The Republic Fund for Health Insurance

Name

The Republic Fund for Health Insurance

Legal name

Републички фонд за здравствено осигурање

Website

https://rfzo.rs

Company type

Private

Founded year

2006

Operating status

Operating

Headcount range

1,001–5,000 employees

Ownership category

akta.pro rank

Product category

Public Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Health and Welfare Funds (52512)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Public Health Financing, Budgeting & Grants Management (HLAJAMAC)

akta.pro secondary industry

Public Health Block Grants & Formula Funding Administration (HLAJALAD)

Keywords

• Public health insurance
• Statutory health coverage
• Electronic prescription services
• Health insurance reimbursement
• Healthcare claims management

Headquarters

HQ city

Novi Beograd

Offices32 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Infrastructure, Technology or R&D, Marketing or Sales

Revenue model

1. Mandatory Social Health Insurance Contributions: The Fund is funded primarily through mandatory social health insurance contributions paid by employers, employees, pensioners, and self-employed individuals based on the Law on Health Insurance. Monthly contribution rate for voluntary inclusion in 2026 is 5,283.60 RSD. The state also contributes for certain categories (children, unemployed, welfare recipients). Revenue is supplemented by copayments (participation) for certain services.

Pricing tiers

Go-to-market motion1 record

Distribution channels6 records

Marketing channels6 records

Core offering

The Republic Fund for Health Insurance is the national statutory health insurance organization of Serbia, providing mandatory health insurance coverage to all insured persons in Serbia. It also operates voluntary health insurance enrollment, an electronic health insurance card system, electronic prescription services, the DSG/DRG healthcare invoicing portal for contracted providers, and specialized funding programs (including IVF/BMPO, rare diseases, medical-technical aids, and treatment abroad) reimbursed through contracts with approximately 245 healthcare institutions.

Product overview

The Republic Fund for Health Insurance (RFZO) operates a unified digital health insurance platform that delivers government-mandated mandatory health insurance services to all Serbian citizens. The core platform is built around the electronic Health Insurance Card (KZO) system, which replaced paper booklets in 2017 and enables automatic card verification, electronic prescriptions, and real-time insurance status checks. The portfolio consists of multiple interconnected digital products: the mRFZO mobile app (for citizen-facing access), a web-based waiting list management system, a drug availability tracking system, the DSG (DRG) portal for hospital financing, a capitation system for primary care, a National Contact Center, and a sick leave payment verification service. Core services also include the publicly funded IVF (BMPO) program, medical-technical aids provision, and health coverage for treatment abroad. The platform integrates with the government's e-Uprava portal, the Central Registry of Mandatory Social Insurance, pharmacy networks, healthcare institution systems, and major app stores for the mobile application.

Differentiator

Problem solved

Functional benefit

Products and services

• Mandatory Health Insurance Statutory mandatory health insurance coverage for all insured persons in Serbia, providing access to a comprehensive benefits package including healthcare services and pharmaceuticals. Funded through mandatory social health insurance contributions from employers, employees, pensioners, and other insured categories.
• Voluntary Health Insurance Voluntary health insurance enrollment available to insured persons who elect extended or additional coverage beyond mandatory statutory health insurance.
• Electronic Health Insurance Card Electronic health insurance card issued to insured persons in Serbia for real-time verification of insurance status at healthcare institutions and pharmacies with automatic verification terminals.
• mRFZO Mobile Application Mobile application (iOS/Android) enabling insured persons to access health insurance information and self-service functions related to their RFZO coverage.
• Electronic Prescription Service Electronic prescription platform enabling insured persons to receive and pharmacists to dispense and verify prescriptions through the Republic Fund's digital systems.
• DSG/DRG Invoicing Portal DSG/DRG invoicing portal (portal.dsg...) used by contracted healthcare institutions to submit invoices and documentation for reimbursement of insured healthcare services to the Republic Fund.
• BMPO (Biologically Medically Assisted Fertilization / IVF) Program Funding program for Biologically Medically Assisted Fertilization (BMPO) / in vitro fertilization administered by the Republic Fund for eligible insured persons in Serbia.
• Rare Disease Funding Program Centralized funding program administered by the Republic Fund for rare disease therapies, providing access to high-cost treatments for insured persons with rare diseases in Serbia.
• Medical-Technical Aids Funding Program Funding program administered by the Republic Fund to provide insured persons with medical-technical aids such as prosthetics, orthopedic devices, and mobility equipment.
• Treatment Abroad Services Treatment abroad referral and funding program administered by the Republic Fund for insured persons requiring medical treatment not available within Serbia.
• Drug Availability and Short-Supply Tracking Drug availability tracking service operated by the Republic Fund, including listings of alternative medicines, to help insured persons and pharmacists identify substitutes when drugs are in short supply.
• National Contact Center National Contact Center operated by the Republic Fund (0800 number) providing telephone-based information and support to insured persons about health insurance services, benefits, and procedures.
• Waiting List Information System Waiting list information services providing insured persons with information on expected wait times for diagnostic and therapeutic procedures at contracted healthcare institutions in Serbia.

Named customers6 records

Segments5 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration8 records

Feature5 records

Partnerships

Ten partnerships are on record, tiered minor and core.

• University of Belgrade – Faculty of Biology (Center for Human Molecular Genetics)minorStrategic or Co-development Partner · 7 September 2023The Fund finances mandatory neonatal screening for spinal muscular atrophy (SMA) starting September 14, 2023, with sample analysis performed at the Faculty of Biology's Center for Human Molecular Genetics at the University of Belgrade. The center has decades of experience in molecular genetics diagnostics for rare diseases.
• Republic of Serbia – Ministry of HealthcoreStrategic or Co-development PartnerThe Fund operates under the regulatory oversight and policy direction of the Serbian Ministry of Health. The Ministry sets health policy, and the Fund implements coverage decisions including drug list management, provider contracting, and care standards. Joint initiatives include foreign expert recruitment programs where the Ministry and Fund jointly finance international medical specialists to perform procedures in Serbian hospitals.
• Contracted Healthcare Institutions (hospitals, clinics, domovi zdravlja)coreStrategic or Co-development PartnerThe Fund contracts approximately 245 healthcare institutions including clinical centers, institutes, and general hospitals. Providers deliver healthcare services to insured persons under various payment models (capitation, DSG). The Fund funds infrastructure and equipment for these institutions.
• Contracted Pharmacies (public and private)coreChannel Partner/ Reseller/ DistributorBoth state-owned and private pharmacies contract with the Fund to dispense medications from the official drug list. Private pharmacies outside the network plan are also contracted via public calls for proposals to expand access.
• 25 Countries and 1 Province (bilateral health insurance agreements)coreStrategic or Co-development PartnerSerbia has concluded bilateral health insurance agreements with 25 countries and 1 province (Quebec): Austria, Belgium, Bulgaria, Bosnia and Herzegovina, Luxembourg, Hungary, Germany, Romania, Italy, France, Netherlands, Croatia, Montenegro, Czech Republic, North Macedonia, Slovenia, Tunisia, Turkey, and Switzerland (principle of insurance); United Kingdom and Poland (principle of reciprocity); Denmark, Norway, and Sweden (principle of reimbursement). These enable insured persons to access emergency care abroad and enable foreign nationals to access emergency care in Serbia.
• Tax Administration (Poreska uprava)coreTechnology or IntegrationThe Fund integrates with the Tax Administration's data systems to automatically verify social contribution payments and perform electronic insurance card verification without requiring citizens to visit branch offices.
• National Employment Service (Narodna služba za zapošljavanje)minorStrategic or Co-development PartnerThe Fund collaborates with the National Employment Service to implement the 'Moja prva plata' (My First Salary) youth employment program. The Fund hired 72 young people through this program in 2023 to work at its branch and local offices.
• Central Register of Mandatory Social Insurance (CRPS)coreTechnology or IntegrationThe Fund uses the Central Register's portal for automatic insurance card verification and employer contribution tracking, enabling fully electronic verification without manual processes.
• Private healthcare institutions (outside the network plan)minorChannel Partner/ Reseller/ DistributorThe Fund contracts private healthcare institutions for services not available in the public network plan, including: in vitro fertilization (BMPO), cataract surgery, hyperbaric oxygen therapy (HBO), biomedical procedures, and pathological analyses. These are contracted via public calls for proposals.
• International pharmaceutical companiescoreStrategic or Co-development PartnerThe Fund negotiates with pharmaceutical companies to place innovative drugs on the national formulary. In 2022, a record ~5.8 billion RSD was allocated for 26 new innovative drugs. In 2023, the drug budget reached ~30 billion RSD. The Fund also enables off-label drug use funded from the budget.

Scale indicators8 records

Recent moves7 records

Expansion highlights5 records

Broad incumbents

• Turkish SGK (Sosyal Güvenlik Kurumu): Turkey's Social Security Institution administering universal health insurance for ~85M citizens. Comparable as a large single-payer system with mandatory contributions, e-prescription infrastructure, and a unified national drug formulary.
• Centers for Medicare & Medicaid Services (CMS): US federal agency administering Medicare, Medicaid, and CHIP for ~150M beneficiaries. Comparable as a public health insurance administrator with national formulary (Medicare Part D), provider contracting, and digital modernization programs, though operating in a multi-payer system context.
• Caisse Nationale de l'Assurance Maladie (CNAM): France's national health insurance fund managing statutory coverage for ~67M insured persons. Comparable in operating model (mandatory contributions, provider reimbursement, drug formulary management) but at much larger scale and with richer benefit scope.

Direct peers

• NHS England: Statutory public health system providing universal coverage to England's population through taxation-funded commissioning. Directly comparable to RFZO as a single-payer public entity managing provider contracts, drug formularies, and waiting lists at national scale.
• Croatian Health Insurance Fund (HZZO): Croatia's mandatory health insurance fund administering statutory coverage, provider contracting, and a national drug list. Most direct regional peer given shared post-Yugoslav healthcare system legacy and similar benefit package design.
• Czech VZP (Všeobecná zdravotní pojišťovna): Czech Republic's largest public health insurance fund covering ~60% of the population. Comparable as a Central European single-payer system with statutory provider contracting, electronic health card infrastructure, and similar drug reimbursement processes.
• Hungarian NEAK: Hungary's National Health Insurance Fund Administration managing statutory coverage, provider contracts, and pharmaceutical reimbursement. Direct regional peer with similar Central European single-payer structure and benefit design.
• Slovenian ZZZS: Slovenia's Health Insurance Institute managing mandatory and voluntary health insurance for ~2M insured persons. Direct regional peer with comparable single-payer model, e-health card system, and provider contracting framework.
• Bulgarian NHIF (НЗОК): Bulgaria's National Health Insurance Fund — the regional counterpart to RFZO. Closely comparable in scale, benefit scope, and institutional design as fellow post-transition EU-accession health system.
• Health Insurance Fund of North Macedonia (ФЗО): North Macedonia's Health Insurance Fund providing mandatory health insurance coverage. Regional peer sharing similar post-Yugoslav healthcare system legacy, mandatory contribution financing, and provider reimbursement models.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Instagramrfzo.rs/index.php/mediji2022/insta2022

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about The Republic Fund for Health Insurance