Healthcare Reimbursement in Bosnia and Herzegovina: Who Pays for What Depending on Your Situation

Coordination between France and Bosnia and Herzegovina rests on the general Franco-Yugoslav agreement of 5 January 1950, its administrative arrangement of 23 January 1967 and the exchange of letters of 3 and 4 December 2003, in force on the same day (CLEISS). It applies to employed workers of French or Bosnian nationality and covers sickness-maternity, invalidity, old age and survivors, industrial accidents and occupational diseases, family benefits and death, but not unemployment insurance. As a general rule, the employee comes under the legislation of the place where they work, with exceptions notably for seconded employees. Bosnia and Herzegovina is not on the list of agreements applicable to non-employed workers.

The carte Vitale and the EHIC open no rights there. CLEISS specifies that an insured French person generally has no way of having their care paid for on the spot outside particular cases, and that their fund may reimburse unforeseen care after the event on paid invoices, with no obligation. The notions of reimbursement base and out-of-pocket cost help to compare cover. How care is organised is presented in the page on the healthcare system of Bosnia and Herzegovina.

An employee on a local contract is affiliated to the health insurance fund of the entity or canton of their place of employment; no affiliation period is required to open rights. Before leaving, they inform the CPAM (the local health insurance office), the CAF (the family allowances fund) and France Travail (the employment agency) and ask their fund for form SE 21-02, which certifies their French insurance periods for the Bosnian authorities. Family members who remained in France without cover of their own can be covered through their Bosnian employment by registering with their CPAM with form SE 21-08 issued by the Bosnian fund, and form SE 21-23 is used to apply for the agreement’s family benefits. The glossary entry on the local contract completes this point.

A seconded employee of a French employer remains affiliated to the French scheme with no local contribution, for up to three years for an initial secondment, with form SE 21-01. They can either send their paid invoices to their French fund with form S 3125c, or send their application to the Bosnian body with a copy of the SE 21-01. As care is sometimes more expensive than in France, CLEISS advises checking with your top-up health insurer whether the contract needs adjusting. Sick leave is reported to the fund within 48 hours, with a copy to the employer; the fund pays the daily allowances directly. An accompanying family uses the same routes with the secondment certificate. See seconded or expatriate and the glossary entry on the seconded employee.

A self-employed person contributes locally for the same risks as employees, excluding unemployment, and receives the same benefits (CLEISS); the agreement does not apply to non-employed workers. They can also choose the CFE (Caisse des Français de l’Étranger, the French expatriate social security fund) or international insurance; see digital nomad insurance.

A French student does not have the EHIC, and the agreement opens no cover on the spot for an ordinary student. Student insurance abroad or, before age 30, the CFE youth offer meets this need for cover. CLEISS lists full-time students under 26 who are not dependants among local insured people; the conditions of access for a foreign student should be checked with the entity’s fund.

The spouse and children are dependants of the insured person: spouse or partner and children in full-time education in the Federation and the Republika Srpska, to which are added ascendants and other dependent relatives without resources; in Brčko, only the spouse and children in education are cited. The CFE and international insurers offer family contracts; see expat family insurance.

A French retiree with no right of their own under Bosnian legislation can obtain cover from the Bosnian fund of their place of residence. They first approach this fund, which checks that no local right exists and then forwards form SE 21-34 to the French institution that pays the basic pension. The latter replies with the SE 21-35 (approval) or the SE 21-36 (refusal). With the SE 21-35, the Bosnian fund reimburses the care of the retiree and of their dependants living with them; no certificate is issued before departure, the procedure being started on the spot. There is no S1 form, which is reserved for the European Union.

During temporary stays in France, the holder of the SE 21-35 is covered; beyond one month of hospitalisation, prior authorisation from the CPAM is required after a medical check. The spouse is not covered during these stays in France, hence the value of insurance. The CNAREFE (CPAM of Seine-et-Marne; the health insurance centre for retirees living abroad) handles the files of general-scheme retirees. If tax residence is no longer in France, the pension bears neither CSG, nor CRDS, nor CASA (French social charges and a solidarity contribution on pensions); a health contribution of about 3.2% on the basic pension, 4.2% on the supplementary pension and 7.1% for former self-employed people may remain. See the guide to health insurance for retirees abroad and the page on retirement in Bosnia and Herzegovina.

The CFE reimburses the healthcare costs of the member and their dependants according to the country of care, on the basis of a rate or flat amount applied to actual expenses; in France, it follows the rules of Assurance Maladie (the French national health insurance) with direct payment in public and private hospitals. Cover is immediate if joining before departure or within three months of settling abroad; after that, the waiting period is three months before age 45 and six months beyond. Maternity requires conception after joining. The contributions published by the CFE depend on age and the plan chosen, for the youth offer (under 30), the main offer and the retiree offer, to be confirmed for Bosnia and Herzegovina depending on age and family situation. See the guide to CFE reimbursements.

International health insurance on a first-euro basis reimburses actual costs within the contract ceilings, after any deductible, waiting periods and exclusions. It gives access to private facilities with direct payment and covers the repatriation that France Diplomatie (the French foreign ministry’s travel advice) judges essential. Contracts are compared on the annual ceiling, the zone, evacuation and the handling of pre-existing medical conditions.

A tourist stays for a short time. CLEISS indicates that no cover on the spot is provided for an insured French person, apart from the case of a Bosnian national without French nationality on paid leave holding form SE 21-04 A. The French fund may reimburse unforeseen care after the event, with no obligation, and daily allowances are paid only after the return to France and a sick leave certificate issued by a doctor practising in France. See long-stay travel insurance.

On return, taking up a job in France reopens protection from the first hour worked, with no minimum number of hours or contributions, and with no waiting period for care in countries linked to France by an agreement (CLEISS). Without immediate employment, the application for universal health coverage is made to the CPAM of the place of residence, with a waiting period of about three months for stable and regular residence; a CFE member keeps their rights free of charge during the first three months after the return, under conditions. The CPAM may consider lifting the waiting period depending on the situation, for example in the case of a French retirement pension. See the page on returning to France and the guide to reducing the waiting period.

• Consultation: general practitioner chosen for a minimum of one year, contribution of 10 to 20% of the price (10 to 25% in the Republika Srpska); specialist on the general practitioner’s recommendation, except paediatrician and gynaecologist. Seconded: paid invoices reimbursed under French rules.
• Hospitalisation: contribution of about 15% of medical costs and 20% of hotel costs for the local insured person, with exemptions for certain categories; CFE with direct payment in France; international contract with direct payment.
• Medicines: official list reimbursed at 50, 70, 90 or 100% depending on the category. A seconded employee presents them on paid invoices.
• Dental: CLEISS indicates cover at 100% for local insured people and full coverage of corrective prostheses for children under 15; the real extent of treatments should be confirmed with the fund.
• Optical: no official information on glasses and lenses was found in the sources consulted; the cover is read in the table of a CFE or international contract.
• Maternity: pregnancy and delivery costs covered at 100% by local insurance; daily allowances require six months of contributions in the Federation, three in Brčko and no condition in the Republika Srpska. The CFE requires conception after joining.

The reimbursement guide and the page on expat health insurance give points of reference; Expavy helps to match these options against your situation.