Terminal Illness & End-of-Life Planning in Bulgaria: 5-Step Official Checklist

1. 1

   Coordinate Palliative Care, NHIF Clinical Pathways, and Home Support

   In the Republic of Bulgaria, public medical and palliative care services are regulated by the Health Act (Закон за здравето) under the Ministry of Health of the Republic of Bulgaria (Министерство на здравеопазването) and funded for insured persons through the National Health Insurance Fund (Национална здравноосигурителна каса - NHIF / NZOK) [1][2][3]:

   • Outpatient pain control and GP coordination: Contact the ill person's chosen general practitioner (общопрактикуващ лекар / личен лекар) and treating specialist (such as an oncologist, neurologist, or cardiologist) to establish an individualized symptom-management plan [2][3]. For severe chronic pain, the specialist and GP coordinate the issuance of electronic prescriptions (including special yellow or green prescription protocols for opioid analgesics registered in the National Health Information System - НЗИС) and home medical visits [1][2].
   • Hospital palliative care under NHIF Clinical Pathway No. 297: For patients with advanced terminal oncology conditions who have continuous health insurance rights with the National Health Insurance Fund, a specialist or oncology committee can issue a hospital referral (Направление за хоспитализация - бланка МЗ-НЗОК № 7) for inpatient palliative care under Clinical Pathway No. 297 (Клинична пътека № 297 „Палиативни грижи при онкологично болни“) at an NHIF-contracted hospital or Comprehensive Oncology Centre (Комплексен онкологичен център - KOC) [2][3].
   • Medical aids, private hospices, and municipal home care: Through the National Health Insurance Fund and the medical expertise system, eligible patients can obtain funding for medical devices, wheelchairs, and anti-decubitus aids [3]. Because NHIF inpatient palliative pathways have statutory duration limits per calendar year, families frequently combine public coverage with licensed inpatient or home hospices (хосписи) registered under the Medical Establishments Act or municipal integrated health and social care services (патронажна грижа / асистентска подкрепа) [1][2][3].
2. 2

   Record Medical Treatment Preferences and Authorize a Healthcare Representative

   In Bulgaria, patient autonomy, informed consent, and access to medical information are governed by Articles 87 to 98 of the Health Act (Закон за здравето), overseen by the Ministry of Health of the Republic of Bulgaria [1][2]:

   • Right to informed consent and refusal of medical procedures: Under Article 90 of the Health Act, any legally capable adult patient has the right to refuse proposed medical procedures or continuation of non-palliative treatment (except in statutory infectious-disease or psychiatric emergencies), provided the refusal is recorded in writing with the patient's signature in the hospital or outpatient medical chart [1][2].
   • Notarized authorization for medical representation and access to the Electronic Health Record (Електронно здравно досие): Because Bulgaria does not maintain a standalone state living-will registry, the most effective way for your family member to empower a trusted relative while mentally capable is to execute a notarized power of attorney (нотариално заверено пълномощно) before a notary of the Notary Chamber of the Republic of Bulgaria (Нотариална камара на Република България) [1][5]. This instrument should explicitly authorize the representative to receive full medical information under Article 28 of the Health Act, request certified copies of medical documentation, access the patient's electronic patient file (Електронно здравно досие) via the National Health Information System (HIS.bg) or the Unified Portal for Electronic Administrative Services (eGov.bg), and communicate treatment preferences to physicians if the patient becomes unable to speak [1][5][6].
3. 3

   Execute Notarial Powers of Attorney (*Пълномощно*) and Bank Mandates While Capacity Is Intact

   Under the Bulgarian Obligations and Contracts Act (Закон за задълженията и договорите) and the Notary and Notarial Activity Act, spouses and children do not have automatic legal authority to manage another adult's property or bank accounts without a formal power of attorney granted while the principal has full legal capacity (дееспособност) [5]:

   • Notarial powers of attorney and registration in the Unity Information System: Arrange for your family member to execute a general power of attorney (общо пълномощно) for administrative representation before state and municipal bodies (such as NSSI, NHIF, NRA, and municipal authorities) and, where needed, a specific power of attorney (изрично пълномощно) before a Bulgarian notary registered with the Notary Chamber of the Republic of Bulgaria [5]. If your family member cannot visit a notary office due to illness, Bulgarian notaries are legally empowered to perform bedside notarial certifications at a home or hospital within their judicial district [5]. For any disposition or management of real estate, the notary certifies both the signature and the content of the power of attorney (едновременно удостоверяване на подпис и съдържание) and registers it in the Unity Information System (Единна информационна система) of the Notary Chamber of the Republic of Bulgaria so third parties can verify its authenticity [5].
   • Explicit bank account powers of attorney: Bulgarian commercial banks strictly require either a power of attorney signed in person on the bank's own template or a notarized specific power of attorney that lists the exact bank name, IBANs, and authorized banking operations (such as cash withdrawals, wire transfers, online banking management, and card issuance) [5]. Keep in mind that under Bulgarian civil law, any power of attorney terminates automatically upon the principal's death [5].
4. 4

   Activate TELK Disability Expertise, Attendance Allowance, and Caregiver Benefits

   Bulgaria provides medical disability certification, pension supplements, and personal assistant support through the Territorial Expert Medical Commissions (Териториална експертна лекарска комисия - TELK) under the Ministry of Health of the Republic of Bulgaria, the National Social Security Institute (Национален осигурителен институт - NSSI / NOI), and the Agency for Social Assistance (Агенция за социално подпомагане - ASP) [1][3][4]:

   • Applying for a TELK Expert Decision (Експертно решение на ТЕЛК): Ask the ill person's general practitioner or treating specialist to issue a medical referral for TELK (медицинско направление за ТЕЛК) [1]. The patient or their authorized representative can file the application at the Regional File of Medical Expertise (Регионална картотека на медицинската експертиза - RKME) or online through the Information System for Control of Medical Expertise (ibd.mh.government.bg) overseen by the Ministry of Health of the Republic of Bulgaria [1]. Where a patient is immobile or terminally ill, TELK can assess the case on the basis of clinical medical documentation (освидетелстване по документи) without requiring physical attendance [1].
   • Disability pension, Third-Party Assistance Supplement (добавка за чужда помощ), and financial support: Once TELK issues an Expert Decision establishing 50% or more permanently reduced working capacity (трайно намалена работоспособност), submit a claim to the National Social Security Institute for a disability pension (пенсия за инвалидност) [4]. If TELK certifies over 90% disability with determined need for third-party assistance (с определена чужда помощ), the person is entitled to the monthly Third-Party Assistance Supplement (добавка за чужда помощ under Article 103 of the Social Insurance Code) from the National Social Security Institute, monthly financial support under the Persons with Disabilities Act from the Agency for Social Assistance, and municipal Personal Assistant support (Лична помощ / Асистентска подкрепа) [1][3][4].
   • Paid sick leave (болничен лист) and family caregiver leave: For employed patients or employed family members caring for an acutely ill spouse, parent, or child, the attending physician or medical consultative commission (ЛКК) issues an electronic sick-leave certificate (електронен болничен лист), which is transmitted directly to the National Social Security Institute for payment of temporary incapacity cash benefits [4].
5. 5

   Organize the Will (*Завещание*), Property Records, and Civil Status Certificates

   Under the Bulgarian Inheritance Act (Закон за наследството), reviewing testamentary and property records while your family member retains full mental capacity prevents future disputes and delays [5][6]:

   • Notarial or holographic will (нотариално или саморъчно завещание) and reserved shares: A mentally capable adult in Bulgaria can execute a notarial will (нотариално завещание, dictated directly to a notary in the presence of two witnesses) or a holographic will (саморъчно завещание, written entirely by hand, dated, and signed by the testator), which can be handed over in a sealed envelope to any notary of the Notary Chamber of the Republic of Bulgaria for official safekeeping and immediate entry in the national Register of Wills [5]. When drafting a will or lifetime property transfer (such as a contract for transfer of real estate in exchange for care and maintenance - прехвърляне на имот срещу задължение за гледане и издръжка), consult a notary regarding statutory reserved shares (запазена част от наследството) protected for children, spouses, or parents under Article 28 of the Inheritance Act [5].
   • Verifying title deeds (нотариални актове) and GRAO family records: Check that all real estate title deeds (нотариални актове) are properly recorded in the Property Register (Имотен регистър) of the Registry Agency, and obtain updated marital and birth certificates through the local municipality or the Unified Portal for Electronic Administrative Services (eGov.bg) to confirm that all family relationships in the national GRAO database are accurate [5][6]. If your family member holds foreign citizenship or owns property in another EU Member State, ask a notary about including a choice-of-law clause under Regulation (EU) No 650/2012 [5].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Medical Expertise (TELK) and Citizen Health Information — Ministry of Health of the Republic of Bulgaria (Министерство на здравеопазването)
2. [2]
   National Health Insurance Fund (NHIF / NZOK) - Clinical Pathways and Inpatient Palliative Care — National Health Insurance Fund (Национална здравноосигурителна каса - НЗОК)
3. [3]
   National Health Insurance Fund (NHIF / NZOK) - Medical Devices and Aids for Persons with Disabilities — National Health Insurance Fund (Национална здравноосигурителна каса - НЗОК)
4. [4]
   National Social Security Institute (NSSI / NOI) - Pensions, Disability Benefits, and Supplements — National Social Security Institute (Национален осигурителен институт - НОИ)
5. [5]
   Notary Chamber of the Republic of Bulgaria - Powers of Attorney, Wills, and Notarial Registers — Notary Chamber of the Republic of Bulgaria (Нотариална камара на Република България)
6. [6]
   Unified Portal for Electronic Administrative Services (eGov.bg) - Civil Status and Electronic Services — Ministry of Electronic Governance of the Republic of Bulgaria