Expat insurance and health insurance in Andorra

Andorra has a mixed healthcare system, built around the Caixa Andorrana de Seguretat Social (CASS), the country’s single social security fund. Affiliation is mandatory for anyone carrying out professional activity in Andorra (employed or self-employed), as well as for pensioners of the Andorran scheme. It covers sickness, maternity, workplace accidents, disability and old age; there is, however, no unemployment insurance in Andorra. Care is provided by practitioners who are either contracted or not contracted with CASS, with the reimbursement level varying accordingly; in practice, a large majority of insured people also take out optional private insurance to reduce out-of-pocket costs.

The Hospital Nostra Senyora de Meritxell, in Escaldes-Engordany, is the country’s only hospital (run by the Servei Andorrà d’Atenció Sanitària — SAAS). It provides 24/7 emergency care, surgery, maternity and rehabilitation, but such a small territory cannot host every heavy technical platform: certain treatments (complex neurosurgery, severe burns, long-term intensive care) are not available locally. In a life-threatening emergency that cannot be treated locally, evacuation to a university hospital in France (Toulouse) or Spain (Barcelona) may be necessary — a point worth anticipating when choosing insurance that includes repatriation/medical evacuation cover.

• Short (tourist) stay: no visa required for a French national, a valid national ID card or passport is enough. As Andorra is not a member of the Schengen area, entry must go through a border post.
• Move with professional activity: requires an immigration authorisation issued by the Departament d’Immigració of the Govern d’Andorra (“residency and work”), subject to a quota and to an employment contract or the setting up of self-employed activity; CASS affiliation then becomes automatic as soon as the activity begins.
• Move without professional activity (“passive residency”): a separate regime, with income and minimum-presence conditions set by the Andorran government; this status gives no entitlement to CASS, so full private health insurance is essential.
• Seconded employee: may stay on the French scheme under certain conditions set out in the bilateral agreement, on request to Urssaf before departure (secondment certificate SE 130-01).
• Locally hired employee (“expat”): CASS affiliation as soon as professional activity begins in Andorra, with a notification to be made in France (CPAM, CAF, France Travail) to avoid undue payment of French benefits.

There is no fine as such, but the absence of CASS affiliation (or private cover for a passive resident) means bearing the full cost of any medical care received in Andorra, with no possible help from the French embassy.

Andorra is not a member of the European Union: coordination with France therefore does not run through EU regulations 883/2004 and 987/2009, but through a specific bilateral agreement: the France-Andorra social security agreement of 12 December 2000 (general administrative arrangement of 23 January 2001, in force since 1 June 2003). Its scope is broad — sickness-maternity, disability, old age and survivors, workplace accidents and occupational diseases, family benefits, death — except for unemployment insurance, which is not covered (Andorra does not have its own unemployment scheme either).

The principle applied is that of the state of employment: a worker, whether employed or self-employed, falls under the social security scheme of the country where they carry out their activity, with exceptions for seconded workers, diplomatic staff, civil servants and international transport personnel. Insurance periods completed in either country are aggregated when establishing entitlements.

• A person insured under the French scheme staying or travelling in Andorra: prior authorisation from the French fund (CPAM/MSA) and form SE 130-05 allow care to be covered by CASS on behalf of the French fund, particularly for convalescence or care not available in France within a reasonable time.
• An expatriate employee who has worked in France: form SE 130-03 (certificate of aggregated insurance periods) allows them to assert their rights with CASS.
• Seconded employee: form SE 130-01 (secondment certificate) and SE 130-08, stays on the French scheme with no extra contribution in Andorra; suitable supplementary cover is still recommended, as Andorran medical fees can exceed French reimbursement bases.
• The agreement covers neither unemployment insurance nor supplementary top-up cover: out-of-pocket costs depend on the individual contract taken out.

1. Before departure, for a seconded employee: check with the employer the conditions for staying on the French scheme under the bilateral agreement (request via the employer’s Urssaf account).
2. For a move with professional activity: apply for an immigration authorisation (residency and work) with the Departament d’Immigració of the Govern d’Andorra, before or on arrival depending on status.
3. For a move without professional activity: apply for passive residency authorisation with the same department, and take out full private health insurance beforehand.
4. When starting a job, for a locally hired employee: check with the employer that CASS affiliation has been declared and that the corresponding certificate has been issued.
5. Notify CPAM, CAF and France Travail of your departure to avoid undue payment of French benefits; request form SE 130-03 if you have a work history in France.
6. Registration with the roll of French nationals living abroad is recommended.