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

CLEISS’s list of social security agreements does not mention Georgia, which belongs neither to the European Union nor to the European Economic Area. CLEISS specifies that, outside an agreement, no local cover is provided for a temporary stay. It recommends taking out travel insurance suited to the real cost of care in the country, and checking the cover of a bank card or a car insurance contract. French health insurance does not cover medical repatriation.

Four players may be involved: the retained French scheme (posting), the Georgian public scheme, whose access for a foreigner should be confirmed with the National Health Agency (see the guide Georgian healthcare system), the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help compare offers.

The employee on a local contract depends on the insurance provided by their employer and on Georgian law. The sources consulted describe no compulsory health insurance scheme for a foreign employee: the universal public coverage programme is aimed first at citizens, and the employer’s group contract or the CFE fill this gap. Negotiating health insurance into the contract is one of the points to settle before signing. See the glossary entry on the local contract.

The posted employee of a French company comes under the posting outside an agreement described by CLEISS: they remain affiliated to the French scheme, which reimburses care received abroad up to what the same service would give in France, on paid invoices with form S 3125c. The length is three years, renewable once. Their family who accompany them follow the same procedure; those who stay in France continue to come under the French fund. Daily allowances are paid by the fund, with a sick-leave notice sent within 48 hours. Suitable supplementary cover is suggested when care is costly. See posted worker or expatriate and the glossary entry on the posted worker.

The self-employed person or digital nomad has no employer to affiliate them. They choose between the CFE and international health insurance, which covers hospitalisation, outpatient care and repatriation; the insurance required on entry, of 30,000 lari minimum, is a floor, not complete cover. See digital nomad insurance.

The student who applies for a study permit must show a bank balance of at least twice the subsistence minimum per month (Public Service Development Agency). Before age 30, the CFE offers its youth offer; student insurance or a long-stay travel contract completes the arrangement. See student insurance abroad.

The retiree does not come under form S1, reserved for the European Union and the European Economic Area, and France has no agreement with Georgia: cover goes through the CFE, with its retirees’ offer (with a contribution that depends on age and the plan chosen), or through international insurance. The waiting period can be nil if membership takes place within three months of departure. See the guide retirees’ health insurance abroad and the page retiring in Georgia.

The spouse and children follow the holder under the same cover (posting, CFE or family insurance) or hold their own permit, for which family reunification and study stay set minimum resources. The family contracts of the CFE and of international insurers provide maternity and paediatrics depending on the contract. See expat family insurance.

The CFE reimburses abroad on a rate or flat amount specific to the country of care, applied to actual expenses: the example given by the fund is a French general practitioner consultation set at €25 and reimbursed at 70%, or €21. In France, it follows the principles of Assurance Maladie with direct payment, for stays of under three months. The contributions depend on age and the plan chosen, for the main offer (over 30), the youth offer and the retirees’ offer. No waiting period applies if membership takes place before departure or within three months of settling; after that, the waiting period is three months before age 45 and six months from age 45. Maternity requires conception after membership. See CFE reimbursements.

International health insurance on a first-euro basis reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. France Diplomatie recalls that insurance is essential: without it, access to care can be difficult, even in an emergency, and the embassy cannot pay the costs. The contract is compared on the ceiling, evacuation, the zone and the handling of medical history.

The tourist staying up to a year takes out insurance before departure, because Georgia requires it on entry. On returning to France, they can ask their fund to reimburse unforeseen care, which CLEISS describes as a possibility and not an obligation; daily allowances are only paid on return, on sick leave issued by a doctor practising in France. See long-stay travel insurance.

On returning to France, a 3-month waiting period applies to a French national with no professional activity before affiliation to the CPAM (local health insurance office) under the PUMa (universal health cover); a CFE member with no activity benefits free of charge from retention of rights for the 3 months following return (Assurance Maladie). See reducing the waiting period and return to France.

• Consultation: reimbursed at the French tariff on invoice for the posted worker; at the country scale for the CFE; at actual costs within the ceilings of a first-euro contract. Primary care under the public programme is free for its beneficiaries.
• Hospitalisation: the most costly; CFE direct payment in France; direct cover possible with an international contract. Direct payments are high, as hospitalisation weighs more heavily in household spending.
• Medicines: at the patient’s expense on an outpatient basis, except a limited list or insurance; CFE scales; contract ceilings.
• Dental: included at the CFE according to its scales and in most international contracts according to an annual ceiling.
• Optical: mainly under international contracts, with ceilings per period.
• Maternity: the CFE requires conception after membership; international contracts generally apply a waiting period to maternity.

The reimbursement guide and the page expat health insurance give pointers; Expavy helps compare these options with your situation.