Reimbursements: how it works in international private health insurance

At a facility within the insurer’s approved network, direct billing lets the insurer settle the facility directly, without the insured person having to pay upfront — a particularly useful mechanism for hospitalisation, where amounts can be high abroad.

Outside this network, the insured person pays the costs upfront, then submits a reimbursement request once care has been received. How wide the approved network is varies considerably from one insurer to another and from one country to another: it should be checked before you leave, not at the point of hospitalisation.

International private health insurance generally reimburses based on actual costs incurred — unlike CFE, which reimburses on a fixed French reference rate (see reimbursement basis). But “actual costs” doesn’t mean full reimbursement: the amount you get back depends on any deductible (an amount that systematically stays with you before the guarantee kicks in) and on the cover cap that applies to the relevant category, often lower for dental and optical care than for hospitalisation.

What remains once the deductible is subtracted and the cap applied makes up the insured person’s out-of-pocket cost — to compare before you subscribe, category by category, rather than on the single reimbursement percentage shown at the top of the contract.

A reimbursement request generally relies on a paid, itemised invoice (nature and amount of the treatments), a prescription for medication or prescribed procedures, and sometimes a medical report for more substantial procedures. Most insurers now offer online submission of supporting documents.

Processing times and the maximum deadline to submit a request are set by each contract and vary from one insurer to another: they should be checked in the general terms before you leave, not after you’ve incurred costs. Systematically keeping the originals until reimbursement is confirmed remains the safest rule, even when online submission is available.