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

Djibouti is 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 (the French foreign ministry’s travel advice) points out that the embassy can in no case pay medical costs and describes a contract covering all medical costs (surgery, hospitalisation) and medical repatriation as essential. The embassy page ‘Coverage of healthcare costs’ indicates that the French State will not pay these costs.

Four payers may be involved depending on status: the Djiboutian 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 Djiboutian healthcare system.

An employee on a local contract comes in principle under the Djiboutian 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 Djiboutian fund and the employer, as the official pages consulted do not detail them. 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 Djiboutian 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 Djibouti.

The spouse and children of a seconded employee have the same options as the employee; those of a local employee depend on the Djiboutian 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 covers evacuation to a better-equipped country or to France. It also provides the certificate that Law No. 201/AN/07 asks for as repatriation guarantees. 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, by e-visa or on arrival for one month. France Diplomatie asks travellers to check their insurance before departure: medical costs, hospitalisation and medical repatriation for the whole length of the stay. 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: direct payment and evacuation are the cover features to compare first; French scheme maintained for the seconded employee, within the limit of French benefits.
• 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.

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