cover in Romania?

No. CASS is compulsory on salary, so a global plan can only add to the public cover.

Can a US company use an employer of record in Romania?

Law-firm guidance describes Romania as having no separate employer of record licence, with third-party staffing lawful only through a licensed temporary work agency for temporary assignments, so a long-term hire usually needs a different structure.

Are children covered under the Romanian system?

Yes. Children under 18, and young people up to 26 who are pupils, recent graduates or students, are insured without paying contributions.

International Health Insurance for Remote Employees in Romania