Healthcare Reimbursement in Andorra: Who Reimburses What Depending on Your Situation

Andorra is one of the countries linked to France by a bilateral social security agreement in force (CLEISS list of agreements). The text of 12 December 2000 applies whatever the nationality and sets the principle of the state of employment: you come under the scheme of the country where you work, with exceptions for seconded employees. Unemployment insurance is not part of it and the agreement does not cover supplementary health insurance: the out-of-pocket share depends on the contract taken out individually. The glossary explains the notion of a bilateral agreement and those of reimbursement base and out-of-pocket share.

Several forms punctuate the procedures: SE 130-01 (secondment certificate), SE 130-08 (care of a seconded employee and their dependants with the Andorran body), SE 130-03 (aggregation of insurance periods), SE 130-04 (temporary stay of a French scheme member), SE 130-06 and SE 130-07 (family remaining in France) and SE 130-09 (registration of a retiree). The page healthcare system in Andorra presents the care network.

The locally hired employee is affiliated to CASS from the start of their activity. On the liability tariff, CASS reimburses 65% (for example physiotherapy) or 75% of outpatient care and 90% of hospitalisation, up to 100% for particularly costly diseases or in case of insufficient resources. An employee who has worked in France requests form SE 130-03 before departure so that their French periods count towards opening Andorran rights (CLEISS). See the glossary entry on the local contract.

The self-employed person is compulsorily affiliated to CASS; the Andorran scheme is compulsory for employees and for the self-employed (CLEISS). Daily allowances are paid to them on the basis of their average monthly income of the previous year.

The spouse and children are covered as dependants: non-working spouse, children under 18 and children under 25 who are studying or registered with the employment service. If the worker works in Andorra and their family remains in France, they keep the French system’s benefits in kind for them: CLEISS provides for forms SE 130-06 (for the worker) and SE 130-07 (for the dependants), prepared by CASS and handed to the local CPAM (French health insurance fund). See expat family insurance.

An employee of a company established in France who is seconded to Andorra remains affiliated to the French scheme under certain conditions, with no additional contribution. Two routes exist for care: send the paid invoices to your fund with form S 3125c, or present the secondment certificate SE 130-01 and form SE 130-08, requested before departure, to the Andorran body. Daily allowances are paid directly by the French fund, the sick note being sent to it within 48 hours (CLEISS). As healthcare costs in Andorra may exceed French bases, CLEISS advises checking with the supplementary health insurer whether the contract needs to be adapted. See the guide seconded or expatriate.

The retiree of a French scheme in mainland France or the overseas territories, of any nationality, who has no entitlement open under the Andorran scheme can obtain coverage of their care by CASS: their pension fund completes part A of form SE 130-09, which registers the pensioner and their resident dependants. For the general scheme, the request goes through the Assurance retraite questionnaire; for civil and military pensions, through the pension management centre. During temporary stays in France, the SE 130-09 certificate is presented to the French fund; only the pensioner and their minor children are covered, and an accompanying spouse must arrange insurance (CLEISS). See the page retiring in Andorra and the guide health insurance for retirees abroad.

The student is covered as a dependant of a parent affiliated to CASS up to age 25, provided they continue their studies or are registered with the employment service. Without an affiliated parent, individual insurance should be arranged, as no specific student scheme was found in the sources consulted. See student insurance abroad.

The CFE is a voluntary social protection body open to French expatriates. A worker carrying out an activity in Andorra is affiliated to CASS on the basis of their activity; CFE membership remains possible on a voluntary basis, for example for a resident without activity. The reimbursement conditions, the country scales and the waiting periods should be checked on cfe.fr and in the guide CFE reimbursements.

The resident without activity does not come under CASS on the basis of work; the file for renewing their residence requires proof of cover for sickness, incapacity and old age (Govern d’Andorra). International health insurance with first-euro cover reimburses actual costs within its ceilings, after the deductible, waiting periods and exclusions of the contract; it may include medical transport outside Andorra, which the Servei Andorrà d’Atenció Sanitària organises for certain patients. Expavy helps you compare these options against your situation.

A member of the French scheme on a stay requests form SE 130-04 from their fund (CPAM, MSA) before departure and presents it to CASS; their dependants listed on the form are covered in the same way. In case of sick leave in Andorra, they notify their fund and send it the notice issued by an Andorran doctor; the allowances are paid by the French fund. France Diplomatie (the French foreign ministry) recalls that a contract covering all medical costs, including surgery, hospitalisation and medical repatriation, is recommended, the embassy being unable to pay these costs. See long-stay travel insurance.

On return to France, the CFE maintains rights for up to 3 months after the return, subject to prior notification. An employee who takes up a contract in France is covered from the start; without a contract, three months of stable residence are required, a procedure to be made with the CPAM using form 1106 (CFE). Andorran insurance periods count towards opening rights thanks to the agreement. See the guide reducing the waiting period and the page return to France.

• Consultation: 75% or 65% of the liability tariff at CASS with a contracted professional, 33% without a contract; French scheme and SE 130 forms for the seconded employee; actual costs within the ceilings of a first-euro contract.
• Hospitalisation: 90% of the liability tariff at CASS; up to 100% for costly diseases; French scheme retained for the seconded employee on paid invoices.
• Medicines: to be taken in original packaging with a prescription in international nonproprietary name; their authorisation in Andorra should be checked before departure (France Diplomatie). The rate at which CASS reimburses medicines should be confirmed with the fund.
• Dental: CASS liability tariffs cover medical and dental procedures; the detail of the procedures covered and the rates should be confirmed with CASS.
• Optical: no CASS rate was found for glasses and lenses; this item generally falls under supplementary insurance or an international contract, with ceilings to be read in the benefits table.
• Maternity: pregnancy and childbirth covered at 100% by CASS, free check-ups in the 3rd, 4th, 6th and 8th months; maternity leave of 20 weeks at 100% and paternity leave of 28 days (CLEISS).

The reimbursement guide and the page expat health insurance give benchmarks for comparing contracts.