Expat insurance and health insurance in Brazil

The SUS (Sistema Único de Saúde), created by law No. 8,080 of 1990, is a universal state-funded public system, free at the point of use, built around three principles: universality, comprehensiveness and equity. Access is in principle not reserved for Brazilian nationals: a foreign resident in a regular situation can use SUS primary care units (UBS) and emergency departments like a national, with no nationality condition. Emergency care is also provided to anyone present on the territory, whatever their immigration status.

In practice, the SUS suffers from significant waiting times for specialist consultations, tests and non-urgent surgery, as well as sharp disparities between regions and between large metropolitan areas and rural areas. This is why a large share of the Brazilian middle class, and almost all expatriates, take out a plano de saúde (local private health insurance, often tied to employment or taken out individually) or international insurance, to access the private hospital network (Rede D’Or, independent hospitals such as Albert Einstein or Sírio-Libanês) with much shorter waiting times.

• Tourist stay (less than 90 days): no health insurance legally required to enter the country; France Diplomatie nonetheless describes cover of at least €30,000 (medical costs and repatriation) as essential in practice, as actual costs can far exceed this amount.
• VITEM VI — Working holiday programme (PVT) : mandatory insurance explicitly required in the consular file, covering medical and hospitalisation costs, medical repatriation, accidental permanent disability and maternity, for a continuous period of 12 months covering the whole stay. An incomplete file on this point results in a visa refusal.
• Other temporary resident visas (VITEM) — work (VITEM V), study (VITEM IV), family reunification, retirement, digital nomad: proof of health insurance valid in Brazil is generally among the documents requested by Brazilian consular posts, but the exact list varies by post and purpose of stay. Direct verification with the relevant Brazilian consulate general remains essential before any application.
• Stay of more than 90 days: registration with the Polícia Federal (Registro Nacional Migratório / carteira de identidade de estrangeiro) is mandatory for any resident, regardless of the insurance question.

No official quantified fine has been identified for lacking cover outside the PVT framework; the documented risk is an incomplete visa file, or, in the case of uncovered private care, full billing to the patient.

A social security agreement between France and Brazil was signed on 15 December 2011, supplemented by an implementing agreement of 22 April 2013, in force since 1 September 2014 (decree No. 2014-1013 of 8 September 2014). CLEISS handles liaison on the French side, the INSS on the Brazilian side.

• Scope covered: old age, disability and survivors’ benefits (totalisation of insurance periods), workplace accidents and occupational diseases, family benefits, and sickness-maternity-paternity — but for this last area, only the totalisation of insurance periods for establishing entitlement to cash benefits (daily allowances), not the cover of care.
• The agreement provides no arrangement for reimbursing care received in Brazil on the basis of a French pension or affiliation: it is not a healthcare cost coordination agreement, unlike a European social security agreement.
• French non-contributory solidarity benefits (ASPA, ASI, AAH) are not exportable under this agreement.

As the bilateral agreement provides no cover for care, CLEISS recommends, for anyone settled in Brazil, voluntary affiliation with the Caisse des Français de l’étranger (CFE) or taking out private insurance, in the absence of any provider list supplied by the body.

• Before departure: check the exact list of documents required (often including health insurance) with the relevant Brazilian consulate based on the type of VITEM requested.
• For a PVT (VITEM VI): take out insurance covering the whole length of the stay (hospitalisation, repatriation, maternity, disability) before submitting the visa application.
• Within 90 days of arrival for a long stay: registration with the Polícia Federal (Registro Nacional Migratório).
• Obtaining a CPF (Brazilian tax number), generally required to open standard administrative entitlements, including easier access to the SUS via the Cartão Nacional de Saúde.
• Register with the roll of French nationals living abroad at the relevant consulate (São Paulo, Rio de Janeiro or another post): free, valid for 5 years, recommended as soon as you settle.
• As the bilateral agreement provides no cover for care: voluntary affiliation with the CFE or taking out private insurance as soon as you settle.