The Healthcare System in Andorra: Organisation, Access for Foreigners and Emergencies

The Andorran social security scheme is compulsory for people carrying out an employed or self-employed activity. It comprises two branches: the general branch (sickness, maternity, industrial accidents, disability, orphans’ pensions, death grant) and the old-age branch. CASS collects the contributions and pays the benefits, except family benefits, which fall under the Ministry of Social Affairs; each branch has its own budget and the sickness branch receives a contribution from the State (CLEISS).

Care is provided by professionals who are contracted or not contracted with CASS. The public hospital network is run by the SAAS: the Nostra Senyora de Meritxell hospital, in Escaldes-Engordany, is the country’s only hospital. The country devotes about 8% of its GDP to health and life expectancy at birth exceeds 84 years (World Bank). Households’ direct payments represent a little over 11% of current health spending: the rest of the spending is financed by contributions and by the State.

The worker and their family are covered: non-working spouse, children under 18 and children under 25 who are studying or registered with the employment service (CLEISS). Benefits in kind are open from the first claim if the member can show 25 days of contributions and a salary at least equal to the minimum wage. Subsequent claims require recent activity: 15 days in the previous month between 25 days and one year of affiliation, 10 days in the previous two months between one and three years, 5 days in the previous three months between three and five years, one day beyond five years. After the loss of a job, the right to care is maintained for 60, 90 or 120 days depending on seniority, provided the person resides in Andorra.

For a French national, several cases arise. The locally hired employee is affiliated from their first day of activity. The seconded employee keeps their French scheme. The resident without activity is not affiliated on the basis of work; renewal files for residence without gainful activity require proof of cover for sickness, incapacity and old age (Govern d’Andorra). A retiree of a French scheme with no Andorran entitlement may, under the agreement of 12 December 2000, be registered with CASS through form SE 130-09 completed by their pension fund (CLEISS): this case is detailed in the page retiring in Andorra.

CASS keeps a list of healthcare professionals who have signed an agreement, and the “preferential route” of reimbursement applies only to these providers. A non-contracted practitioner remains free to set their fees, but CASS then reimburses only 33% of the liability tariff, except in an emergency (CLEISS). The list can be consulted on the CASS website, and the published version of this document should be checked before each consultation.

The liability tariffs cover medical and dental procedures, transport and accommodation, as well as socio-health services for dependent people over 65; they were updated by several decrees in 2024. In practice, the patient chooses a contracted general practitioner, who refers them to a specialist or the hospital. How the different contracts and reimbursements work is presented in the page healthcare reimbursement in Andorra.

The Nostra Senyora de Meritxell hospital (Avinguda Fiter i Rossell, 13, AD700 Escaldes-Engordany; switchboard 871 000) is the Principality’s only hospital establishment. Its emergency department is open 24 hours a day, all year round, and the SAAS recommends calling 116 before going there, to avoid unnecessary trips. Reception follows a five-level triage, from level I (resuscitation, immediate life-threatening risk) to level V (non-urgent visit that could be made by appointment or at the family doctor’s); patients arriving by ambulance are triaged before administrative admission.

The SAAS also offers scheduled medical transport and transport outside Andorra (871 116). When specialised care cannot be provided locally, the patient may be transferred to an establishment outside the country: you should check that your insurance or assistance contract covers this transport. The French embassy in Andorra (38 Carrer les Canals, Andorra la Vella, by appointment) cannot pay medical costs (France Diplomatie).

France Diplomatie recommends taking only the necessary medicines, in their original packaging, with a prescription stating the international nonproprietary names (INN), and checking that these medicines are authorised in Andorra. Medicines sold by street vendors are to be avoided. A chronic treatment is prepared before settling: sufficient starting quantity, an INN prescription, and contact with a contracted doctor to ensure continuity of care.

For members of the French scheme on a temporary stay, form SE 130-04 (certificate of entitlement to benefits in kind) is requested before departure from the affiliation fund and presented to CASS; the dependants listed on the form are covered in the same way. An agreement between France and Andorra also covers hospital costs paid on the spot (France Diplomatie, CLEISS).

France Diplomatie asks travellers to check that the vaccinations of the French schedule are up to date, in particular against diphtheria, tetanus, polio, whooping cough and measles, and to consult their doctor or an international vaccination centre before departure. One-off health alerts may be published. The other advice concerns road safety, swimming, heat and sun, cold and altitude (suited to a mountain country), as well as pollution.

Natural risks (avalanches, landslides) and mountain activities (mountaineering, snowmobiling, hiking) engage the personal responsibility of the person practising them: France Diplomatie reports serious accidents linked to recklessness. An insurance or assistance contract covering medical costs, surgery, hospitalisation and medical repatriation is recommended for any stay, even a short one. See the pages repatriation and assistance and expat health insurance.

A CASS member can receive care outside Andorra directly in an emergency, or when studying abroad, provided the insured conditions are met. For a provider without a CASS agreement, a justified emergency in an area with no contracted provider gives the right to a reimbursement of 75%, or 90% in case of hospitalisation, of the applicable liability tariffs (CASS). Scheduled care abroad follows separate rules, to be checked with the fund before departure.

Non-occupational disability insurance requires a reduction in working capacity of at least 60% and a minimum contribution period depending on age. The pension ceiling is 2.5 times the minimum wage, and at 65 the disability pension converts into an old-age pension of the same amount, or a higher amount if the calculation is more favourable (CLEISS).

Pregnancy and childbirth costs are covered at 100%, with free check-ups in the third, fourth, sixth and eighth months. Maternity cash benefits last 20 weeks at 100% of the average salary (two additional weeks in case of multiple births or disability), and paternity leave is 28 consecutive days. In case of an industrial accident or occupational disease, care is covered at 100% of the liability tariff with no minimum affiliation period (CLEISS).

Daily sickness allowances amount to 53% of the average salary for the first thirty days, then 66%, after a three-day waiting period; they are paid for 12 months, extendable up to three years. The figures in CLEISS’s country sheet are revised regularly: they should be confirmed with CASS before each procedure.