Healthcare Reimbursement in Costa Rica: Who Reimburses What Depending on Your Situation

CLEISS publishes a country page for each country bound to France by a social security agreement; its list of 94 countries or territories does not include Costa Rica. In practice, the carte Vitale does not work there, and insurance periods are not totalised between the two countries. CLEISS points out that, in a country with no agreement, an expatriate employee loses insured status under the French scheme, joins the local scheme and may, if they wish, take out cover with the CFE or private insurance.

Five players may be involved: the CCSS (local scheme), the French scheme kept in place (secondment), the CFE, an international health insurance and, for a short stay, travel insurance. The notions of reimbursement base and out-of-pocket cost help you compare. How the public and private networks work is presented in the guide to the Costa Rican healthcare system.

The locally employed worker is registered with the CCSS from hiring: the founding law of the fund makes the seguro social compulsory for all workers who receive a wage, and the risks of sickness and maternity are among the risks covered. Contributions are calculated on all remuneration; rates are published by the CCSS, whose website could not be consulted for this page. See the glossary entry on the local contract.

The seconded employee sent by a company established in France remains affiliated to the French scheme for three years, renewable once, in a country with no agreement. CLEISS indicates that they then have dual affiliation: the French scheme, and the local scheme if it is compulsory, the employer paying the corresponding contributions. Healthcare reimbursements remain limited to the French level; for the family, only the benefits of children living in France apply. An employee already seconded for the maximum period can be seconded again to the same country only after a two-year interval. As local healthcare costs may exceed French rates, supplementary cover should be discussed with the employer. See secondment versus expatriation and the glossary entry on the seconded employee.

The self-employed person can insure themselves with the CCSS, with exemption from the employer share, and a resident whose immigration status requires it joins the fund’s insurance schemes. They can supplement this with the CFE main plan (from €87 a month from age 30, with no health questionnaire) or with international insurance, which reimburses actual costs within its ceilings but requires a medical questionnaire.

The digital nomad (Law No. 10008) provides, when filing the application, a medical services policy covering the whole length of their stay, and the DGME (the immigration directorate) sets the minimum cover required; this private policy is the reference cover for this status. See digital nomad insurance.

The spouse and children follow the status of the policyholder. For the rentista, the same residence application covers the spouse and children under 25; for the digital nomad, the family group includes the spouse or pareja de hecho (unmarried partner), children under 25 and elderly adults living with them, each of whom must be covered by a medical policy. The dependants of a seconded employee follow French rules, with the limit mentioned above for children. A CFE or international family contract covers paediatrics and maternity depending on the contract. See expat family insurance and the guide to children’s health cover abroad.

Assurance Maladie reserves cover for retirees living outside Europe to twelve states or territories that have signed an agreement: Andorra, Quebec, Saint-Pierre-et-Miquelon, Serbia, Bosnia and Herzegovina, Montenegro, New Caledonia, French Polynesia, Kosovo, Macedonia, Morocco and Tunisia. Costa Rica is not one of them, and form S1 applies only in Europe. A pensionado remains subject to the requirement of CCSS affiliation to renew their residence; they can also join the CFE retirees’ plan (from €147 a month), reserved for holders of a French basic scheme pension, with no professional activity and no health questionnaire, or take out international insurance.

Temporary stays in France: the retiree registers with the National Centre for Retirees of France Abroad (Cnarefe). Since 1 July 2019, living outside an agreement country gives access to reimbursement in France only if the person has contributed at least 15 years to one or more French schemes; those affiliated before 2019 with at least 10 years of contributions keep their rights. See retirees’ health insurance abroad and the page on retiring in Costa Rica.

The student falls under the rule that Assurance Maladie describes outside Europe: before age 20 or for studies of under six months, urgent medical costs are reimbursed by the parents’ fund (institution preparing for an official qualification, enrolment certificate and return to France at least once per academic year required); beyond that, they register with the host country’s scheme and can supplement with the CFE (youth plan, from €57 a month before age 30). See student insurance abroad.

• CFE member: abroad, the CFE reimburses according to the country of care, by a rate or flat amount applied to actual expenses; in France, according to social security principles, with direct payment (tiers payant) in public and private hospitals. Cover is immediate if enrolment takes place before departure or within three months of settling in; beyond that, the waiting period is three months before age 45 and six months from age 45. Maternity requires a conception date after enrolment. See CFE reimbursements.
• First-euro insurance: reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions, with direct payment possible in network facilities. Contracts are compared on the annual ceiling, the coverage zone and evacuation.
• Tourist: France Diplomatie (the French foreign ministry) considers an assistance or insurance contract that covers all medical costs, surgery, hospitalisation and repatriation essential, as private facilities ask for a payment guarantee on admission. Outside Europe, Assurance Maladie reimburses, at most, only urgent and unforeseen care, at French rates, on paid invoices with form S 3125. See long-stay travel insurance.

The CFE indicates, for its members, no waiting period on return: they automatically rejoin the general social security scheme, provided they meet the conditions of work or stable and regular residence in France. A French national who has not joined the CFE regains their rights under the usual French rules, which may include a waiting period; the arrangements should be confirmed with the local primary insurance fund (caisse primaire) of the place of residence. See the guide to reducing the waiting period and the page on returning to France.

• Consultation: covered by the CCSS for insured people, under the fund’s rules; in the private sector, paid in advance then reimbursed by the CFE on its country scale, by an international contract at actual cost within its ceilings, or by the fund of affiliation on the French rate for a seconded employee.
• Hospital stay: a payment guarantee is requested on admission in the private sector; direct payment is possible with an international contract within its network, whereas the CFE reimburses after payment according to the country scale.
• Medicines: the official sources consulted do not detail the lists of medicines covered by the CCSS; the CFE covers medicines, and an international contract reimburses them within its ceiling.
• Dental: dental care is part of the CFE main plan cover; an international contract reimburses it according to its annual ceiling and waiting periods, to be read in the table of benefits.
• Optical: the official sources consulted do not detail this item; it falls mainly under international contracts, with ceilings per period.
• Maternity: maternity is one of the risks covered by the CCSS compulsory seguro social; the CFE requires conception after enrolment; international contracts generally apply a waiting period to be confirmed before pregnancy.

The reimbursement guide and the page on expat health insurance give benchmarks; Expavy helps you weigh these options against your situation.