Dependent health coverage in Romania has undergone a major transformation following the adoption of Law No. 141/2025. The new legislation fundamentally changes how spouses and parents without income can access the public healthcare system and introduces additional costs for families that previously benefited from free healthcare coverage through an insured family member.
For years, many individuals relied on dependent health coverage to access medical services without paying health insurance contributions themselves. This was particularly common among non-working spouses, stay-at-home parents, and elderly family members without taxable income.
However, starting with August 2025, Romania abolished this mechanism and replaced it with a voluntary insurance model. As a result, thousands of families must now reconsider how they maintain healthcare coverage for their dependents.
For employees, employers, HR professionals, and expatriates living in Romania, understanding these changes is essential to avoid interruptions in healthcare access.
Before the tax law reform of last year, Romanian healthcare legislation allowed certain family members to benefit from dependent health coverage through an insured individual.
Typically, the following categories could be covered:
Under this system, the dependent family member gained access to public healthcare services without paying the Romanian health insurance contribution (CASS). Therefore, for many households this represented an important financial benefit and ensured access to public healthcare without additional administrative procedures.
Law No. 141/2025 eliminated the legal provisions that allowed spouses and parents without income to benefit from dependent health coverage free of charge. This tax reform was introduced as part of broader measures intended to modify the financing structure of Romania’s public healthcare system.
As a result, healthcare coverage for these individuals is no longer automatic and now requires an active contribution to the public health insurance system. Therefore, the practical effect is that many families face new financial obligations.
The removal of dependent health coverage primarily affects:
Many of these individuals had uninterrupted healthcare access for years and may be unaware that their insurance status has changed. This makes awareness and timely action particularly important.
The most important consequence is that affected individuals may lose access to the full package of public healthcare services unless they can arrange for alternatives.
Without insurance coverage, individuals may no longer be entitled to:
Emergency medical services may remain available under separate legal provisions, but routine healthcare access may become significantly more limited.
Although possibility of dependent health coverage has been cancelled, the law introduced a voluntary insurance mechanism. According to this, an insured individual may choose to pay the health insurance contribution on behalf of a spouse or parent that doesn’t generate any taxable income.
This can be done through the annual tax return, commonly known in Romanian as the “Declarația Unică”.
The insured individual (who files the tax form) must submit the tax return and include the identification details of the family member who requires coverage. Unlike the previous system, insurance coverage is no longer granted automatically, and the insured individual must pay for the dependent.
The annual contribution must be calculated by applying the standard 10% CASS rate to a base equal to six national gross minimum wages.
Using the 2026 minimum gross salary of RON 4,050, the calculation is:
The contribution applies separately to each family member. Therefore, if for example a person wishes to maintain healthcare coverage for both a spouse and a parent, they would need to pay RON 4,860 annually.
For many households previously benefiting from dependent health coverage, this represents a significant new expense.
Let’s consider the case of Andrei, an employee working for a company in Bucharest. His wife has no employment income and previously benefited from dependent health coverage under the former rules. Following the legislative changes, her status as a dependent insured person ended.
If Andrei wishes to ensure that his wife remains covered by the public healthcare system, he must take several steps for this:
Andrei must complete and file the tax return form in the year for which he wishes her spouse to benefit of health insurance. The tax form includes a dedicated section allowing taxpayers to opt for healthcare coverage for eligible family members.
The form can be submitted as follows:
The law allows the contribution to be paid in two installments:
Timely payment is important to maintain insurance coverage.
After the tax form is submitted and the contribution paid, the information is automatically processed by the Romanian authorities and transmitted to the National Health Insurance House (CNAS).
It is advisable to verify your insurance status through official channels before accessing healthcare services.
One important aspect of the new system is that healthcare coverage is not retroactive. For example, if Andrei delays filing the annual tax declaration for several months, his wife will not be insured for the previous period.
According to the applicable rules, coverage becomes effective after the declaration has been submitted and the contribution payment has been done. Consequently, individuals affected by the removal of dependent health coverage should act promptly to avoid gaps in their insurance protection.
If no tax return is filed and no contribution paid, the affected family member may remain uninsured. This can lead to substantial healthcare costs. For example, a single hospitalization or specialized medical procedure may cost significantly more than the annual contribution required under the new rules.
For this reason, families should carefully evaluate their healthcare needs before deciding whether to maintain dependent health coverage or not.
The elimination of dependent health coverage does not automatically create any direct reporting or payment obligations for employers. The responsibility for filing the tax declaration and paying the contribution belongs exclusively to the insured individual that wants to continue coverage of their dependent person.
Nevertheless, we believe that HR and payroll departments play an important role in helping those employees understand the new requirements.
This means that organizations should consider:
Proactive communication can prevent confusion and reduce employee concerns regarding this topic.
Yes, there are specific categories of individuals who can still benefit of healthcare without health insurance contribution payment.
Even though dependent health coverage has been abolished for spouses and parents without income, Romanian legislation continues to provide healthcare coverage without CASS for certain protected categories.
These generally include:
So, before paying the contribution, individuals should verify whether they already qualify for public healthcare coverage under another legal provision.
Of course, voluntary public insurance is not always the only available option in Romania for someone who needs healthcare coverage.
Depending on individual circumstances, you may also consider the following options:
You may want to evaluate each option carefully, based on your healthcare needs, the implied costs, and long-term financial planning.
But understanding the new rules and acting quickly to find the best solution for yourself can help prevent interruptions in your healthcare access.
