Healthcare Reimbursement in the Comoros: Who Pays for What Depending on Your Situation

The Comoros are not on the list of States linked to France by a social security agreement published by CLEISS. There is therefore no European card, no totalisation of insurance periods and no cross-coverage between the two schemes. France Diplomatie points out that the embassy can in no case pay medical costs and describes a contract covering medical costs, surgery, hospitalisation and medical repatriation as essential: without this cover, access to care may be refused, even in a life-threatening emergency.

Four payers may be involved depending on status: the Comorian scheme, the French scheme maintained (secondment), the CFE and international health insurance. The choice is made before departure. The notions of reimbursement base and out-of-pocket cost help to compare offers. How facilities work is presented in the guide to the Comorian healthcare system.

An employee on a local contract comes in principle under the Comorian social security scheme to which the employer contributes; the extent of sickness benefits and the procedures for a foreign employee should be confirmed with the Comorian fund and the employer, as the official pages consulted do not detail them. As households directly finance 56.6% of health expenditure according to the World Bank, private top-up cover providing for medical evacuation is generally useful. See the glossary entry on the local contract.

A seconded employee of a French employer comes under secondment outside an agreement. According to CLEISS, they remain affiliated to the French scheme for three years, renewable only once, with a two-year gap before a new secondment in the same country for the same company. Sickness-maternity is reimbursed within the limit of the benefits that would be paid in France, whatever price is charged locally, and family benefits are paid only for children living in France. See seconded or expatriate and the glossary entry on the seconded employee.

A self-employed person or digital nomad has no employer to affiliate them to a local scheme. They choose between the CFE, the voluntary social protection body for French nationals abroad, and international insurance covering hospitalisation, outpatient care and medical repatriation, the most complete solution for a stay of several years; see digital nomad insurance.

A student is not covered by a French public scheme locally for lack of an agreement. 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. The requirements of the host institution should be checked before enrolment. See student insurance abroad.

A retiree comes under neither the S1 form (valid in the European Union) nor an automatic Comorian scheme. CLEISS indicates that they should find out what the local scheme covers, join the CFE or take out private insurance. 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. For a temporary stay in France, coverage requires a pension from a French basic scheme and at least fifteen years of insurance, with CNAREFE (the French health insurance centre for retirees living abroad) handling the files of general-scheme retirees outside the European Union. See the guide to health insurance for retirees abroad and the page on retirement in the Comoros.

The spouse and children of a seconded employee have the same options as the employee; those of a local employee depend on the Comorian scheme and the employer’s group contract. The CFE and international insurers offer family contracts, with maternity and paediatrics depending on the 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 facilities with direct payment and, above all, to evacuation to La Réunion, Mayotte or mainland France, the destinations cited by France Diplomatie for hospitalisations. Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of pre-existing medical conditions.

A tourist enters with a visa issued on arrival and a return ticket. France Diplomatie asks travellers to check before the trip that the insurance really covers the stay, with medical costs and medical repatriation. See long-stay travel insurance.

• Consultation: paid by the patient unless covered by a contract or local affiliation; reimbursed by the CFE on its country scale; at actual cost with a first-euro contract; within the limit of French benefits for a seconded employee.
• Hospitalisation: France Diplomatie describes frequent evacuation to La Réunion; direct payment and evacuation are therefore the cover features to compare first.
• Medicines: reimbursed according to CFE scales or within the ceilings of an international contract; street purchase to be avoided because of counterfeits.
• Dental: included at the CFE according to its scales and in most international contracts according to an annual ceiling; to be checked in the table of benefits.
• Optical: glasses and lenses fall mainly under international contracts, with ceilings per period.
• Maternity: the CFE requires conception after joining; international contracts generally apply a waiting period; follow-up and delivery are prepared with the insurer, given the situation described on the islands of Anjouan and Mohéli.

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