Expat insurance and health insurance in Macao

Macao's health system falls under its own government, through the Health Bureau. Holders of the Macao resident identity card are entitled to free primary care in the public health centres (nine centres across the territory) and to complementary tests prescribed at the public hospital at no charge when referred there by a health centre. The other CHCSJ services are chargeable, with a 30% reduction for residents (Government of the Macao SAR). Non-residents pay for care according to the Health Bureau's tariff.

This tariff has three levels: holders of the resident card, holders of the non-resident worker identification card, and holders of another identity document. In the emergency department and for hospitalisation, the consultation or the price per day of room is MOP 42 for the first level, MOP 60 for the second and MOP 120 for the third; tests, medicines, treatments and surgery are billed in addition, at 70%, 100% and 200% of the reference rate (Health Bureau). Alongside, private facilities, including three private hospitals according to the SAR Government, complete the offering.

France Diplomatie does not describe the quality of hospital care in its China page, but reminds readers that it is essential to hold an assistance policy or insurance covering all medical costs and medical repatriation, including for Hong Kong and Macao, failing which access to care may be compromised, even in a life-threatening emergency. These costs can under no circumstances be covered by the French embassy.

• Short stay: no visa for a French citizen, for 90 days at most according to France Diplomatie; the passport must be valid for at least three months after the planned end of stay. The Macao authorities (Public Security Police Force) also ask for a return or onward ticket and means of subsistence, from MOP 5,000 for 7 days at most to MOP 20,000 beyond 21 days.
• Mainland China: to continue to mainland China, the rules of the China page apply; travellers who do not meet the exemption conditions must hold a visa before departure (France Diplomatie).
• Working: a non-resident foreigner can only work with an authorisation. An employee is recruited on an employment permit issued to their employer by the Labour Affairs Bureau (DSAL) and then receives a non-resident worker card; the self-employed activity of a non-resident requires a specific work permit.
• Health insurance: France Diplomatie declares it essential, including for Hong Kong and Macao. No individual fine for lacking insurance is mentioned in the sources consulted.
• Local contribution: the Social Security Fund (FSS) scheme covers resident employees (MOP 90 per month since 1 January 2017, of which MOP 60 paid by the employer and MOP 30 by the employee); it does not fund medical care but cash benefits (retirement, disability, unemployment, sickness, birth).
• Student: no EHIC, as Macao is outside the European Union; a student insurance or comprehensive travel insurance covering medical costs and repatriation is essential.
• Seconded employee : in the absence of an agreement, secondment falls under French law on secondment outside agreements; duration and conditions are to be confirmed with CLEISS and the Urssaf before departure. Affiliation with the Caisse des Français de l'Étranger (CFE) and an assistance policy remain recommended in addition.
• Retiree: no agreement allows health rights to be transferred; the routes are the CFE (retiree offer, reserved for holders of a French basic scheme pension), international insurance or care paid at the non-resident tariff.

The list of social security agreements kept by CLEISS contains no agreement between France and Macao. For China, it shows an agreement signed on 31 October 2016 and an administrative arrangement signed on 16 September 2019, whose entry into force should be checked with CLEISS; CLEISS specifies that an agreement only applies after mutual notification of the completion of internal procedures. CLEISS publishes no page specific to Macao: the page on China mentions Hong Kong but not Macao. No coordination therefore exists between French health insurance and Macao's system: no Carte Vitale abroad, no S1 form, no aggregation of periods.

• Temporary stay: no cover by a local scheme; care is billed at the non-resident tariff and remains at the traveller's or their insurer's expense. The conditions for any reimbursement on return should be checked with the French fund.
• Secondment: the seconded employee keeps the French scheme for all risks (service-public.fr); invoices and proof of payment are submitted to the CPAM on return.
• Local employee: they cease to depend on French Sécurité sociale and fall under the scheme of the country of work; in the absence of an agreement, their rights depend on local rules and voluntary insurance (service-public.fr).
• Tax: the "International conventions" page of impots.gouv.fr cites treaties for China (agreement of 26 November 2013, in force on 28 December 2014) and for Hong Kong (agreement of 21 October 2010, in force on 1 December 2011), but none for Macao. The Government of the Macao SAR, for its part, does not list France among its double taxation agreements (Portugal, Belgium, Mozambique, Cape Verde, Vietnam, Cambodia, as well as arrangements with mainland China and Hong Kong).

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds).
2. Take out an assistance policy or insurance covering all medical costs and medical repatriation, essential according to France Diplomatie, including for Macao.
3. Check the validity of your passport: at least three months after the planned end of stay in Macao according to France Diplomatie, and six months if your route passes through other Asian countries that require it.
4. Prepare the documents requested at entry: return or onward ticket and means of subsistence.
5. Seconded employee: find out from the Urssaf and CLEISS about secondment outside agreements.
6. Employee or self-employed: have the employment permit (employer, DSAL) or the self-employed work permit issued before starting work.
7. Retiree or spouse: compare the CFE, international insurance and the cost of care at the non-resident tariff before settling.
8. Return to France: allow for the three-month residence period before rights open, unless you resume employment.
9. Register with the roll of French nationals living abroad at the Consulate General of France in Hong Kong and Macao.