Expat insurance and health insurance in Benin

Benin's health system has, since 1995, rested on a three-tier pyramidal organisation: a peripheral tier of 34 health zones (grouping municipal/district health centres and a public or private first-referral zone hospital), an intermediate tier of departmental hospital centres (CHD) — including the CHD Ouémé-Plateau in Porto-Novo — and a central tier of 5 national hospitals, foremost among them the CNHU-Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, the country's main reference facility (642 beds in 2018, emergency reception department, two resuscitation rooms), and the CHU de la Mère et de l’Enfant Lagune (CHU-MEL, formerly HOMEL), a reference in obstetrics-gynaecology and paediatrics. The private sector covers around 30% of care supply, concentrated in urban areas (Cotonou, Porto-Novo). According to the International Labour Organization (data cited by Wikipedia), 90% of the Beninese population had no access to health social protection in 2017. France Diplomatie recommends consulting the list of trusted practitioners published by the French embassy in Cotonou to identify a reliable practitioner or facility, and indicates that in the event of a serious health problem, it is strongly recommended to return to France for treatment — hence the importance of insurance explicitly covering medical evacuation.

• Visa mandatory before departure for any stay, with the option of applying online via Benin's e-visa system (since April 2018) or through consular representations.
• Yellow fever vaccination mandatory, international vaccination certificate required on entry, in addition to a passport valid for at least 6 months after the return date and a return ticket.
• No health insurance formally required for the visa or entry, but France Diplomatie strongly recommends checking your cover before departure and stresses the need for insurance covering all medical costs (including surgery and hospitalisation) and medical repatriation, failing which access to care is not guaranteed, including in a life-threatening emergency.
• CFE recommended in addition to private insurance, with an assisted category on consular file for lower-income households.

Heightened health vigilance: malaria, dengue, chikungunya and Zika (vector-borne diseases), seasonal cholera, Lassa fever in the east of the country, bacterial meningitis in the north during the dry season.

Security context, addressed here only from the angle of access to care: France Diplomatie formally advises against the northern border areas (Burkina Faso, Niger) and the W and Pendjari parks, where night-time travel is also advised against — restrictions that in practice limit the capacity for rapid medical evacuation in these regions.

The France-Benin social security agreement, signed 6 November 1979 (in force since 1 September 1981), coordinates the invalidity, old-age-survivors, occupational injury/disease and family benefit branches, as well as a specific maternity provision (article 7, for women transitioning from employment in France).

• According to CLEISS, the Franco-Beninese agreement contains no coordination provision for the sickness branch itself: no reimbursement of care received in Benin under French health insurance is provided for by this text.
• Protocol no. 1 annexed to the agreement provides only for the maintenance of certain sickness benefits for a limited period of 6 months when residency is transferred between the two countries.
• Unemployment insurance is explicitly excluded from the scope of the agreement.

• Before departure: yellow fever vaccination, passport valid for at least 6 months after return, return ticket, e-visa or consular visa, and an assistance contract covering hospitalisation, surgery and repatriation / medical evacuation.
• Before any travel to the north of the country: check France Diplomatie's travel advice, updated regularly given the border security context.
• On arrival: registration with the roll of French nationals living abroad recommended (Consulate General of Cotonou, the country's only French consular post).
• On site: if needed, consult the list of trusted practitioners published by the French embassy in Cotonou to identify a practitioner or facility.
• Voluntary affiliation with the CFE recommended, as the Franco-Beninese agreement does not coordinate the sickness branch.