Healthcare Reimbursement in Albania: Who Pays for What Depending on Your Situation

CLEISS, in its list of social security agreements concluded by France, does not mention Albania, which belongs neither to the European Union nor to the European Economic Area. According to CLEISS, no local cover is provided outside an agreement for a temporary stay: it recommends travel insurance suited to the real cost of care in the country, and recalls that French health insurance does not cover medical repatriation. France Diplomatie (the French foreign ministry) advises an assistance contract covering medical costs, surgery, hospitalisation and repatriation: the embassy cannot pay these costs.

Four players may be involved: the Albanian scheme (FSDKSH, see the guide Albanian healthcare system), the retained French scheme (posting), the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help compare offers.

The employee on a local contract is affiliated to the FSDKSH by their employer: the contribution of 3.4% of gross salary is split equally, or 1.7% each, and the residence permit number serves as the insured number. They benefit from the public pathway (family doctor, referral to specialists, public hospitals) and from the list of reimbursed medicines; private establishments are not covered by the public pathway, patients there paying the full cost. Private supplementary cover opens direct access to the private sector. See the glossary entry on the local contract.

The posted employee of a French company comes under posting outside an agreement: they remain affiliated to the French scheme, contribute in France and obtain reimbursement of care received abroad up to what the same service would give in France, on paid invoices with form S 3125c. The length is three years, renewable once. Their family who accompany them follow the same procedure; those who stay in France continue to come under the French fund. Daily allowances are paid by the fund with a sick-leave notice sent within 48 hours. See posted worker or expatriate and the glossary entry on the posted worker.

The self-employed person joins the FSDKSH on a base equal to twice the minimum wage, set by the Council of Ministers separately for towns and villages; voluntary insurance follows the same base. They can also choose the CFE or international insurance, particularly to gain access to private clinics and repatriation. See digital nomad insurance.

The student has an insured number linked to their residence permit; their precise status with regard to the FSDKSH should be confirmed with the Fund and the establishment. Before age 30, the CFE offers its youth offer; student insurance completes the picture. See student insurance abroad.

The retiree does not come under form S1, reserved for the European Union and the European Economic Area, and France has no agreement with Albania. The FSDKSH counts retirees among the insured; access for a foreign retiree should be confirmed with the Fund, and the CFE (retirees’ offer, with a contribution that depends on age and the plan chosen) or international insurance completes or replaces this cover. See the guide retirees’ health insurance abroad and the page retiring in Albania.

The spouse and children follow the holder under the same cover (posting, CFE or family insurance); the FSDKSH counts children and pregnant women among the insured. The family contracts of the CFE and of international insurers provide maternity and paediatrics depending on the contract. See expat family insurance.

The CFE reimburses abroad on a rate or flat amount specific to the country of care, applied to actual expenses: the fund’s example is a French general practitioner consultation set at €25 and reimbursed at 70%, or €21. In France, it follows the principles of Assurance Maladie with direct payment, for stays of under three months. The contributions depend on age and the plan chosen, for the main offer, the youth offer and the retirees’ offer. No waiting period applies if membership takes place before departure or within three months of settling; after that, it is three months before age 45 and six months from age 45. Maternity requires conception after membership. See CFE reimbursements.

International health insurance on a first-euro basis reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. It meets the recommendation of France Diplomatie: some emergencies or complex cases may require priority private hospitalisation or evacuation abroad.

The tourist stays up to 90 days in 6 months without a visa and takes out travel insurance before departure. On returning to France, they can ask their fund to reimburse unforeseen care, which CLEISS describes as a possibility and not an obligation; daily allowances are only paid on return, on sick leave issued by a doctor practising in France. See long-stay travel insurance.

On returning to France, a 3-month waiting period applies to a French national with no professional activity before affiliation to the CPAM (local health insurance office) under the PUMa (universal health cover); a CFE member with no activity benefits free of charge from retention of rights for the 3 months following return (Assurance Maladie). See reducing the waiting period and return to France.

• Consultation: primary care free for all residents since 2016 (European Observatory); specialists free or inexpensive on referral from the family doctor; reimbursed at the French tariff on invoice for the posted worker; at the country scale for the CFE; at actual costs within the ceilings of a first-euro contract.
• Hospitalisation: public hospitals through the FSDKSH for an insured person; full cost at the patient’s expense in private hospitals; CFE direct payment in France; direct cover possible with an international contract.
• Medicines: list I for hospital pharmacies and list II for open-network pharmacies, published by the FSDKSH; CFE scales; contract ceilings.
• Dental: growing private sector; included at the CFE according to its scales and in most international contracts according to an annual ceiling.
• Optical: mainly under international contracts, with ceilings per period.
• Maternity: pregnant women are among those insured by the FSDKSH; the CFE requires conception after membership; international contracts generally apply a waiting period to maternity.

The reimbursement guide and the page expat health insurance give pointers; Expavy helps compare these options with your situation.