Before you start

CNP from the residence permit
Employment with Romanian payroll, or voluntary CASS registration if self-employed
Registration with a family doctor (medic de familie) near your address
Private subscription, if your employer provides one

Step-by-step

1
Confirm CASS is being deducted
The 10% health contribution is withheld by the employer alongside the 25% pension contribution. Check the first payslip — enrolment is automatic but can lag for a new foreign employee whose CNP arrived late.
Via employerWho: YouFirst payslip
2
Register with a family doctor
The medic de familie issues referrals, prescriptions and sick notes. You choose one and register with a form. Cluj practices near the university and the tech districts fill up, so ask early rather than when you need something.
In personWho: YouFirst month
3
Know which hospital handles what
The Cluj county emergency clinical hospital and the university clinics take serious cases and are among the best-equipped in Romania outside Bucharest. Private clinics handle routine outpatient work and will refer an emergency onward rather than treat it.
In personWho: You
4
Use the private subscription for routine care
Regina Maria, MedLife and local providers run clinic networks in Cluj and most professional employers provide a subscription. These cover consultations, imaging and routine care quickly; major surgery and intensive care still run through the state hospitals.
Via employerWho: You
5
Register for voluntary CASS if you are self-employed
Freelancers and company directors pay the health contribution on a calculated base rather than through payroll, and the rules on that base have been amended repeatedly in successive Romanian budgets. Get current advice rather than last year's.
OnlineWho: You
6
Get the European Health Insurance Card
Insured residents can request the EHIC free from the county health insurance house. It covers necessary treatment across the EU and EEA — more useful now that Cluj airport's Schengen routes operate without border checks.
OnlineWho: You

Documents you’ll need

CNP and residence permit
Health insurance evidence or the payslip showing CASS
Family doctor registration form
Private subscription card, where provided
EHIC, once issued

Things most newcomers don’t know

Cluj is Romania's second clinical centre, which changes what the public system can actually do for you.

The Iuliu Hațieganu medical university trains a large share of Romania's doctors, including big English and French-language cohorts, and the associated county emergency and university clinics concentrate specialist capacity that most Romanian cities do not have. For serious conditions this is a genuine advantage over living in a smaller Romanian city — the referral you need probably exists within the city rather than requiring a trip to Bucharest.

Source: CNAS; Iuliu Hațieganu University

The two 10% figures are different taxes and conflating them costs you the argument.

Romania levies a flat 10% personal income tax and, separately, a 10% employee health contribution (CASS) alongside a 25% pension contribution. Employee deductions total roughly 35% of gross before income tax is applied to what remains. Anyone evaluating a Cluj tech offer on the strength of 'Romania has a 10% tax rate' is wrong by a very wide margin, and the removal of the IT exemption in 2025 made it wider.

Source: ANAF

Family doctor lists near the universities and the tech districts fill up.

Cluj's population swells by around a hundred thousand students in term time and its tech districts have grown faster than primary care provision. Practices in Centru, Grigorescu and Marăști close their lists. Because referrals, prescriptions and sick notes all flow through the registered family doctor, being insured without one leaves you outside the system for everything but emergencies. Register in your first month, and be willing to take a practice slightly further out.

Source: community-reported; CNAS

Self-employed health contribution rules change almost every budget cycle.

The base on which freelancers, sole traders and company directors compute CASS has been rewritten repeatedly, including material changes for 2025 and 2026 covering ceilings, floors and the treatment of dividends. Cluj has an unusually high proportion of independent contractors because of the tech sector, so this bites harder here than elsewhere. It is the single clearest case for a Romanian accountant.

Source: ANAF

Common mistakes to avoid

Confusing the 10% income tax with the separate 10% health contribution.
Paying CASS for months without registering with a family doctor.
Assuming a private clinic subscription covers surgery or intensive care.
Relying on last year's rules for self-employed health contributions.
Letting cover lapse between jobs and hitting the qualifying period on re-entry.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.

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