Health Insurance in Poland When Living Abroad: NFZ, EKUZ, and Treatment Without Insurance (2026)

“I am a Polish citizen, I have paid contributions for years, so I must have NFZ?” Most often, no. Polish health insurance does not arise from citizenship. The right to treatment under NFZ expires 30 days after losing the title to insurance, e.g., Polish employment, and a person permanently residing in the USA or Canada is generally outside the system. This guide explains based on the current text of the Act on Health Care Benefits (Dz.U. 2025 poz. 1461) who is entitled to NFZ, how voluntary insurance works (from October 2026 at least 844.77 PLN per month, with the condition of residing in Poland and an additional fee up to 18,772.56 PLN), what is due to a ZUS pensioner living in America, and how returning from London differs from returning from Chicago.

Flowchart: Do You Have the Right to Treatment Under NFZ?

Answer a few questions, and the flowchart will indicate which part of the guide pertains to your situation.

When You Lose NFZ After Departure

• 30 days from losing the title. The right to benefits ceases 30 days after the expiration of the obligation to have health insurance (Article 67, paragraph 4). This also applies to registered family members. Graduates have longer: 6 months after secondary school and 4 months after university (Article 67, paragraph 5). A person who has applied for a pension or disability retains the right to benefits during the proceedings (Article 67, paragraph 7).
• Living outside Europe excludes you from the system. According to Article 3, paragraph 1 of the Act, a Polish citizen can be “insured” generally only if residing in an EU, EFTA, or UK state. An exception applies to those living further away but subject to the obligation of health insurance in Poland and covered by Polish pension and disability insurance (or KRUS). A Pole permanently residing in the USA, Canada, or Australia is therefore outside the Polish system, regardless of registration and citizenship.
• How to check your status. Clinics and hospitals check the right to benefits in the eWUŚ system using the PESEL number. You can see your status in the Internet Patient Account (pacjent.gov.pl) in the health insurance section.

Voluntary NFZ Insurance: How It Works and Where the Pitfalls Are

A person without a title to insurance can sign a contract for voluntary health insurance with NFZ. The contribution is 9% of the declared income, but not less than 9% of the average salary from the previous quarter (Article 68, paragraph 4, Article 5, point 31). In July, August, and September 2026, it was 845.67 PLN per month. GUS reported on October 20, 2026, that the average salary in the third quarter was 9,386.28 PLN, so for October, November, and December 2026, the minimum contribution is 844.77 PLN. The contribution is paid to the ZUS account by the 20th of the following month. Three things that few people mention:

Formalities: you submit an application for voluntary insurance at the provincial NFZ branch appropriate for your place of residence, in two copies, with proof of identity, ZUS ZZA form (for yourself) and ZUS ZCNA form (for family members), and confirmation of the additional fee, if applicable. Family members must be reported within 7 days (Article 68, paragraph 3). The right to benefits begins on the date specified in the contract and expires 30 days after its termination (Article 68, paragraph 12). The contract also terminates after one month of continuous arrears in contributions (Article 68, paragraph 5).

Returning to Poland: London and Chicago Are Two Different Worlds

The order after returning from the USA: if your spouse is insured in Poland, the easiest way is to register as a family member. If not, registration at the employment office as unemployed also grants a title to insurance. A full list of matters after moving is described in the guide on returning to Poland after years.

EKUZ: Who Will Get It from NFZ

The EKUZ card entitles you to necessary, unplanned treatment in the public system of another EU, EFTA and the United Kingdom, under the same conditions as local patients. It is issued by the country where you have the right to benefits. A person insured only in the USA will not receive EKUZ anywhere.

NFZ issues the card to insured persons and also to some individuals with the right to benefits without insurance, e.g., children with Polish citizenship. Validity periods according to NFZ:

• Pensioners of retirement age (60 years for women, 65 years for men): 20 years,
• Pensioners before retirement age and uninsured children with Polish citizenship: 5 years, for children no longer than until their 18th birthday,
• Children registered as family members: until their 18th birthday,
• Employees, entrepreneurs, individuals receiving benefits or pre-retirement benefits: 3 years,
• Disability pensioners, adult family members, students: 18 months,
• Contract workers: 6 months,
• Unemployed: 2 months.

ZUS Pensioner in America: The Myth of the Polish Bank Account

A ZUS pensioner living in the USA is therefore uninsured during visits to Poland. More about benefits from both countries is discussed in the guide on pensions from the USA and Poland. Medicare outside the USA generally does not pay for treatment. For visits, you are left with a policy covering medical expenses or private visits for cash. When you return permanently to Poland, ZUS will register you with NFZ and start deducting contributions. Pensioners who receive only a pension from ZUS and live in another EU country or the United Kingdom are better off: they usually remain insured in Poland, take the S1 document from NFZ, and EKUZ for 20 years.

Treatment Without Insurance: What Really Happens

• In an emergency, no one will refuse assistance. A healthcare provider cannot refuse to provide services to a person who needs them immediately due to a threat to life or health (Article 15 of the Act on Medical Activity). The Act on Benefits stipulates that services provided under the State Medical Rescue Act are free regardless of insurance (Article 12, point 7). However, for further treatment in the hospital, a person without the right to benefits may receive a bill. What to do in such a situation is described in the guide on emergencies during visits to Poland.
• Children under 18 years old with Polish citizenship are entitled to benefits without the condition of residing in Poland (Article 2, paragraph 1, point 3, letter a). The residence condition only applies to children without Polish citizenship. Facilities may not always be aware of this provision, so keep proof of the child's citizenship with you.
• Pregnant women, during childbirth, and postpartum. Here, the opposite is true: the law requires Polish citizenship and residence in Poland (Article 2, paragraph 1, point 4). A resident of the USA who is pregnant cannot therefore receive treatment in Poland under NFZ for this reason.
• Individuals with low incomes living in Poland may receive the right to benefits for 90 days by decision of the mayor, town president, or city president (Article 2, paragraph 1, point 2, Article 54). This requires documented residence in Poland, a social interview, and meeting the income criterion from social assistance, so a visitor from abroad will not be covered.
• Do not sign a statement “just in case.” When eWUŚ does not confirm the right to benefits, the clinic may ask for a written statement. If you submit it without the right to benefits, NFZ may demand reimbursement of treatment costs by administrative decision (Article 50, paragraphs 16 and 18). The exception is a justified mistaken belief that you are entitled.

Insurance for Visits

• Regular Polish travel insurance is for people leaving Poland. Living in the USA, look for a visitor/travel medical policy purchased in the USA with coverage in Poland or a Polish policy for people coming to Poland. Check the sum for medical expenses, medical transport, and whether the policy covers chronic diseases.
• Poland and the USA do not have an agreement on funding treatment. Without a policy, you pay out of pocket.
• Readers from the United Kingdom: the free GHIC card covers necessary state treatment in EEA countries, including Poland. Obtain it before traveling.

Frequently Asked Questions

Does Polish citizenship grant the right to treatment under NFZ?

Citizenship alone does not. A title to insurance or special entitlement is needed. The exception is children under 18 years old with Polish citizenship, who are entitled to benefits regardless of residence.

Can I pay for voluntary NFZ insurance while living in the USA?

No. A voluntary insurance contract can only be concluded by a person residing in Poland (Article 68, paragraph 1).

What will the additional fee be after 15 years in the USA?

A break of over 10 years means a fee of 200% of the contribution assessment base, at least 18,772.56 PLN from October 2026. In justified cases, NFZ may spread it over installments or waive it. First, check if you have a cheaper option, e.g., registration through an insured spouse.

As a ZUS pensioner in the USA, will I receive EKUZ?

No. ZUS does not register pensioners living in the USA for health insurance, so NFZ has no basis to issue the card.

How can I check if I am insured?

Log in to the Internet Patient Account or the mojeIKP app. If in doubt, contact the provincial NFZ branch or the NFZ helpline (800 190 590).

Sources

Status as of October 23, 2026. This guide is for informational purposes only and does not constitute legal advice. The amounts of contributions and additional fees change quarterly; confirm them at the provincial NFZ branch before signing the contract.