Published on and written by Cyril Jarnias
Moving abroad involves handling administrative procedures, finding housing, a school… and, most importantly, ensuring you can receive proper medical care if needed. Healthcare for expatriates in Slovakia is based on a mandatory insurance system, fairly strict rules, and a sometimes delicate balance between the public sector and private clinics. For a foreigner, the picture can seem complex, especially if you don’t speak Slovak.
This guide covers how the system works, the differences between public and private care, access conditions based on expatriate status, typical costs, managing emergencies and pharmacies, as well as the use of European cards. It provides concrete benchmarks to anticipate and avoid unpleasant surprises.
A mandatory health insurance system, but not entirely free
In Slovakia, healthcare is a paid service, even though coverage is universal for contributing residents. The system relies on mandatory health insurance, separate from social insurance, and managed by the Ministry of Health. Every resident – including foreigners – must be insured, and proof of insurance is an integral part of the application file for temporary residence.
The described model is that of a healthcare system based on a ‘basic care basket’ financed by mandatory contributions. It is complemented by an extensive private offering. In practice, most consultations, hospitalizations, and examinations are covered for insured individuals. However, this system includes a series of out-of-pocket fees, for example for emergency room visits, for certain medications, and for a significant portion of dental care.
Public insurance companies
Three health insurance companies manage public funds at the national level:
| Insurance Company | Legal Type | Mentioned Particularities |
|---|---|---|
| Všeobecná zdravotná poisťovňa (VšZP) | Public insurance | Largest fund, also handles many specific cases |
| Dôvera | Private insurance within the public system | Often offers additional services |
| Union | Private insurance within the public system | Foreign (Dutch) capital ownership, strong presence in commercial insurance |
The law imposes the same basic coverage on these three insurers. However, each adds its own “bonuses” (prevention programs, additional reimbursements, online services, etc.). Insured individuals have the right to change insurers, but only once a year, by submitting their request before September 30 for a change effective on the following January 1.
Who pays what?
The contribution depends on status:
| Insured Person’s Situation | Who pays the contribution? | Rate or key principle |
|---|---|---|
| Employee | Employee + employer | Approximately 14% of gross salary (4% employee, 10% employer) |
| Self-employed | The insured themselves | Percentage applied to declared income base |
| Full-time Slovak student | The State | Contribution fully covered |
| Registered job seeker | The State | Contribution fully covered |
| Recipient of certain social benefits | The State | Contribution fully covered |
| Eligible scholarship holders (national program, CEEPUS, Erasmus+, etc.) | The State | Contribution fully covered, under conditions |
Important point: the insured person is not always the payer. An expatriate employee, in theory, has no financial steps to take: their employer handles the registration and payments. On the other hand, a foreign self-employed person or a resident without employment will have to handle their own registration and payment.
Who is entitled to public insurance as an expatriate?
The basic rule is simple: any person with permanent residence in Slovakia must be affiliated with public insurance, unless they are already subject to the healthcare system of another country (for example because they work abroad). For foreigners without permanent residence, eligibility depends on employment status, type of stay, or certain specific statuses.
Typical conditions for accessing public insurance
Among the main cases that allow joining the public system without having permanent residence, are:
Several situations allow coverage under Slovakia’s public health system. This notably includes: being an employee of a local employer with a minimum salary of €750 (2024), engaging in authorized independent work, being a student (EU/EEA or third country via agreement), being a scholarship holder of specific programs (National Scholarship Programme, CEEPUS, Erasmus+…) for more than one month, being a minor whose parent is locally insured, being an asylum seeker or refugee, or being detained on Slovak territory.
Once one of these conditions is met, the person concerned has eight days to register with the chosen insurance company. The employer usually does this for their employees, but a self-employed person, student, or scholarship holder must do it themselves.
Exemption cases for Slovak residents
Conversely, certain people residing permanently in Slovakia are exempt from public insurance because they are already covered in another country. This is the case, for example, of a Slovakian working full-time in Germany and contributing to the German system, or of a dependent spouse of an insured person from another EU member state and subject to that state’s legislation.
For an expatriate, the country responsible for social protection is not freely chosen. It is determined by employment situation and place of effective residence, not by the person’s nationality.
Mandatory commercial insurance for those who don’t qualify for the public system
Not all foreigners meet the conditions to join the Slovak public insurance. In this case, the law requires taking out commercial (private) insurance, often required when applying for a visa or residence permit (notably for family reunification, stay for special activity, research, etc.).
Who must absolutely use private insurance?
Several categories find themselves in this situation:
– third-country students who are not covered by an international agreement;
– foreign researchers and teachers working on a scholarship or project, but without a local employment contract;
– temporary residents who are not yet working (for example, spouse of an expatriate, certain workers waiting to start a contract);
– nationals of third countries not covered by a bilateral social security agreement.
Insurance can be taken out with Slovak or foreign companies. To be valid in Slovakia, the contract must explicitly mention coverage on Slovak territory. If issued abroad, a certified translation by a sworn translator into Slovak is mandatory.
Notable example: Union offers products specifically designed for foreigners, with several levels (full coverage, urgent coverage only), and a special offer for Ukrainian citizens. Prices vary based on age, health status, and extent of coverage, with daily premiums potentially ranging, for some offers, between €0.8 and €4.
Public vs. private: what each solution really covers
The main differences can be summarized as follows:
| Insurance Type | Public (mandatory) | Commercial (private) |
|---|---|---|
| Legal basis | Act No. 580/2004, No. 577/2004 | Free contract with insurer |
| Typical beneficiaries | Residents, employees, self-employed, protected students, eligible scholarship holders | Third-country students not covered, researchers without contract, temporary residents |
| Geographic scope | Slovakia (with EU mechanisms for cross-border care) | Often wider areas (Schengen, Europe, world…) |
| Coverage level | “Necessary” or “comprehensive” care, hospital, general and specialist medicine | Variable: sometimes urgent care only, sometimes comprehensive care, repatriation, etc. |
| Payment method | Third-party payment at contracted providers, with copayment | Direct payment by patient then reimbursement by insurer |
| Legal obligation | Yes for eligible persons | Yes for foreigners not eligible for public system |
In practice, many expatriates combine both: public insurance as soon as they become employees, but maintaining private international insurance to cover evacuation, care abroad, or easier access to the private sector.
European cards, S1/S2 forms, and cross-border care
For citizens of the European Union, the European Economic Area, and Switzerland, a specific mechanism simplifies access to care during a temporary stay in Slovakia: the European Health Insurance Card (EHIC).
The European Health Insurance Card (EHIC)
The EHIC, issued by the health insurance fund of the country of origin, allows one to be treated in case of illness or accident during a temporary stay in Slovakia, under the same conditions as Slovak insured persons. It covers:
In Slovakia, care considered ‘medically necessary’ and that cannot be postponed until return to your home country is covered. This includes acute illnesses, worsening of a chronic condition, or pregnancy-related care. These treatments must be provided within the public health system, by doctors and hospital facilities contracted with at least one Slovak health insurance fund.
However, it does not cover:
– care provided by 100% private providers without a contract with a Slovak insurer;
– medical repatriation;
– stays organized primarily to receive treatment (planned medical tourism).
During the consultation, the patient must present their EHIC (or a temporary replacement certificate) and an ID, and indicate with which Slovak fund they wish to be covered. Any copayments that a Slovak would pay are also their responsibility.
S1 and S2 forms, frontier workers, and EU residents
European regulations provide other useful forms for expatriates:
The S1 form covers persons insured in one country but residing in another (e.g., a French worker living in Slovakia while remaining insured in France), giving them the right to comprehensive care in the country of residence. It also serves for frontier workers whose family resides in another EU country, opening rights for dependents in that country. The S2 form (ex-E112) is required for planned care abroad and must be obtained before departure from the insurance body in the country of origin.
Directive 2011/24/EU also opens the way to reimbursement of care received in another Member State outside the S2 scheme, under certain conditions (often paying upfront then requesting reimbursement from one’s original fund).
Accessing daily care: general practitioners, specialists, hospitals
For an expatriate, the first concrete step is registering with a general practitioner (“všeobecný lekár”) and a dentist. Without this registration, access to non-urgent care in the public system is very limited.
Registering with a primary care doctor
The general practitioner is the gateway to the system:
– they maintain the medical file;
– ensure follow-up for common and chronic illnesses;
– issue prescriptions;
– provide most medical certificates;
– refer to specialists via referral letters.
Legally, a general practitioner in your district must accept your registration if you have public insurance or a temporary protection status. However, in practice, some clinics may be full and refuse new patients. It is therefore advisable to start your search early, by asking your neighbors, colleagues, or via the health insurance funds’ websites which publish lists of contracted doctors.
To make an appointment, you generally need to call the office in advance. Walk-in consultations exist but are often limited to urgent cases.
Specialists and hospitals
Access to specialists (cardiologist, neurologist, rheumatologist, etc.) is most often via referral from the general practitioner, using a “referral slip.” Some specialties, like gynecology, ophthalmology, or psychiatry, are accessible without a referral.
Wait times for a specialist appointment can reach several weeks in public hospitals.
Urgent hospitalizations (accidents, heart attacks, acute conditions) are available 24/7 in public hospitals. For a non-urgent hospitalization, a referral letter is required.
Emergencies, ambulances, and expected costs
In case of immediate danger to life or health, call 155 (emergency medical service) or 112, the European emergency number. Operators are trained and may answer in English. The ambulance is generally well-equipped, but its primary role is rapid transport to a hospital.
Even for insured persons, some costs remain the patient’s responsibility:
| Service or situation | Main billing rule |
|---|---|
| Emergency room consultation | Flat fee usually between €2 and €10, even for insured persons |
| Ambulance (insured patients) | Free in case of a covered medical emergency |
| Ambulance (uninsured patients) | Approximately €120 charged for the intervention |
| Non-urgent medical transport | Approximately €0.10 per km, with several exemptions (dialysis, cancer, severe disability, etc.) |
| Hospital companion | €3.30 per day, with exemptions (breastfeeding mother, child < 3 years, minor in oncological treatment) |
Certain situations automatically grant free emergency services (no copayment): serious accident (excluding cases related to substance use), an emergency room stay of more than two hours, hospitalization following an ER visit, or a special status (decorated blood donors, for example).
Note finally: mountain rescue and certain special transports are not covered by the public system. For an expatriate who enjoys skiing or hiking in the Tatras, private insurance including mountain rescue is strongly recommended.
Medications and pharmacies: a dense network, strict rules
Slovakia has a very dense network of pharmacies (“lekáreň”), identified by a green cross on a white background. They sell not only prescription medications, but also all over-the-counter products: no medication can be legally sold in supermarkets or other stores, unlike some neighboring countries.
Hours and on-call pharmacies
Most pharmacies are open Monday to Friday, typically from 8 a.m. to 6 p.m., with reduced hours on Saturday. On Sundays and holidays, only on-call pharmacies operate. Each city must have at least one 24/7 on-call pharmacy.
No pharmacy is open all night in Slovakia beyond 10 p.m. It is therefore necessary to anticipate medication needs. To find the nearest on-call pharmacy, check the website or app Otvorenalekaren.sk, or notices posted at pharmacy entrances.
Medication costs and reimbursements
Prescription medications are, for the most part, covered by public funds, with a reference price system and widely used generics. Some key points:
– a small administrative fee (€0.17 per prescription or voucher) is charged, with exceptions;
– the patient’s share depends on the medication (some are fully reimbursed, others only partially);
– retirees often benefit from reduced participation rates.
The first generic must be at least 45% cheaper than the original, the second 10% cheaper than the first, and the third another 5% cheaper. Doctors must prescribe the active substance, not a brand, to leave the choice to the patient and pharmacist.
Prescriptions have a limited validity period:
| Type of prescription | Validity period in Slovakia |
|---|---|
| Standard prescription | 7 days |
| Prescription issued at ER | 1 day |
| Antibiotics | 5 days |
| Prescription issued in another EU state | Valid according to the issuing country’s rules, but subject to local dispensing deadlines |
Without Slovak public insurance, the patient pays the full price at the pharmacy and can only request any possible reimbursement from their own company (travel insurance, international insurance, etc.).
Over-the-counter medications and specific features
Most painkillers, cough syrups, cold remedies, mild antihistamines, or antifungal creams can be obtained without a prescription, but still only at a pharmacy. The prices of over-the-counter medications are, according to some studies, among the lowest in Europe, even though for an expatriate used to buying painkillers at the supermarket, the obligation to go through a pharmacy may seem restrictive.
Pharmacies also offer consultation services: the pharmacist can recommend simple treatments or refer to a doctor in case of worrying symptoms.
Dental and optical care: the country’s strengths, but not always reimbursed
Slovakia has made a name for itself in Central Europe for its dental care and certain ophthalmological procedures, notably within the context of medical tourism. For an expatriate, this is an asset, provided they understand what the public insurance does – or does not – cover.
Dentists: prevention covered, the rest often paid
Under the public system, an annual preventive dental check-up is covered (two for pregnant women). However, if this check-up is not performed, certain coverages the following year may be denied, and the insured will have to pay the full cost of some procedures.
The treatments actually reimbursed by the basic system remain limited:
– certain emergency treatments (treatment of acute pain, extraction of a tooth in case of infection);
– certain surgical procedures (for example: extraction of impacted wisdom teeth);
– use of “standard” materials for simple fillings.
Aesthetic treatments, premium materials (ceramics, implants, veneers), orthodontics, and most dental prosthetics are largely the patient’s responsibility, whether in the public or private sector. This explains the popularity of specialized private dental clinics, which also attract patients from the UK and other countries due to prices well below those in Western Europe.
Optical care: basic glasses covered, surgery mainly private
For vision care, public funds cover a basic level, including a simple pair of glasses or certain standard lenses, as well as essential interventions like cataract surgery with a monofocal lens. However, most refractive surgeries (LASIK, PRK, etc.) and multifocal lenses fall under the private sector.
Opticians are numerous, often open until late evening. Initial consultations may be free, but private surgical procedures represent a significant cost, even if they often remain cheaper than in Western Europe.
Public system under strain, attractive private sector: what choice for an expatriate?
Many reports indicate that Slovak public hospitals suffer from underfunding, staff shortages, and sometimes outdated equipment. Wait times are longer than the European average and some specialists are lacking, which pushes part of the population – expatriates included – to turn to the private sector or neighboring systems, notably in Austria or Germany.
In major Slovak cities (Bratislava, Košice, etc.), the private health sector offers modern clinics with recent equipment, doctors trained abroad, and multilingual services. The welcome is more comfortable and wait times shorter. However, costs can be significantly higher, especially without international health insurance.
In practice, many expatriates adopt a mixed strategy:
– use the public system for general medicine, routine care, prescriptions, simple tests, and emergencies;
– resort to the private sector for scheduled operations, comprehensive check-ups, advanced dentistry, cosmetic surgery, or certain high-tech exams, relying on international private insurance or paying out of pocket.
Special cases: students, researchers, British nationals, Ukrainians…
Healthcare for expatriates in Slovakia varies significantly based on the purpose of stay and nationality. Several groups benefit from specific rules.
International students and scholarship holders
All foreign students must have health coverage during their studies.
– An EU/EEA/Swiss student, already insured in their country, generally uses their European Health Insurance Card for necessary care during their stay. For a long-term stay with residence registration, they may also join the Slovak system depending on their situation.
– Some third-country students, enrolled in programs resulting from international agreements (for example, certain government scholarships, Erasmus+ under the conditions provided by law), benefit from public insurance paid by the Slovak state. They must, however, register with a fund within eight days of starting their studies.
– Other third-country students must take out commercial insurance, often required for visa issuance.
Since January 1, 2023, scholarship holders staying more than one month under programs listed by the Ministry of Education benefit from comprehensive public health insurance, fully financed by the government.
Researchers and teachers
Foreign researchers and teachers without a local employment contract must also be covered:
– if they come from an EU/EEA/Switzerland country and remain affiliated with their national fund, the EHIC is generally sufficient for temporary stays;
– if they are not covered by Slovak public insurance, they must insure themselves via a private policy covering at least urgent care and hospitalization.
Slovak academic institutions often assist with these procedures but it remains prudent to verify one’s coverage before departure.
British nationals after Brexit
For British citizens, the situation is now aligned with that of third-country nationals, with some specific mechanisms:
For a temporary stay (tourism, short studies, posting), the GHIC or a British EHIC grants access to necessary care in the public system. For a long-term move, one must either enter the Slovak public system (via employment, residence permit, etc.), or present an S1 form issued by the UK (for public pensioners, for example). Proof of this health coverage is required for any visa or residence permit application.
Once a British S1 is registered in Slovakia, the resident benefits from a Slovak insurance card and can also obtain a GHIC/EHIC for travel.
Ukrainians and beneficiaries of protection
Persons fleeing Ukraine benefit from several specific measures:
– Ukrainian citizens entering Slovakia are entitled to free urgent care for 30 days, or until filing an application for international protection or temporary protection;
– persons granted temporary protection are entitled to comprehensive care comparable to that of Slovak citizens (except for spa treatments);
– Ukrainian children under 18 under temporary protection or granted asylum are entitled to all healthcare services;
– specific commercial insurance offers at reduced prices are also proposed by some insurers (e.g., Union), notably for Ukrainian nationals who do not yet meet the conditions for the public system.
Concrete preparation as an expatriate
For a new arrival, the landscape may seem complex. In practice, a few structured steps allow securing one’s medical situation.
Before departure
– Check if you will be quickly eligible for public insurance (Slovak employment contract, scholarship, exchange program, etc.) or if you’ll need to rely on private insurance for several months.
– In any case, take out international insurance covering at minimum emergency care, hospitalization, repatriation, and ideally mountain rescue if you plan to engage in outdoor sports.
– For EU/EEA/Swiss nationals, request and bring your European Health Insurance Card.
– Prepare a medical file in English (or German): medical history, exams, medication lists, allergies. Translating key documents can be useful, as the responsibility for transferring medical data from one country to another lies with the patient.
Once in the country
– Register, as soon as possible, with a public insurance fund if entitled (employee, self-employed, eligible student, scholarship holder…) and keep the affiliation certificate while waiting for the card.
– Choose a general practitioner and a dentist who have a contract with your fund. Early registration greatly facilitates access to care.
– Identify the nearest hospitals and emergency services, as well as the on-call pharmacy in your city.
– Note the emergency numbers (112, 155) and verify that you can briefly explain an emergency in English (or ideally Slovak).
– Inquire about any potential copayments for services you are likely to use (emergency consultations, transport, medical documents, etc.).
Key takeaways
Healthcare for expatriates in Slovakia is based on a mandatory insurance system that gives access to a wide range of services, but not to total free care. Access to care depends on your status (employee, student, researcher, retiree, protection seeker…), and one goes, depending on the case, through public insurance, commercial products, or a combination of both.
The French public system is accessible but may be subject to wait times and aging infrastructure, while the private sector offers more comfort and speed at a higher cost. For expatriates, it is crucial to take out health insurance suited to their profile and to understand the practical functioning: the role of the European Health Insurance Card (EHIC), the registration process with a general practitioner, emergency procedures, and medication reimbursement modalities.
By taking the time to inform yourself and plan ahead even before arrival, it is possible to transform a system that seems opaque into a clear and relatively reliable setup, capable of meeting the health needs of daily expatriate life, while avoiding surprise bills and coverage gaps at the worst moment.
Disclaimer: The information provided on this website is for informational purposes only and does not constitute financial, legal, or professional advice. We encourage you to consult qualified experts before making any investment, real estate, or expatriation decisions. Although we strive to maintain up-to-date and accurate information, we do not guarantee the completeness, accuracy, or timeliness of the proposed content. As investment and expatriation involve risks, we disclaim any liability for potential losses or damages arising from the use of this site. Your use of this site confirms your acceptance of these terms and your understanding of the associated risks.
Cyril Jarnias is an independent expert in international wealth management with over 20 years of experience. As an expatriate himself, he is dedicated to helping individuals and business leaders build, protect, and pass on their wealth with complete peace of mind.
On his website, cyriljarnias.com, he shares his expertise on international real estate, offshore company formation, and expatriation.
Thanks to his expertise, he offers sound advice to optimize his clients' wealth management. Cyril Jarnias is also recognized for his appearances in many prestigious media outlets such as BFM Business, les Français de l’étranger, Le Figaro, Les Echos, and Mieux vivre votre argent, where he shares his knowledge and know-how in wealth management.
