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

Iraq does not appear in the list of social security agreements concluded by France (CLEISS). No coordination therefore exists between the Assurance Maladie (the French national health insurance fund) and the Iraqi scheme: no European card, no posting certificate provided for by an agreement, no totalisation of periods. France Diplomatie reminds that the embassy does not pay medical costs and that, without a contract covering all costs and repatriation, access to care can be refused, including in a life-threatening emergency.

Four players can be involved depending on status: the Iraqi scheme (workers’ social security and employer insurance), the retained French scheme (secondment), the CFE and an international health insurance. The notions of reimbursement basis and out-of-pocket cost help with comparison. How the local system works is in the guide Iraq’s healthcare system. Before taking out a contract, check with each body (CFE, insurer, assistance provider) that Iraq, the city of residence and the security zone are covered, and under what conditions.

The local-contract employee comes under Iraqi social security: the law adopted on 17 May 2023 extends coverage to all workers, provides for maternity, unemployment and health insurance with public, cooperative and private providers (ILO). According to the US Social Security Administration, the combined contribution outside the oil sector is 25% of covered salary, of which 5% for the employee, 12% for the employer and 8 points borne by the employer for a non-Iraqi employee. The nature of reimbursements and a foreigner’s access should be confirmed with the employer, who often supplements with private insurance including evacuation. See the glossary entry on the local contract.

The seconded employee sent by a French employer remains, in principle, attached to French Social Security during their assignment; in the absence of an agreement, this retention falls under French law on secondment outside an agreement. Duration, conditions and contributions should be checked with the Urssaf (the French social security contributions collection body) and CLEISS before departure. Costs are then reimbursed under French rules, on paid invoices, whatever price is asked on the spot; employers generally add a group assistance contract. See posted worker or expatriate and the glossary entry on the posted worker.

The self-employed person or consultant has no employer to enrol them. The 2023 law provides for coverage of the self-employed; in practice, international insurance with evacuation or the CFE forms the foundation of protection, depending on the country’s acceptance conditions. See digital nomad insurance.

The student chooses between the CFE (youth offer before age 30) and international student insurance; access to free public care does not replace an assistance contract. See student insurance abroad.

The spouse and children follow the status of the holder; the CFE and international insurers offer family contracts, with maternity and paediatrics depending on the contract. See expat family insurance.

The retiree is not covered by form S1, valid in the European Union. The CFE offers its retirees’ offer to holders of a pension from a French basic scheme, with no health questionnaire. See the guide health insurance for retirees abroad and the page retiring in Iraq.

The CFE is a voluntary social protection body. In France, it reimburses according to Social Security principles; abroad, reimbursement depends on the scale of the country of care, applied as a rate or a flat amount to actual expenses. When the price asked exceeds the basis used, the difference remains payable by the member: the guide CFE reimbursements details this mechanism.

• Offers: the main offer (over 30, excluding retirees), the youth offer (under 30) and the retirees’ offer; the contribution is calculated on the simulator at cfe.fr according to age, family situation and country.
• Waiting period: immediate cover if membership takes place before departure or within three months of settling in; beyond that, three months’ waiting, then six months from age 45.
• Maternity: conception must take place after membership or attachment.
• Conditions specific to Iraq: the residence zones advised against by France Diplomatie should be reported to the CFE before membership to confirm cover.

On returning to France, without resuming work, a three-month period with stable residence applies before rights open; a CFE member without professional activity benefits free of charge from retention of rights for the first three months. See the guide reducing the waiting period and the page return to France.

International health insurance at the first euro reimburses actual costs within its limits, after any deductible, waiting periods and exclusions of the contract. It gives access to reference hospitals with direct settlement, and evacuation to Dubai or France, mentioned by France Diplomatie, is a benefit to be checked line by line. A contract is compared on the annual limit, the coverage zone, evacuation and the handling of medical history.

The visitor stays on a 30-day visa. France Diplomatie advises an assistance contract covering all costs and repatriation before the trip; bank card assistance can supplement it, with limits to be read. See long-stay travel insurance and repatriation and assistance.

• Consultation: free in the public sector; paid in the private sector, borne by the patient unless covered by a contract; CFE on its country scale; actual costs for a first-euro contract.
• Hospitalisation: free in the public sector; in the private sector, direct settlement under an international contract; French scheme for the seconded employee; medical evacuation depending on the contract.
• Medicines: free in the public sector when available, according to the WHO; counterfeiting is widespread, hence the value of buying chronic treatments in France.
• Dental: according to the CFE scale and the annual limits of international contracts.
• Optical: mainly falls under international contracts, with limits per period.
• Maternity: the CFE requires conception after membership; international contracts generally apply a waiting period; the 2023 law provides for maternity benefits for enrolled workers.

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