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

CLEISS states it clearly: the social security agreement of 30 September 2008 between France and India, in force since 1 July 2011, coordinates only invalidity, old-age and survivors’ insurance. It allows insurance periods to be added together and pensions to be exported, but covers neither sickness nor maternity. There is therefore no European card, no cross-coverage and no S1-type form between the two countries: it is the occupational status that designates the paying body. France Diplomatie also reminds us that the French state never pays medical costs or medical repatriation, and calls an assistance contract or insurance covering surgery, hospitalisation and repatriation essential.

Four players may step in: the Indian scheme (ESIC, for employees below the ceiling), the French scheme kept in place (limited to old age for a seconded employee), the CFE and international health insurance. The notions of reimbursement base and out-of-pocket cost help compare offers, and the glossary entry on the bilateral agreement recalls what such an agreement covers. How the care networks work is described in the guide to the Indian healthcare system. The conversions on this page rely on the ECB reference rate of 02/10/2026: 108.1245 INR per €1.

The local-contract employee comes under Indian law. The ESIC covers employees of factories and shops with at least ten people whose pay stays below 21,000 INR a month: medical, surgical and obstetric care, medicines provided free with no spending cap in approved dispensaries and hospitals, and maternity benefits of 100% of average daily wage for up to 26 weeks (CLEISS). A foreign employee on an employment visa is well above this ceiling, so the employer most often offers group health insurance, which can be supplemented by an individual contract if needed. See the glossary entry on the local contract.

The seconded employee of a French employer stays in the French scheme for old age alone for 5 years, with form SE 223-01 IN/FR 101 issued by the Urssaf or the MSA (the French social security collection bodies); for the other risks, Indian law applies (CLEISS). Care received in India is therefore not reimbursed on the basis of the secondment: the employer generally adds an international group contract, and each employee’s exact situation is confirmed with the Urssaf and CLEISS. See seconded or expat and the glossary entry on the seconded worker.

The self-employed person has no Indian employer to enrol them in the ESIC. They can keep the French scheme for old age with the same form, and for sickness choose between the CFE and international insurance covering hospitalisation, outpatient care and medical repatriation. See digital nomad insurance.

The student checks with their Indian institution and the Indian consulate the insurance requirements linked to their visa. Under 30, the CFE offers its youth plan; international student insurance remains an alternative. See student insurance abroad.

The spouse and children follow the holder’s visa. They are covered by the employer’s group contract when it includes the family, by the CFE or by an international family contract, with maternity and paediatrics depending on the contract. At the CFE, a child must be conceived after enrolment or after joining as a dependant for maternity cover to apply. See expat family insurance.

A retiree who settles in a country outside the European Union no longer has their healthcare costs covered by the French Assurance Maladie in their country of residence: India, whose agreement does not cover sickness, falls into this case (Assurance Maladie, CLEISS). The S1 form, valid in the European Union, does not exist here. Three routes are available: the CFE, with a retirees’ plan from €147 a month, reserved for holders of a pension from the French basic scheme, with no health questionnaire; international insurance; or the Indian public scheme, whose Ayushman Bharat cover is reserved for Indian citizens.

During a temporary stay in France, a retiree of the general scheme who does not work is covered by the CNAREFE (the Assurance Maladie centre for French retirees living abroad), provided they have contributed at least 15 years to a French scheme; a hospital stay of more than one month requires prior medical approval, and a spouse living abroad does not benefit. See the guide to retiree health insurance abroad and the page on retiring in India.

In France, the CFE reimburses on the same terms as Sécurité sociale (French social security). Abroad, it reimburses according to rates or flat amounts specific to the country of care; when the Indian price exceeds the base used, the difference remains at the member’s expense. The guide to CFE reimbursements details this mechanism.

• Plans: the main plan from €87 a month, the youth plan from €57 a month and the retirees’ plan from €147 a month, with no health questionnaire; consultations, medicines, hospitalisation, maternity, dental care and vaccines are covered, including stays of less than three months in France.
• Waiting period: none if enrolment takes place before departure or within three months of moving abroad; beyond that, three months before age 45 and six months from age 45. See the glossary entry on the waiting period.

International health insurance at the first euro reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. It opens access to private clinics, with direct billing when the establishment accepts it, and includes evacuation and medical repatriation. The tourist travelling on an e-visa or a tourist visa takes out travel insurance with assistance before departure, which meets the recommendation of France Diplomatie; see long-stay travel insurance.

On return, compulsory affiliation to French health insurance is acquired from the first hour worked in France. For a person with no activity, a three-month waiting period applies in principle before rights open on a residence basis (CLEISS). Exceptions exist, for example when the person receives certain benefits or a French retirement pension, and contributions paid to the CFE can be taken into account; the local health insurance office examines each file. As the France-India agreement coordinates only pensions, it does not remove the waiting period for sickness. See the guide to reducing the waiting period and the page on returning to France.

• Consultation: covered by the ESIC in its dispensaries for employees below the ceiling; reimbursed by the CFE on its country scale; actual costs for a first-euro contract; at the patient’s expense without a contract.
• Hospitalisation: ESIC in its approved establishments; group or international contract with direct billing; CFE according to its scale. A request for prior approval from the insurer precedes a planned procedure.
• Medicines: provided free by the ESIC; reimbursed according to CFE scales; covered within the ceilings of an international contract. Antibiotics require a prescription.
• Dental: included at the CFE according to its scales and in most international contracts with an annual ceiling; the extent of ESIC dental care should be checked with the body.
• Optical: glasses and lenses fall mostly under international contracts, with ceilings per period to read in the table of benefits.
• Maternity: ESIC obstetric care and benefits for enrolled employees; at the CFE, conception must follow enrolment; international contracts generally apply a waiting period.

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