Expat insurance and health insurance in North Macedonia

The Macedonian healthcare system relies on a single public fund, the Fond za zdravstveno osiguruvanje na Republika Severna Makedonija (FZO), created in 2000 and under the Ministry of Health, alongside the pension and disability insurance fund and the Employment Agency (unemployment insurance); all contributions are collected by the Public Revenue Office, together with income tax. Opening rights requires a qualifying contribution period: 6 months of prior insurance for sickness benefits, and 6 months of contributions before childbirth for maternity benefits. The patient contributes to costs at 10 to 20% depending on the type of care, excluding emergencies, this contribution becoming nil once it exceeds around 70% of the average net monthly salary over a year; dental care is only covered for prevention and periodic check-ups, with a 20% contribution remaining payable by the patient, and medicines on the reimbursable list leave 5 to 20% payable by the insured person depending on the product.

Health insurance funding relies on an employer contribution of 7.3% of gross salary (capped at 16 times the national average monthly gross salary, i.e. 64,697 Macedonian denars in 2025), plus 0.5% and 4% for workplace accidents and occupational diseases (benefits in kind and in cash), 18% for retirement, disability and survivors, and 1.2% for unemployment — i.e. 31% in total, with no direct employee share according to CLEISS, as of 1 January 2025. France Diplomatie flags healthcare conditions deemed inadequate in the country's hospitals and recommends, for serious illness requiring hospitalisation, returning to France for treatment; a private sector has developed in Skopje alongside the public network.

• Stay under 90 days: no visa required for a French citizen holding a passport valid for at least 6 months or a valid national ID card, though a passport remains recommended to avoid any dispute at the border; overstaying exposes travellers to turning back at the border and legal proceedings, with a fine of around €200 and temporary confiscation of the passport during the process.
• Mandatory registration: any foreign national staying with a private host must be registered with the nearest police station within 48 hours of arrival; hotels handle this automatically for their guests.
• Stay over 90 days: an application must be filed with the foreigners' office of the Macedonian Ministry of the Interior, for a professional or family reason; contact the French embassy in Skopje before departure for exact procedures.
• Local registration: mandatory for any employee or self-employed person working in North Macedonia, with the FZO.
• Without local registration or cover under the bilateral agreement: care is billed at full rate by the facility, public or private, at a rate that varies by facility and isn't published uniformly.
• Student: no EHIC, as North Macedonia isn't an EU member (only a candidate since 16 December 2005); a student insurance plan or comprehensive travel insurance remains necessary, as the France-Yugoslavia agreement opens no local cover for an ordinary French student.
• Seconded employee : stays on the French scheme on presentation of the secondment certificate (form SE 21-01); the maximum duration of this arrangement isn't stated publicly on the CLEISS pages consulted, to be checked directly with that body before departure.
• Retiree: cover by the FZO remains possible, on individual request (forms SE 21-34/35/36), if the retiree has no rights under Macedonian law; an accompanying spouse isn't covered by this process and must take out their own insurance before departure.

No individual fine is mentioned in the sources consulted for failure to register with the FZO, but the employer remains required to register their employee; for the expat themselves, the risk is above all financial, with no help from the French embassy for uncovered care.

As North Macedonia isn't an EU member (only a candidate since 16 December 2005, accession negotiations opened on 19 July 2022 but stalled to this day), coordination with France doesn't run through EU regulations 883/2004 and 987/2009. It relies on an old text: the general France-Yugoslavia social security agreement of 5 January 1950, supplemented by an administrative arrangement of 23 January 1967, made applicable to North Macedonia (as successor state) by an exchange of letters signed in Paris on 13 December 1995 and in Skopje on 14 December 1995, entering into force on 14 December 1995. It coordinates all social security branches except unemployment insurance.

• Temporary stay: for a French tourist without dual nationality, the agreement opens no local cover; only a retroactive reimbursement of unplanned care, optional and not guaranteed, remains conceivable on return to France. An exception exists for a Macedonian national living in France, returning home on paid leave: form SE 21-04 A (certificate of entitlement to benefits in kind), requested before departure, covers care during the stay and certain daily allowances, excluding planned care and repatriation.
• Secondment: secondment certificate (form SE 21-01), stays on the French scheme with no FZO contribution; medical costs incurred locally can be submitted for reimbursement via form S 3125c. The sources consulted don't state a maximum duration figure for this arrangement.
• Long-term move (expatriation): direct FZO registration; form SE 21-02 (certificate of French insurance periods), requested before departure, allows the Macedonian authorities to take into account periods already contributed in France when opening rights. If the family stays in France, they can continue to benefit from health insurance via form SE 21-08, to be submitted to the primary health insurance fund of their place of residence.
• Retiree: a holder of a French pension with no rights of their own in North Macedonia can request cover by the FZO of their place of residence, which first checks the absence of local rights before forwarding the file (form SE 21-34) to the French pension fund, which replies with form SE 21-35 (approval) or SE 21-36 (refusal). An accompanying spouse isn't covered by this process.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds).
2. For any stay, including temporary: take out travel insurance or an assistance contract covering the entirety of medical costs and medical repatriation, as the France-Yugoslavia agreement opens no local cover for an ordinary French tourist.
3. Seconded employee: request the secondment certificate (form SE 21-01) from your French fund before departure.
4. Long-term move: request form SE 21-02 (certificate of insurance periods) from your French fund before departure.
5. Family staying in France during an expatriation: request form SE 21-08 from the local Macedonian fund to maintain health cover in France.
6. Retiree: contact CLEISS or your pension fund before departure to start, if needed, the local cover request (form SE 21-34).
7. For a stay over 90 days: contact the French embassy in Skopje before departure for the procedures applicable at the foreigners' office.
8. On arrival: ensure registration with the local police within 48 hours if staying with a private host.
9. Employee hired locally: check with your employer on FZO registration.
10. Self-employed: register and contribute directly with the FZO.
11. Register with the roll of French nationals living abroad (French embassy in Skopje).