Healthcare Reimbursement in Cabo Verde: Who Pays for What Depending on Your Situation

According to CLEISS (the French liaison centre for social security abroad), the Franco-Cape Verdean agreement applies to nationals of both States who have worked or are working as employees, and to their dependants. The rule is the legislation of the country of work, with exceptions for seconded workers, public administration staff, diplomatic and consular personnel, cooperation workers and employees of transport companies. It covers all branches except unemployment insurance and is not among the agreements that extend their scope to self-employed workers. For other situations, it is the status that determines the payer.

Four parties may be involved: the Cape Verdean scheme (INPS), the French scheme maintained (secondment), the CFE and international health insurance. France Diplomatie (the French foreign ministry’s travel advice) points out that the embassy does not pay medical costs and that a contract covering medical costs, surgery, hospitalisation and medical repatriation is needed. The notions of reimbursement base and out-of-pocket cost help to compare offers; see also the glossary entry on the bilateral social security agreement. How facilities work is presented in the guide to the Cabo Verde healthcare system.

An employee on a local contract comes under the National Social Welfare Institute (INPS), to which the employer declares the employee. According to CLEISS, care is covered for insured people and their dependants, with a patient contribution of 15 to 50% for workers; contributions are 4% for sickness-maternity paid by the employee and 4% paid by the employer. Sickness daily allowances are 70% of the average salary of the last four months, from the fourth day, and maternity, paternity and adoption allowances 90%. Private top-up cover gives access to the private sector and to medical evacuation. See the glossary entry on the local contract.

A seconded employee of a French employer can be kept in the French scheme. CLEISS specifies that they keep French health insurance with no additional contribution and that care received in Cabo Verde is covered: they send their paid invoices and form S 3125c to their fund, or send an application to the Cape Verdean body with the secondment certificate (form SE 396-01 or SE 396-02). Dependants who accompany them have the same options; those who stay in France continue with the fund. Sick leave is sent to the fund within 48 hours, and the fund pays the daily allowances. As local care may cost more than in France, top-up health cover should be adapted. See seconded or expatriate and the glossary entry on the seconded employee.

A self-employed person has been covered since October 2006 by the Cape Verdean scheme, excluding unemployment and family benefits, with a rate of 8% for sickness-maternity included in a total of 19.91% or 24.92% (CLEISS). As the Franco-Cape Verdean agreement does not include them in its scope, the CFE or international insurance are the alternatives for complete cover with repatriation. A digital nomad, who has no local employer, is insured in the same way; see digital nomad insurance.

A student is not an employee: the agreement does not apply to their case. The CFE offers its youth offer before age 30 (with a contribution that depends on age and the plan chosen), and student insurance with repatriation exists. See student insurance abroad.

A retiree receives their French pension, which is exportable under the agreement (old age and survivors), but CLEISS indicates that the agreement contains no provision allowing reimbursement of care received in Cabo Verde under a French pension. The retiree joins the CFE or takes out private insurance, or asks the INPS about the conditions of local affiliation. The CFE offers its retiree offer (with a contribution that depends on age and the plan chosen), reserved for retirees of a French basic scheme, with no medical questionnaire. During a stay in France, coverage requires a pension from a French basic scheme with at least fifteen years of insurance; an accompanying spouse is not covered; CNAREFE (the French health insurance centre for retirees living abroad) handles general-scheme retirees outside the European Union. See health insurance for retirees abroad and the page on retirement in Cabo Verde.

The spouse and children of a seconded employee have the same options as the employee; those of a local employee are INPS dependants; those of a self-employed person or retiree are covered by a CFE or international insurance family contract. See expat family insurance.

Abroad, the CFE reimburses on rates or flat amounts specific to the country of care, applied to the actual expense. When the price charged exceeds the base used, the difference remains payable by the member: the guide to CFE reimbursements details this mechanism, and the map of zones and the table of benefits can be consulted on the CFE website.

• Offers: the main offer, the youth offer and the retiree offer, each with a contribution that depends on age and the plan chosen, and the short-stay offer for stays of less than three months in France; the final amount depends on the country, age and family situation.
• Waiting period: none if joining before departure or within three months of settling abroad; beyond that, three months before age 44 and six months from age 45. No medical questionnaire.
• Maternity: conception must come after joining or after being attached as a dependant.

On return to France, the CFE indicates that there is no waiting period: the person returns to social security, subject to residence rules to be confirmed with the local health insurance office (caisse primaire). See the guide to reducing the waiting period and the page on returning to France.

International health insurance on a first-euro basis reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions of the contract. It gives access to private facilities with direct payment and covers evacuation, a sensitive point as France Diplomatie describes weak local medical capacity and the absence of rescue resources at sea and in the mountains. Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of pre-existing medical conditions.

A tourist stays up to 30 days without a visa, or 30 to 90 days with a tourist visa. France Diplomatie asks for insurance covering medical costs, hospitalisation and medical repatriation for the whole length of the stay. See long-stay travel insurance.

• Consultation: covered by the INPS with a patient contribution of 15 to 50%; reimbursed by the CFE on its country scale; at actual cost with a first-euro contract; reimbursed to the seconded employee on invoices or via the Cape Verdean body.
• Hospitalisation: INPS for members; French scheme maintained for the seconded employee; direct payment with an international contract; evacuation to be planned for serious conditions.
• Medicines: access may be limited according to France Diplomatie; reimbursed according to CFE scales or within the ceilings of an international contract.
• Dental: included at the CFE according to its scales and in most international contracts according to an annual ceiling; the extent of INPS dental care should be checked with the institute.
• Optical: glasses and lenses fall mainly under international contracts, with ceilings per period.
• Maternity: covered by the INPS for affiliated employees, with allowances at 90%; the CFE requires conception after joining; international contracts generally apply a waiting period.

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