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

CLEISS (the French Centre for European and International Social Security Liaison) keeps the list of France’s social security agreements. Macao does not appear on it. For China, the list mentions 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. No coordination therefore exists between the French Assurance Maladie (national health insurance) and Macao’s system: no European card (Macao is outside the European Union), no S1 form, no aggregation of periods. France Diplomatie (the French foreign ministry) makes the same point in another way: an assistance policy or insurance covering all medical costs is essential, including for Hong Kong and Macao, and these costs can under no circumstances be covered by the French embassy.

Four players may therefore step in depending on the profile: the Macao system (public tariffs by status level), the French scheme maintained (secondment), the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help to compare offers. How hospitals and health centres work is set out in the page Macao’s healthcare system.

An employee on a local contract is recruited on an employment permit and receives a non-resident worker card. According to service-public.fr, an expatriate employee ceases to depend on French Sécurité sociale and falls under the scheme of the country of work; in the absence of an agreement, their rights depend on local rules and voluntary insurance. In Macao, the Social Security Fund (FSS) scheme is for resident employees (MOP 90 a month) and pays cash benefits: pensions, unemployment, sickness, birth, marriage and death allowances. It does not reimburse medical care. Care is billed according to the patient’s status: the holder of the non-resident worker card falls under the second level (emergency consultation at the CHCSJ at MOP 60, other services at 100% of the reference rate). The conditions of any health cover offered by the employer are read in the contract; see the glossary entry on the local contract.

A seconded employee sent by a French employer keeps the French scheme for all risks (service-public.fr). With no agreement with Macao, this continuation falls under French law on secondment outside agreements: duration, conditions and contributions should be checked with the Urssaf and CLEISS before departure. According to service-public.fr, invoices and proof of payment must be kept and submitted to the CPAM with form cerfa no. 12267 on return. An employer may add an international group contract to cover the gap with local rates. See seconded or expatriate and the glossary entry on seconded employees.

A freelancer must hold a work permit for a non-resident’s gainful activity (DSAL, the Labour Affairs Bureau); having no employer to declare them, they choose between the CFE, which admits voluntary membership notably in the absence of an agreement (service-public.fr), international insurance or direct payment at the rate of their level. Their tariff level depends on their card: the holder of a resident card pays the lowest rate, any other foreigner the highest. Insurance covering hospitalisation, outpatient care and medical repatriation remains the most complete solution for a stay of several years; see digital nomad insurance.

A student does not benefit from the European health insurance card in Macao. They take out student insurance, comprehensive travel insurance or, before age 30, the CFE youth offer. The conditions of access of a foreign student to the local system are not detailed on the official pages consulted: the tariff level depends on their card (a resident card gives the first level, another identity document the third). See student insurance abroad.

A retiree is not covered by the S1 form, which is valid in the European Economic Area and Switzerland, and no agreement transfers their rights. According to service-public.fr, if France has no agreement with the country of settlement, the retiree falls under the local scheme and can take out insurance. In Macao, the FSS funds no care reimbursement; the CFE retiree offer is reserved for holders of a pension from the French basic scheme with no professional activity; it applies to the retired spouse and minor children, requires no health questionnaire and covers only care received abroad. See the guide health insurance for retirees abroad and the page retiring in Macao.

The spouse and children follow the status of the policyholder. The Macao Government provides a stay authorisation for family reunification, notably for relatives of skilled workers employed by a local employer; the conditions should be checked with the Public Security Police Force. Without a resident card, their public care falls under the third tariff level. The CFE and international insurers both offer family contracts, with maternity and paediatrics depending on the contract. See expat family insurance.

The CFE is a voluntary social protection body. Its reimbursements depend on the country where care is delivered and the type of procedure; when the local price exceeds the basis used, the gap remains the member’s responsibility. The guide CFE reimbursements details this mechanism.

• Offers: the main offer (30 and over), the youth offer (under 30) and the retiree offer, each with a contribution that depends on age and the plan chosen, at the date of consultation. The main offer covers GP consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines, including for stays of under three months in France.
• Waiting period: immediate cover if joining takes place before departure or within three months of settling abroad; otherwise three months for those under 44 and six months for those over 45 (the CFE does not specify the situation at exactly 44 and 45).
• Maternity: the date of conception must come after joining or after becoming attached as a dependant. Maternity daily allowances require at least ten consecutive months of membership of the daily allowances option at the presumed date of delivery.

On returning to France, service-public.fr states that if activity is not resumed, a residence period of three consecutive months must be observed before rights open, proven by any means; affiliation is acquired from the first hour worked for an employee who takes up a job again. A CFE member can, under conditions, receive the benefits of the CFE expatriate scheme for the three months following their return. For retirees, the rules depend on the social security agreement with the country concerned. See the guide reducing the waiting period and the page return to France.

International health insurance with first-euro cover reimburses actual costs up to its ceilings, after any deductible, waiting periods and exclusions in the contract. Faced with a three-level public tariff, it limits the out-of-pocket cost, above all for the third level (consultation at MOP 120, other services at 200% of the reference rate) and for private facilities, whose rates are not published by an official source. Contracts are compared on the annual ceiling, the coverage area, evacuation and the handling of pre-existing medical conditions.

The tourist stays 90 days at most without a visa. France Diplomatie recommends an assistance policy or insurance covering all medical costs and repatriation, including for Macao. They fall under the third tariff level in the emergency department. Bank card assistance can complement this arrangement, with ceilings to be checked. See long-stay travel insurance.

• Consultation: at a health centre, free for a resident, chargeable according to the tariff for a non-resident; in the CHCSJ emergency department, MOP 42, 60 or 120 depending on the level; reimbursed by the CFE according to the country of delivery; actual costs under a first-euro contract.
• Hospitalisation: room day at MOP 42, 60 or 120 depending on the level, excluding tests, medicines, treatments and surgery billed at 70%, 100% or 200% of the reference rate; French scheme for a seconded worker; CFE; international contract with direct payment.
• Medicines: billed within the services at 70%, 100% or 200% of the reference rate when dispensed at the hospital; reimbursed according to CFE rules and within the ceilings of an international contract. The rules for prescriptions and authorised products should be checked with the Pharmaceutical Supervision and Administration Bureau.
• Dental: the health centres offer oral health care, not available at every centre; the CFE includes dental care according to its scale; international contracts generally cover it within an annual ceiling.
• Optical: glasses and lenses are not described by the official sources consulted; they mostly fall under international contracts, with per-period ceilings to be read in the table of guarantees.
• Maternity: a separate tariff exists at the Health Bureau for non-resident female workers and non-resident pregnant women; the CFE requires conception after joining; international contracts generally apply a waiting period to maternity.

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