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

Kosovo is among the states linked to France by a social security agreement in force (CLEISS list of texts). It takes the form of an exchange of letters between governments, signed in Paris on 4 February 2013 and in Pristina on 6 February 2013, which continues the application of the treaties concluded with Serbia and Montenegro: the general Franco-Yugoslav agreement of 5 January 1950, its 1967 administrative arrangement and the 2003 succession agreement. It concerns employees of French or Kosovar nationality and covers all risks except unemployment.

For sickness and maternity, the text provides for aggregation of periods, benefits during temporary stays and cover for family members. In practice, coverage on the spot is limited to specific cases described by CLEISS and summarised below. The glossary explains the notions of reimbursement base and out-of-pocket share. How the care system works is presented in the page healthcare system in Kosovo.

The employee on a local contract comes under Kosovar legislation, which also covers family members residing in Kosovo. In the absence of a compulsory health insurance in force, they use the free public care provided for by law (emergencies, prenatal follow-up, basic care for children under 18) and private insurance for the rest. Before departure, they request form SE 21-02 (insurance periods) from their French fund, and their relatives who remained in France with no entitlement of their own can be covered through their employment, with form SE 21-08 issued by the Kosovar fund (CLEISS). See the glossary entry on the local contract.

The seconded employee of a company established in France keeps their French scheme, under conditions and with no additional contribution. They send their paid invoices to their fund with form S 3125c, or send the Kosovar body a reimbursement request with a copy of the SE 21-01 certificate. Family members who accompany them have the same routes. As costs in Kosovo may exceed those in France, CLEISS advises checking with the supplementary health insurer whether the contract needs to be adapted. See the guide seconded or expatriate and expat family insurance.

The self-employed person or digital nomad has no employer affiliating them to a health scheme: in the absence of a compulsory fund, private insurance, voluntary CFE membership or an international contract is necessary, notably because health insurance is among the conditions of the temporary residence permit. See digital nomad insurance.

The student has no European card, Kosovo not being a member of the European Union, and no student-specific coverage was identified in the sources consulted. Student insurance or a comprehensive travel contract should be taken out, with the proof of vaccination and insurance required for the residence permit. See student insurance abroad.

CLEISS explains that the 1950 agreement, still applied to Kosovo, can give health cover to the holder of a French pension who has no entitlement under the Kosovar scheme. No certificate is issued before departure. Once on the spot, the retiree contacts the Kosovar fund of their place of residence: it checks that they have no Kosovar entitlement, then sends form SE 21-34 to the French body that pays the basic pension. The latter replies with the SE 21-35 (right recognised) or the SE 21-36 (rejection). If the right is recognised, the Kosovar fund covers the costs, as well as those of family members living with the retiree.

During a temporary stay in France, the SE 21-35 opens care in France, for the pensioner and their minor children only; an accompanying spouse must arrange insurance. A hospital stay of more than one month requires the prior agreement of the CPAM (the French health insurance fund). For general-scheme pensioners living outside the European Union, the European Economic Area and Switzerland, the CNAREFE manages registration and reimbursements, and a CFE member sends their requests to the Seine-et-Marne CPAM. If Kosovar cover is not granted, CLEISS says to take out insurance with a private company. See the page retiring in Kosovo and the guide health insurance for retirees abroad.

The CFE is a voluntary social protection body for French expatriates: its reimbursements, country scales and waiting periods should be checked on cfe.fr and in the guide CFE reimbursements. International health insurance with first-euro cover reimburses actual costs within its ceilings, after the deductible, waiting periods and exclusions, with direct payment and repatriation; Expavy helps you compare these options against your situation.

The French tourist does not fall under the agreement’s exception: outside the European Union, the French fund may reimburse unforeseen care on paid invoices, but this is a possibility and not an obligation, hence the value of travel insurance. Daily sick-leave allowances are not paid while the insured person is in Kosovo; they may begin after their return to France and a sick note issued by a doctor established in France. The temporary-stay exception (SE 21-04 A) targets only Kosovar nationals, excluding French-Kosovar dual nationals, on paid leave. See long-stay travel insurance.

The CFE maintains rights for at most 3 months after the return, subject to prior notification. An employee who takes up a contract in France is covered from the start; without a contract, three months of stable residence are required, with form 1106 for the CPAM, minor children being attached to a rights holder (CFE). Kosovar insurance periods may be taken into account for opening rights thanks to the aggregation provided for by the agreement. See the guide reducing the waiting period and the page return to France.

• Consultation: free public care for the services provided for (emergencies, prenatal, children under 18); French scheme for the seconded employee; actual costs within the ceilings of a first-euro contract.
• Hospitalisation: public facilities financed by taxes; direct payment to be checked for a private contract; French scheme retained on invoices for the seconded employee.
• Medicines: paid by the patient pending the compulsory scheme; the future scheme provides for reimbursement under conditions (prescription, generic, official invoice, private pharmacy); not all medicines are available locally.
• Dental and optical: no rate was found for these items; the future scheme provides for listed dental care, and international contracts set ceilings to be read in the benefits table.
• Maternity: free prenatal follow-up in public facilities; nine-month maternity leave paid by the employer then by the State; conception after joining is a frequent condition of international contracts.

The reimbursement guide and the page expat health insurance give benchmarks for comparing contracts.