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

The CLEISS lists the countries linked to France by a social security agreement; Colombia is not among them. There is therefore no European card, no totalisation of insurance periods and no cross-coverage between schemes. Resolution 5477 of 2022 provides for applying social security agreements where they exist, which is not the case with France.

Four players may step in depending on status: the Colombian scheme (EPS), the French scheme kept in place (secondment), the CFE and international health insurance. Cover is chosen before departure, according to the visa, the employer and the budget. The notions of reimbursement base and out-of-pocket cost help you compare offers. Conversions use the CLEISS rate (COP 1,750,905, or about €471). How the networks work is presented in the guide to the Colombian healthcare system.

The local-contract employee is enrolled with an EPS as a dependent contributor by the employer. They access the health benefits plan: consultations, hospitalisation, medicines on the lists, dental care and maternity, with the cost-sharing described below. A member of the contributory scheme receives 100% of their last salary for 18 weeks as maternity leave (CLEISS). See the glossary entry on the local contract.

The seconded employee of a French employer can stay in the French scheme under secondment outside an agreement: 3 years, renewable once, on the employer’s application to the Urssaf (the French social contributions collector). This does not exempt them from the contributions due in Colombia, and care is reimbursed within the limit of what social security would have paid for the same care in France, on paid invoices with form S 3125c. Dependants who accompany the employee do not receive French family benefits. Employers often add an international group contract to cover the gap with private clinic prices. See seconded or expat and the glossary entry on the seconded worker.

The self-employed person has no employer to enrol them: they register themselves with an EPS in the contributory scheme and contribute on their income (rates in the guide to working in Colombia). Their M visa for self-employment requires health cover in Colombia or a policy valid across the territory. The digital nomad holding the V visa must hold a policy covering accident, illness, maternity, disability, hospitalisation, death and repatriation; see digital nomad insurance.

The student on a V student visa also presents a health policy, for the duration of their stay, and under 30 the CFE offers its youth plan. See student insurance abroad.

The retiree on an M pensioner visa cannot enrol in the Colombian system, except under a bilateral or multilateral agreement (resolution 5477 of 2022), and shows health cover or a policy valid in Colombia. The S1 form belongs to European coordination and does not apply. The Assurance Maladie (the French national health insurance) specifies that, outside the EU, EEA, Switzerland and the United Kingdom, the healthcare costs of a retiree living abroad are no longer covered by the French scheme: they choose the CFE, private insurance or the local system where they have access.

During temporary stays in France, they are reimbursed only if they have at least 15 years of contributions (registration with the Cnarefe, the fund for retirees living abroad); between 10 and 14 years, only a registration before 1 July 2019 opens this right, and under 10 years they turn to the CFE or private insurance. Dependants are in principle excluded. See the guide to retiree health insurance abroad and the page on retiring in Colombia.

The spouse and children can be registered with a contributor’s EPS with their identity documents and proof of the family relationship; a newborn is reported to the EPS at birth. The CFE and international insurers offer family contracts. See expat family insurance.

The CFE is a voluntary social protection body. In France, it reimburses according to social security principles, with direct billing (tiers payant) in public and private hospitals; abroad, reimbursement relies on rates or flat amounts specific to the country of care, applied to actual expenses. When the local price exceeds the base used, the gap remains at the member’s expense: the guide to CFE reimbursements details this mechanism.

• Plans: a main plan for those aged 30 and over, a youth plan under 30, and a retirees’ plan for holders of a pension from the French basic scheme, with no medical questionnaire. Prices depend on age, country and household composition (CFE simulator).
• Waiting period: immediate cover if enrolment takes place before departure or within three months of moving; beyond that, three months’ wait under 45 and six months from 45.
• Maternity: the date of conception must be after enrolment.

On return to France, without resuming work, a waiting period of three months is in principle applied before universal health coverage; the period of CFE membership may open a three-month retention of rights (CLEISS), and the retirees’ plan provides for reinstatement without delay. See the guide to reducing the waiting period and the page on returning to France.

International health insurance from the first euro reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions in the contract. It meets the visas’ policy requirement and, with direct billing, the private clinics that ask for payment up front. Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of prior medical history.

The tourist stays 90 days, extendable by 90 days. France Diplomatie (the French foreign ministry) recommends insurance covering surgery, hospitalisation and evacuation, because the embassy cannot cover these costs. Outside the EU, only urgent and unforeseen care can be reimbursed on return, on the basis of French rates and on paid invoices, after the opinion of the medical adviser (Assurance Maladie). See long-stay travel insurance.

• Consultation: with an EPS, through the general practitioner of the IPS (care provider institution), with a 2026 cuota moderadora of about COP 5,000 (€1.3) below 2 minimum wages, COP 20,100 (€5.4) between 2 and 5 and COP 52,800 (€14.2) above. In the private sector outside the network, the consultation is at the patient’s expense unless covered by a contract; the CFE applies its country scale; a first-euro contract reimburses actual costs.
• Hospitalisation: the health benefits plan finances it within the EPS network, with a copago of 11.5 to 23% of the value of the service and a ceiling per event of COP 373,715 to 2,995,409 depending on income. In a private clinic, payment or a guarantee up front is requested; an international contract with direct billing avoids the advance.
• Medicines: financed when they are on the benefits plan lists (essential generics, CLEISS) and prescribed; reimbursed according to CFE scales or within the ceilings of an international contract.
• Dental: in 2022 the Ministry of Health extended the benefits plan to periodontal, endodontic and orthodontic treatment and to dental prostheses, when their purpose is not mainly aesthetic; the list in force should be checked with the EPS. The CFE and international contracts apply their own ceilings.
• Optical: the funding rules for lenses appear in the benefits plan lists; international contracts set ceilings per period, to be read in the table of benefits.
• Maternity: covered by the contributory scheme with 18 weeks of paid leave; the CFE requires conception after enrolment; international contracts generally apply a waiting period.

The reimbursement guide and the expat health insurance page give benchmarks for comparing.