Healthcare Reimbursement in Bolivia: Who Reimburses What, Depending on Your Situation

CLEISS publishes sheets for the countries bound to France by a social security agreement: Bolivia does not appear among them. The two countries therefore do not coordinate their schemes: no card giving access to care in both countries, no totalisation of insurance periods, no cross-coverage. ameli.fr (the Assurance Maladie website) reminds readers that a worker expatriated outside the European Union necessarily comes under the scheme of the country of work, which reimburses their medical costs, and that a specific contract, with repatriation insurance, can be useful.

Four players can come into play: the Bolivian scheme (CNS for employees, public SUS), the French scheme kept in place (secondment outside an agreement), the CFE and international health insurance. The notions of reimbursement base and out-of-pocket cost help you compare; the local organisation is described on the page on the healthcare system in Bolivia.

Employee on a local contract. The employer affiliates them to the CNS and pays 10% of the payroll; the employee consults in the fund’s units. Dependants are subject to conditions: for a spouse or partner, supporting documents are requested, and for parents, absolute and permanent dependence verified by a social inquiry. The CNS is present in only 75 of the 339 municipalities, according to a Ministry of Health statement: the place of work matters. See the notion of a local contract.

Seconded employee. In a country without an agreement, the seconded employee remains affiliated to the French scheme for three years, renewable once. They are covered up to the benefits they would have received for the same care in France: they send their fund the paid invoices with form S 3125c, their dependants who accompany them follow the same procedure and those who stayed in France turn to the affiliation fund. A sick-leave certificate must be declared within 48 hours. See seconded worker.

Self-employed. They take out the CFE, which covers sickness-maternity for a self-employed person, or international insurance; access to the SUS depends on their status and the eligible groups.

Retiree. The S1 form, reserved for residents of the European Union, the EEA, Switzerland and the United Kingdom, does not apply. The retiree chooses between the CFE and international insurance; the SUS takes in foreigners over 60 under law 1152. During a temporary stay in France, they are reimbursed for their care if they draw a pension from a basic scheme based on at least 15 years of insurance and have no activity; the spouse who accompanies them is not covered (CLEISS).

Student. In the absence of an agreement, CLEISS indicates that, for a stay of under six months, the French fund may reimburse unforeseen care on a flat-rate basis, on an optional basis and after the costs have been advanced. Beyond six months, a student over 20 is no longer covered by French health insurance and takes out cover locally, with the CFE or a private insurer. See student insurance abroad.

Spouse and children. They are CNS dependants or, for children under 5 and pregnant foreign women, potential SUS beneficiaries; they remain under the French scheme if they accompany a seconded worker. See expat family insurance.

Tourist (90 days). No visa is required, but France Diplomatie considers imperative a contract covering care, hospitalisation and repatriation, since the embassy cannot in any case cover these costs.

The CFE offers its main offer (aged 30 and over), its youth offer (under 30) and a retiree offer, each with a contribution that depends on age and the plan chosen, with no health questionnaire. Cover is immediate if you join before departure or within three months of settling; otherwise the waiting period is three months before age 44 and six months beyond age 45. Abroad, reimbursement depends on the country of care and the procedure, with a rate or a flat amount applied to the actual expense; maternity requires conception after joining. See CFE contributions.

First-euro insurance reimburses actual costs within the contract’s ceilings, with direct payment to the establishment possible, which avoids the advance required on admission; excesses, waiting periods and exclusions determine the out-of-pocket cost. See first euro.

Return to France. A CFE member with no activity in France keeps their rights for up to three months after returning and affiliates to the CPAM (the local health insurance office) of their place of residence with form S1106; an employee taking up a contract in France has rights from the start. Without a social security agreement with Bolivia, the lifting of the waiting period does not rely on an agreement and is confirmed with the CPAM. See return-to-France insurance.

• Consultation: free at the first level of the SUS for beneficiaries; in the CNS units for a member; payable by the patient in the private sector unless covered by a contract; according to the CFE’s country scale.
• Hospitalisation: CNS or SUS network for beneficiaries; French scheme for the seconded worker within the limit of French benefits; in the private sector, advance payment is the rule, hence the value of direct payment.
• Medicines: according to the list and availability of the local scheme; reimbursed according to the CFE’s scales or the ceilings of an international contract.
• Dental: the extent of CNS and SUS cover is checked with the bodies; the CFE and international contracts apply their own ceilings.
• Optical: mainly a matter for international contracts, with ceilings per period to be read in the benefits table.
• Maternity: the SUS covers pregnant women up to six months after the birth, under eligibility conditions; the CNS covers the maternity of its female members; the CFE requires conception after joining.

The reimbursement guide and the page on expat health insurance give benchmarks; Expavy helps you weigh these options against your situation.