A diagnosis of rectal cancer brings, alongside the treatment, a stack of paperwork. What is reimbursed, what is not, where it is filed, who signs it. This page gathers in one place the practical information that the system never sets out in an organised way anywhere.
Verified on 26 July 2026. The legislation in this area changes often — in the last twelve months alone, the criteria for disability classification, the tax exemptions and the sick-leave rules have all been amended. Before acting on any amount or procedure below, check it with your casa de asigurări de sănătate (the county health insurance house, CAS) or with the county DGASPC (the county directorate for social assistance and child protection). At the end of each section you will find the official source.
Reimbursement of stoma supplies
If you have a colostomy or an ileostomy, the supplies are reimbursed monthly by the casa de asigurări de sănătate (the county health insurance house, CAS).
What is reimbursed and how much
There are two systems, and the doctor prescribes only one of them for each stoma:
| System | What the monthly set contains | Reference price |
|---|---|---|
| One-piece, non-drainable bag | 35 pieces | 298 lei |
| One-piece, drainable bag | 20 pieces | 151 lei |
| Two-piece system | 7 support flanges + 7 collection bags | 160 lei |
| One-piece, convex adhesive, non-drainable | 40 pieces | 874 lei |
| One-piece, convex adhesive, drainable | 25 pieces | 580 lei |
| One-piece, diameter over 60 mm, non-drainable | 40 pieces | 452 lei |
The convex versions and those with a large diameter are granted only in particular situations or for stoma complications, on the recommendation of the specialist.
Patients with a double stoma may receive two sets per month.
Three things that can save you time and money
The composition of the set can be changed. On the recommendation of the specialist and with your consent recorded on the prescription, the mix of products can be changed, within the same monthly ceiling. If the standard set does not suit you, this is the lever to use.
The note “stomă permanentă” (permanent stoma) changes everything. If the doctor writes this note on the prescription, the prescription is valid indefinitely and is submitted to the health insurance house only once. The approval decision is renewed annually, but you no longer need a new prescription each time. Many online guides still say the prescription has to be renewed every 12 months — that has not been the case since October 2024.
It is not only the specialist who can prescribe. For stoma devices, the recommendation can also be made by the family doctor on whose list you are registered, not only by the specialist or by the hospital at discharge.
How to obtain them, step by step
- The doctor issues the prescription in two copies, with the note “stomă permanentă” (permanent stoma) where applicable.
- You file it with the health insurance house where you are registered: application form, prescription, identity document. It can also be sent by post, by courier or electronically — you are not obliged to go in person.
- The house has 3 working days to reply. A refusal must be justified in writing, with a legal basis.
- You receive the approval decision. On the back it carries the list of contracted suppliers — you are free to choose among them.
- You go to the supplier with the decision and a copy of the prescription.
The prescription lapses if you do not file it within 30 days of it being issued.
Do you pay a difference?
Yes, you may. The house reimburses up to the reference price. If the product you choose costs more, you pay the difference yourself, directly to the supplier. For many patients the monthly ceiling does not cover actual consumption.
If it is delayed
When applications exceed the county house’s monthly fund, priority lists are drawn up in the order in which applications were registered, and the decision is issued when the fund allows. That is why the waiting time differs between counties and from one month to another — in December it is typically longer.
Legal basis: HG 521/2023, art. 170–171; Order of the Ministry of Health / CNAS 1857/441/2023, Annexes 38 and 39, in the form in force from 1 January 2026.
The certificat de încadrare în grad de handicap (disability certificate)
Warning: the criteria changed completely in November 2025
Ordinul 762/1992/2007, which almost every guide on the internet cites, has been repealed. The current criteria are in the joint Ordinul 2300/1457/2025, published in the Official Gazette no. 1027 of 6 November 2025.
What grade a rectal cancer patient receives
According to the criteria in force:
- Handicap accentuat (accentuated / marked disability) — patients operated on with a permanent colostomy or ileostomy, as well as malignant tumours that are inoperable or operated on with recurrences and metastases in a single organ.
- Handicap grav (severe disability) — malignant tumours, inoperable or operated on, with metastases in multiple locations; cachexia; severe anaemia resistant to treatment.
- Handicap mediu (moderate disability) — malabsorption syndrome with a body mass index below 17, or moderate anaemia.
An early-stage rectal cancer, operated on, without a stoma and without functional impairment, often does not qualify.
For stage IV disease with no remaining therapeutic options, and for situations requiring a permanent stoma, the new order provides for the possibility of a certificate of permanent validity, without periodic re-assessments. The exact conditions for granting it are worth confirming directly with DGASPC — this is a new element and practice is still settling.
Where and with what documents
The file is submitted to the Complex Evaluation Service within the county or sector DGASPC. As a rule the following are required: standard application form, a medical report from the specialist (original), a scrisoare medicală (medical letter) from the family doctor (original), an anchetă socială (social assessment) from the town hall, a copy of the identity document and the medical documents — bilet de externare (discharge letter), buletin histopatologic (histopathology report), imaging, laboratory tests.
Re-assessment must be requested 60 days before the certificate expires.
The exact list of documents and the way they are filed differ between counties. Check on your own DGASPC’s website before you put the file together.
What you receive
The social reference indicator is 660 lei and remained unchanged in 2026.
| Grade | Monthly allowance | Complementary personal budget | Total |
|---|---|---|---|
| Grav (severe) | 528 lei | 198 lei | 726 lei |
| Accentuat (accentuated) | 350 lei | 145 lei | 495 lei |
| Mediu (moderate) | — | 79 lei | 79 lei |
Free urban transport for the severe and accentuated grades, plus the companions of people with severe disability. The travel pass is issued by DGASPC and is valid throughout the country, but the concrete way in which it is granted is set by the local council, so it differs from one city to another.
Free intercity transport: 24 journeys per year for severe disability, 12 for accentuated. Alternatively, on request, you can receive fuel vouchers: 1,500 lei per year at severe grade, 750 lei at accentuated. The two options are mutually exclusive.
Personal assistant or companion allowance — for severe disability, you can choose between a personal assistant employed by the town hall and a monthly allowance, by written application to DGASPC.
Local tax: the exemption has become a reduction
From the 2026 tax year, the full exemption from building and land tax has been abolished. In its place there is a reduction of 50% for severe disability and 25% for accentuated disability, for the home of residence, the land attached to it and one vehicle under 2,000 cc.
The reduction is granted on request, filed with the Direcția de Impozite și Taxe Locale (the local tax office) of the town hall. It is not automatic. The form and the documents required differ from one town hall to another.
Legal basis: Ordinul 2300/1457/2025; Legea 448/2006, art. 23, 24, 42, 58; Legea 239/2025; OUG 9/2026 and OUG 17/2026.
Sick leave
There are three important advantages here that many patients do not know about, because neoplasms have a special regime.
No contribution history is required. You are entitled to sick leave for neoplasms even if you have not contributed for the minimum period normally required.
The duration is one year and 6 months within the last 2 years, depending on the stage of the disease — as against a maximum of 183 days per year for ordinary illnesses.
The benefit is 100% of the calculation base, that is, of the average gross income of the last 6 months.
From 1 August 2025, the percentages for ordinary illness were reduced to 55%, 65% and 75%, depending on duration. These reductions do not apply to neoplasms, which remain at 100%. Many human resources articles from 2025 and 2026 do not make the distinction.
Check the code on the certificate. Neoplasms are reported with a distinct code, which triggers the 100% regime and the extended duration. A certificate issued with an ordinary-illness code costs you money. If you spot an error, ask for it to be corrected.
The employer covers the first 5 days; from the sixth, payment comes from the insurance fund.
Leave for the companion of an oncology patient
A little-known and very useful right: a person designated by you can receive paid leave in order to accompany you to surgery and treatments.
- A maximum of 45 calendar days per year, for each patient
- 85% of the calculation base, borne entirely by the insurance fund
- Only one person can be designated per intervention or treatment
- It also works if the treatment takes place abroad
In addition — and this is a detail worth underlining — in every year in which this leave is granted, both the companion and the patient are entitled to one psychological evaluation session and at least five psychological counselling sessions, reimbursed. This is an almost unknown right to see a psychologist.
Legal basis: OUG 158/2005, art. 9, 13, 17 and Chapter V^1 (art. 30^1–30^3), in the form in force from 1 July 2026.
The invalidity pension
It is granted in three grades, assessed by the social insurance expert doctor (INEMRCM, the national institute for medical expertise and work capacity), not by DGASPC:
- Grade I — total loss of working capacity and of the capacity for self-care; gives entitlement to a companion allowance
- Grade II — total loss of working capacity, but self-care preserved
- Grade III — loss of at least half of working capacity; you can work reduced hours, 4 hours a day
The application is filed with the county pension house, together with the medical decision on working capacity. The deadline for resolution is 45 days.
Do not confuse the invalidity grade with the disability grade. They are two completely separate systems: invalidity is established by INEMRCM and concerns working capacity; disability is established by DGASPC and concerns functioning. A patient may hold one, the other or both, and the invalidity pension can be combined with the disability allowance. This is the most frequent confusion.
If you have not recovered by the time the sick leave expires, the doctor may propose either retirement on invalidity grounds or an extension of the leave by up to 90 days, precisely in order to avoid retirement, where recovery is likely.
Oncological treatment: what you pay for and what you do not
Rectal cancer treatment is covered through the Programul Național de Oncologie (the National Oncology Programme), financed from the insurance fund:
- Cytostatics, immunotherapy, targeted therapies — in continuous hospitalisation, day hospitalisation and outpatient care
- External beam radiotherapy
- Monitoring investigations for the course of the disease
- Genetic testing relevant to colorectal cancer, including MSI/dMMR status and RAS/BRAF mutations
Enrolment is done by the healthcare unit under contract with the health insurance house, on the basis of the opinion of the multidisciplinary oncology board and of a file that includes the histopathology report. For the services included in the programme, the patient pays nothing.
People with oncological conditions remain exempt from paying the health contribution for the duration of treatment and monitoring under the national programmes. This is a high-impact statement that I could not verify directly in the text of the Fiscal Code — confirm it with the health insurance house.
Transport to radiotherapy or chemotherapy
It has to be said plainly: there is no national scheme that reimburses transport for oncology patients to their treatment sessions. The only non-medicalised transport expressly reimbursed from the insurance fund is that of dialysis patients.
What can be used in practice: the 24 or 12 free intercity journeys per year, if you hold a disability certificate, or the fuel vouchers. Some county houses have their own practices — it is worth asking locally.
Your rights in hospital
A second opinion is now reimbursed
From 14 March 2026, the law explicitly provides that all insured persons have the right to a second medical consultation, paid for by the insurance system, in order to obtain a second opinion on the basis of the existing investigations or of additional ones, where justified.
Until that date the right to a second opinion existed, but without funding. For rectal cancer — where a second reading of the staging MRI or a re-assessment of the indication for neoadjuvant treatment can concretely change the treatment plan — this is probably the most valuable new right.
Also from March 2026, the healthcare unit has an obligation to schedule you for the next necessary consultation or investigation, through a mechanism of its own — not merely to hand you a referral on paper.
Access to your medical file
You have the right of access to your personal medical data. One practical detail that avoids later conflict: on admission you can designate a person, through an agreement recorded in the annex to the foaia de observație (the inpatient chart), who will have full access to confidential information, both during your lifetime and after death. It takes thirty seconds and almost nobody does it.
Consent and refusal
You have the right to be informed about your state of health, the interventions proposed, the risks, the alternatives and the prognosis. And you have the right to refuse or to stop a medical intervention, assuming responsibility for the decision in writing.
Legal basis: Legea 46/2003, art. 4, 6, 11, 13, 24, in the form in force from 14 March 2026, amended by Legea 27/2026.
Treatment in other European Union countries
There are three different mechanisms, and confusing them costs money.
The European Health Insurance Card covers only care that becomes necessary during a temporary stay. It does not cover planned treatment. This is the most frequent and most expensive misunderstanding: you cannot go abroad for chemotherapy on the basis of the European card.
Form S2 (the former E112) is for planned treatment. It is granted if two conditions are met cumulatively: the treatment is in the basic package of services in Romania, and it cannot be provided in Romania within a medically reasonable time. If both are met, the health insurance house cannot refuse to issue it, and a refusal must be justified and can be challenged. As a rule it is obtained before departure.
Realistically: for rectal cancer, S2 is hard to obtain, because the second condition is difficult to demonstrate as long as rectal surgery and chemoradiotherapy are performed in the country. It becomes plausible for techniques that are not practised in Romania at all.
The cross-border directive allows you to pay in full abroad and claim reimbursement afterwards, but only at the level of the tariff reimbursed in Romania — frequently far below the real cost.
What differs from one county to another
The legal framework is national, but five things are applied locally:
- The monthly fund for medical devices and, by implication, the waiting time for stoma supplies
- The list of contracted suppliers — you can only choose from those under contract with your own health insurance house
- Free urban transport, established by decision of the local council
- Local tax reductions — the percentages are national, but the form and the documents differ between town halls
- The DGASPC procedure for the disability certificate — the list of documents and the deadlines vary
Official sources
The references below remain current even if the legislation changes. On the Legislative Portal, the menu “Forme act → Forma consolidată” always shows the version in force.
- Legea 46/2003 — patients’ rights
- OUG 158/2005 — leave and benefits
- Legea 448/2006 — persons with disabilities
- Ordinul 2300/1457/2025 — criteria for disability classification
- Ordinul 1857/441/2023 — Framework Contract norms (Annex 38: stomas)
- HG 521/2023 — the Framework Contract
- CNAS — official page
- CNAS — treatment in EU states, European card and S2
- ANPD — benefits and facilities for persons with disabilities
- INEMRCM — expert assessment of working capacity
- Casa Națională de Pensii Publice (the National Public Pension House)
What I could not confirm
In the spirit of transparency, here are the points where the public information is not clear enough and where you must ask directly before counting on anything:
- The exact conditions for a disability certificate of permanent validity — in particular whether it is granted from the first or from the second assessment
- Whether the exception to the “unpaid day” in sick leave, introduced from June 2026, also covers the oncology patient’s own leave or only that of the companion
- The amount of the companion allowance for the grade I invalidity pension
- The legal deadline for resolving a disability file
- Whether the unassisted medical transport in the framework contract can be used for a scheduled journey to radiotherapy
- The exemption from the health contribution for oncology patients, following the 2025 tax changes
This page is for information purposes. It does not constitute legal advice and does not replace the official information of the competent institutions. Amounts and procedures change — check with the health insurance house, DGASPC or the town hall before submitting a file.