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

The CLEISS does not list Ghana among the countries that have concluded a bilateral social security agreement with France. No coordination therefore exists between the schemes: no aggregation of periods, no cross-coverage, no form to maintain rights between the two countries. France Diplomatie (the French foreign ministry) considers it imperative to take out an assistance contract or insurance covering all medical costs (including surgery and hospitalisation) and repatriation, because local services are payable in advance and the embassy never covers these costs.

Four players may be involved depending on status: the NHIS, run by the National Health Insurance Authority (NHIA), the French scheme kept in place for the seconded employee, the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help you compare offers. How the facilities work is presented in the page on the Ghanaian healthcare system.

The employee on a local contract falls under the Ghanaian system. Employees who contribute to the SSNIT are exempt from the NHIS premium on proof of active affiliation, and the NHIA points out that an employer ensures that their employees are registered with the NHIS. The employee pays only the card processing or renewal fees, then is treated in accredited facilities; the SSNIT contribution of 18.5% and the part that finances the NHIS appear in the page on working in Ghana. The contract states whether the employer adds private cover, whose ceilings can be read in the details of the guarantees. See the glossary entry on the local contract.

The seconded employee sent by a French employer remains affiliated to the French compulsory scheme for 3 years, renewable once, with contributions paid in France as if they were working there; local contributions may be added. Care is covered within the limit of the benefits they would have received in France for the same care, on paid invoices sent to their fund with form S 3125c “care received abroad”. Dependants who accompany them follow the same procedure, while those who stay in France continue to deal with the fund; sick leave is notified to the fund within 48 hours and a work accident to the employer within 24 hours (CLEISS). See seconded or expat and the glossary entry on the seconded employee.

The self-employed person who contributes to the SSNIT is exempt from the NHIS premium; without SSNIT contributions, they fall into the informal group and pay an annual premium. Ghana Card data is requested at registration, and the amount of the premium is obtained from the NHIA district office. They can also join the CFE or take out international insurance; see digital nomad insurance for remote workers.

The student under 30 can join the CFE youth plan (from €57 a month) or take out international student insurance; under-18s are exempt from the NHIS premium. See student insurance abroad.

The spouse and children follow the status of the holder: dependants of the seconded employee for the French scheme, separate NHIS members (children under 18 and pregnant women are exempt from the premium), beneficiaries of a family contract with the CFE or an insurer. The family that stays in France continues to deal with its fund of affiliation; children who accompany the seconded employee no longer give entitlement to French family benefits. See expat family insurance and the guide to children’s cover abroad.

The retiree is not covered by form S1, which is valid in the European Union. The CLEISS indicates three solutions in a country with no agreement: the local scheme, voluntary enrolment in the CFE and private insurance. During temporary stays in France, they are covered if they receive an old-age pension corresponding to at least 15 years of insurance in France and carry on no professional activity. Outside France, they pay neither the CSG, nor the CRDS, nor the Casa when their tax residence is no longer in France; a health insurance contribution is withheld from their pensions if they are dependent on a French scheme: 3.2% on the basic pension, 4.2% on the complementary pension and 7.1% for a self-employed worker’s retirement pension. Under the NHIS, people over 70 and SSNIT pensioners are exempt from the premium. See the guide to retirees’ health insurance abroad and the page on retiring in Ghana.

The CFE reimburses according to the country of care, by rates or flat amounts applied to actual expenses, with no health questionnaire; it covers GP consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines, including during stays of less than three months in France, with third-party payment in French public and private hospitals. Cover is immediate if enrolment takes place before departure or within three months of settling; beyond that, cover starts after three months before age 45 and six months from age 45. Plans start at €87 a month (main plan), €57 (youth plan) and €147 (retirees’ plan). The guide to CFE reimbursements details this mechanism.

International health insurance at first-euro level reimburses actual costs within its ceilings, after any excess, waiting periods and exclusions. The NHIA licenses private insurers and specifies that a resident belongs to the NHIS while being able to join a private scheme. With direct billing, the insurer pays the facility, which avoids advancing care payable in advance. Policies are compared on the annual ceiling, the coverage zone, evacuation and the handling of medical history; see the guide to the coverage zone.

The tourist takes out, before departure, insurance covering medical costs and repatriation, which France Diplomatie describes as imperative. Outside the European Union, Assurance Maladie (the French national health insurance) may cover urgent and unforeseen care on the insured person’s return: they send the paid invoices with form S3125 to their fund, which reimburses on the basis of, and within the limit of, the flat-rate French tariffs in force, and not on actual expenses; the medical adviser assesses the urgency and daily allowances are not paid for sick leave outside Europe. A Ghanaian policy on insurance for non-resident visitors is cited by the Ministry of Health; its application should be checked before departure (see the page on the Ghanaian healthcare system). See long-stay travel insurance.

On returning to France, resuming a professional activity opens affiliation from the first hour worked, with no waiting period. Without an activity, universal health protection opens on a stable-residence criterion, with in principle a 3-month waiting period; a CFE member can, under conditions, access the expatriate scheme for the 3 months following their return (CLEISS). See reducing the waiting period and the page on return to France.

• Consultation: the NHIS covers general and specialist consultations, tests, X-rays and ultrasounds in accredited facilities; French rules on paid invoices for the seconded employee; scales of the country of care for the CFE; actual costs within ceilings for a first-euro policy.
• Hospitalisation: the NHIS covers general-ward hospitalisation, surgery and emergencies, but excludes VIP rooms, dialysis for chronic renal failure, heart and brain surgery other than after an accident, transplants and cancers other than those of the cervix and breast; French scheme for the seconded employee, who advances the costs; covered by the CFE; direct billing possible with an international policy.
• Medicines: the NHIS reimburses the medicines on its national list, prescribed by an accredited practitioner, and excludes antiretrovirals and medicines not on the list; reimbursed according to the CFE scales or the ceilings of an international policy.
• Dental: the NHIS covers extraction, pain relief and simple fillings, but excludes dentures; included in the CFE according to its scales and in most international policies, with an annual ceiling.
• Optical: the NHIS covers refraction, visual fields and cataract surgery, but excludes optical aids; an item absent from the list of care cited by the CFE, and covered by some international policies with ceilings per period.
• Maternity: the NHIS covers prenatal follow-up, normal or assisted delivery, caesarean section and postnatal follow-up, with no premium or waiting period for pregnant women; the CFE requires conception after enrolment; international policies generally apply a waiting period.

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