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

CLEISS publishes the list of States and territories bound to France by a social security agreement. Botswana is not on it: there is no coordination between the French scheme and the local arrangement, no aggregation of periods and no cross-coverage. Care received on the spot is billed to the patient, who advances the costs.

Four actors can then step in depending on status: the employer’s local arrangement, the French scheme maintained for a seconded employee, the CFE and international health insurance. The choice is made before departure. The notions of reimbursement basis and out-of-pocket cost help with comparison; the guide CFE or private insurance presents the selection criteria.

France Diplomatie (the French foreign ministry’s travel advice service) describes a contract covering medical costs, surgery, hospitalisation and medical repatriation as essential: without this protection, access to care may be refused, even in a life-threatening emergency, and the embassy covers no costs. How facilities operate is described in the healthcare system in Botswana.

The locally employed worker depends on the cover offered by their Botswanan employer. Its nature (medical provident fund, group insurance or none) appears in the contract and should be read carefully: care network, ceilings, exclusions, hospitalisation, evacuation. A local arrangement is not intended to cover a medical return to Europe; supplementary international cover or CFE membership fills that gap. The glossary defines the local contract.

The seconded employee of a French employer remains attached to French social security. Assurance Maladie (the French national health insurance) specifies that, for a country without an agreement, the seconded employee is affiliated to both the French scheme and that of the host country, that secondment is in principle limited to 24 months and that care abroad is reimbursed on the basis of French rates, within the limit of the expenses actually incurred, on paid invoices (form S3125 or a request from the ameli account). Employers often add an international group contract. See seconded or expatriate and the glossary entry on seconded employees.

The self-employed worker or digital nomad has no employer to insure them: three routes exist, the CFE, international insurance or a combination of the two, depending on age, medical history and budget. See digital nomad insurance.

The retiree can join the CFE (offer reserved for retirees, with no health questionnaire according to the CFE, price on quotation) or choose international insurance. Form S1 does not apply outside the European Union: Assurance Maladie reserves it for moves within Europe. For temporary stays in France, registration with the Cnarefe is possible on condition of at least 15 years of contributions to a French compulsory scheme (10 years for those affiliated before 1 July 2019).

The student under 30 can join the CFE youth offer (price on quotation), or take out student insurance; the requirements of the host institution and of the residence document should be confirmed before departure. See student insurance abroad. The spouse and children join the holder’s contract as dependants at the CFE or on a family contract; see expatriate family insurance.

The CFE offers a youth offer (under 30), a main offer (over 30), an offer for retirees and a France-stay offer (price on quotation, for those who already hold local cover and insure themselves only for stays in France of fewer than three consecutive months). Contributions vary according to the country of residence, age and family situation; the CFE simulator gives the exact rate.

Joining before departure or within three months of settling in opens immediate rights. Beyond that, a three-month waiting period applies before age 44 and six months from age 45, according to the CFE pages. No health questionnaire is requested and a member cannot be excluded. For maternity, conception must take place after the date of membership.

Abroad, reimbursement applies as a rate or flat amount on the actual expense, specific to each country. As an example given by the CFE, social security reimburses 70% of the tariff of a GP consultation in France; the main offer reimburses a higher share of the same consultation in France, and the scale of the country of care applies abroad. See CFE reimbursements.

International first-euro insurance reimburses actual costs within the limits of the contract (ceilings, deductibles, waiting periods, exclusions) and can offer direct payment to the hospital, which avoids advancing the sums. It generally requires a medical questionnaire; the guide medical questionnaire and history explains the pitfalls. The page expat health insurance presents the types of contract.

The tourist has the entry stamp of three months at most. They take out, before departure, travel insurance with assistance, which reimburses medical costs within its ceilings and organises repatriation: it matters to check the length of cover, the inclusion of medical transport to Johannesburg and the exclusions for risky sports. The French embassy advances no costs. For a longer stay, see long-stay travel insurance.

Returning to France reopens access to French social security when the conditions of stable and regular residence are met, with a waiting period that can be lifted depending on the situation. The exact conditions should be confirmed with the local health insurance office (CPAM) of the place of residence before the return.

According to the CFE, the offer for retirees carries no waiting period on return to France. The page return-to-France insurance and the guide reducing the waiting period detail the interim solutions.

• Consultation: paid by the patient on the spot then reimbursed according to the contract (French rates for the seconded employee, country scale for the CFE, actual costs for a first-euro contract).
• Hospitalisation: a financial guarantee is often requested before care in some facilities; direct payment by the insurer or assistance provider avoids the advance. Serious cases are most often evacuated to Johannesburg.
• Medicines: to be bought from a reliable pharmacy with a prescription in international non-proprietary names; reimbursement according to the contract.
• Dental: cover according to the CFE scales and the annual ceilings of an international contract; dental care under the local arrangement should be confirmed with the employer or the insurer.
• Optical: mainly covered by international contracts, with ceilings per period.
• Maternity: at the CFE, conception must come after membership; international contracts generally apply a waiting period; local follow-up depends on the employer.

The reimbursement guide gives general benchmarks; Expavy helps you compare these options against your situation.