Between  1990 and 1992 he was in charge of the Sofia City Hospital No 6.
1993 - Deputy Health Minister in the Berov cabinet.
1994-1998 - Programme Director of a PHARE programme for Bulgara with the Health Ministry.
1997-1999 - Member of the Higher Medicine Council, health institutions manager and a practicing dentist.
From February 1997 till 8 March 1999 he was Deputy Health Minister in the cabinets of Stefan Sofiyanski and Ivan Kostov.
In March 1999 Ilko Semerdjiev was appointed Director of the National Health Insurance Fund, which scandalized the public by having purchased 10 expensive cars before becoming operative.
Semerdjiev was member of the teams that made the health insurance, health reform, and medical professional associations  legislation.
Semerdjiev joined the renewed Kostov cabinet (early 2000) as Minister of Health.
Married,  with two children.