Healthcare Reimbursement in Ireland: Who Pays What, from Employee to Retiree, with the CEAM, S1 or CFE

In Ireland, access to public health services rests on ordinary residence and income, not on paying PRSI (Citizens Information). European coordination settles international situations: an employee comes under the legislation of the country where they work, a retiree with a French pension only stays attached to France, and everyone is treated in the public system of the country where they are with the right document:

• CEAM: necessary care during a temporary stay (definition).
• A1: certificate of secondment, which keeps the French scheme (definition).
• S1: registration with the health insurance of the country of residence at another state’s expense, for example for a retiree (definition).
• S2: prior authorisation for planned care in another state (CLEISS).

HSE amounts and conditions are on the page on the Irish healthcare system.

Local employee. On a local contract, the employee comes under the Irish scheme: the employer deducts PRSI, and the HSE recognises ordinary residence after a year of stay or as soon as you intend to stay at least a year. The GP and medicines remain payable without a medical card, with the Drugs Payment Scheme capping medicines at €80 a month; a sufficient number of PRSI contributions opens the Treatment Benefit Scheme for the annual dental examination and part of optical costs (CLEISS). The departure is reported to the French health insurance fund.

Posted worker. The posted worker keeps French social security for 24 months at most, with the A1 form obtained before leaving (CLEISS). They present their CEAM for care; for a long assignment with residence in Ireland, a posted worker can obtain a medical card with their country’s attachment form, and their dependants can benefit if they do not work in Ireland (Citizens Information). The guide to posted worker or expat compares the statuses.

Self-employed. The 24-month secondment also applies to self-employed workers (CLEISS). A self-employed person settled long-term comes under the Irish scheme (class S PRSI) and the HSE like any ordinarily resident person, as the page on working in Ireland explains.

A retiree who receives only a French pension, lives in Ireland permanently or for more than six months a year and does not work there requests the portable S1 document from their pension fund: the CNAV (the national old-age insurance fund; its “Right to healthcare” department, in Tours) for the general scheme, the specialised public finance directorate for abroad for civil and military pensions. They submit it to the HSE, and each dependant receives their own S1. Care is provided under Irish legislation, on behalf of French social security (CLEISS).

• Medical card: an ordinarily resident person who receives a social security pension from another EU state obtains a medical card without a means assessment, provided they receive no Irish contributory benefit and do not work in Ireland with an obligation to pay PRSI (Citizens Information).
• Stays in France: the retiree remains affiliated to French health insurance and is treated in France with all care covered (CLEISS).
• Health contribution: with tax residence outside France, the CSG and CRDS social levies are not due, but 3.2% is withheld on the basic pension and 4.2% on the supplementary pension of the general scheme, 7.1% for the self-employed (CLEISS).
• Irish pension or activity on the spot: a retiree who also receives an Irish pension comes under Ireland for their care; the S1 is cancelled, no further contribution is withheld on the French pension and the carte Vitale (French health insurance card) is returned (CLEISS).

The page on retiring in Ireland and the guide to using the S1 form complement these points.

Student. A French national studying in Ireland requests their CEAM at least 15 days before leaving; valid for 2 years at most, without exceeding the length of their rights, it opens cover under the legislation of the country of stay (ameli). A job on the spot affiliates the student to the Irish scheme. A study stay of at least a year generally leads to ordinary residence (Citizens Information). The private medical insurance required for a study stay targets students from countries outside the European Economic Area (Irish immigration service), which leaves French students under the CEAM arrangement. See the page on student health insurance abroad.

Spouse and children. Cover follows that of the main person. A retiree obtains an S1 for each dependant; the HSE checks family member status, and an unrecognised dependant affiliates directly to the local scheme (CLEISS). Children under 8 are entitled to a GP visit card, and public maternity care is free for ordinarily resident people (Citizens Information). See the page on expat family health insurance.

CFE member. The Caisse des Français de l’Étranger offers voluntary membership, at any age and with no health questionnaire. If you join before departure or within three months of settling in, cover starts immediately; beyond that, a waiting period of three months applies before 45 and six months after. The CFE reimburses care abroad according to the country, as a rate or a flat amount of the actual cost (CFE). For a resident in Ireland, it adds to HSE entitlements. See the definition of the CFE, the guide to CFE reimbursements and the page on CFE top-up cover.

First-euro insurance and local private insurance. A first-euro contract covers from the first expense, notably private care. A local contract regulated by the Health Insurance Authority offers the same access to the private sector; taking it out within nine months of settling in avoids the lifetime loading for an adult aged 35 or over, detailed on the page on the Irish healthcare system. Expavy helps you compare this cover from the page on expat health insurance.

Temporary stay. With the CEAM, a French insured person receives the cover of a local insured person: a medical or dental consultation in the public system is fully covered if the professional belongs to the Primary Care Reimbursement Scheme, as is emergency care in a public hospital. A prescribed treatment costs €1.50 per medicine, up to €15 a month. If a GP refers you to a specialist, you should ask to be seen as a public patient. A provisional replacement certificate, valid for 3 months, replaces a forgotten card (CLEISS). The CEAM covers the public system only, excluding the private sector and repatriation.

Without a CEAM, form S3125 lets you claim a reimbursement on your return to France, at the Irish rate or under French legislation, up to actual expenses; private care is examined on the basis of French rates (CLEISS).

Returning to France. CFE members who return to France rejoin their Sécurité sociale scheme with no waiting period (CFE). Rights to French health insurance reopen depending on the situation, as the pages on health insurance when returning to France and PUMa detail.

• Consultation: the GP costs about €45 to €65 without a card; a hospital specialist is consulted on GP referral, free of charge as a public patient (Citizens Information).
• Hospital care: daily charges for public patients abolished since 17 April 2023; private patient in a public hospital: €800 to €1,000 a night in a single room depending on the hospital category (Citizens Information).
• Medicines: €1.50 per item with a medical card or a CEAM, €15 a month at most; without a card, €80 a month at most with the Drugs Payment Scheme (CLEISS).
• Dental and optical: medical card holders are entitled each year to certain basic dental treatments; the Treatment Benefit Scheme funds an annual dental examination and contributions towards optical costs for insured people who have paid enough PRSI (CLEISS).
• Maternity: the Maternity and Infant Care Scheme funds, at no cost to the patient, follow-up by the GP and the public maternity hospital: first examination ideally before the 12th week, then 5 examinations for a first pregnancy, an initial examination then 6 for a subsequent pregnancy, and 2 postnatal GP visits (Citizens Information).

The guide to checking the contracted network and the definition of out-of-pocket cost clarify the useful concepts.