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

In Mayotte, CLEISS specifies that the CSSM replaces the primary health insurance fund: it covers sickness-maternity and reimburses at the same rates as on the mainland. The order of 22 July 2026 provides that the social security code applies in Mayotte from 1 January 2028; until then, the scheme remains that of the texts specific to Mayotte, in gradual convergence. The law of 11 August 2025 affiliates to the Mayotte scheme anyone who carries on a professional activity or lives in Mayotte on a stable and lawful basis.

Reimbursement rests on three tiers: the CSSM reimburses on the basis of its rates; the ticket modérateur falls to supplementary health insurance; the complémentaire santé solidaire, free or payable depending on income, covers modest incomes. The out-of-pocket cost therefore depends as much on the supplementary insurance as on the compulsory scheme. How the healthcare offering is organised is described in the guide health system in Mayotte.

The employee is affiliated to the CSSM on the basis of their activity. They benefit from reimbursement of care at CSSM rates, daily allowances in the event of sick leave (50% of base salary, capped at 1.4 times the Mayotte SMIC, after a 3-day waiting period, with contribution and hours-worked conditions) and maternity benefits (CLEISS). Work accidents are reimbursed at 100% of the liability tariff. Supplementary health insurance covers the ticket modérateur; the generalisation of compulsory collective supplementary cover for employees in Mayotte is postponed to 31 March 2036.

The civil servant comes under a managing body that may differ from the CSSM: the CSSM page on medical evacuation cites certificates of entitlement from the CSSM, the MGEN or the MSA. The sources consulted do not specify the competent managing body for an employee transferred from the mainland to Mayotte; it is to be confirmed with their managing department and the CSSM before arrival, as are the file transfer formalities.

Mayotte is part of the national territory: no social security agreement between two states applies, and the sources consulted describe no form for continuing mainland cover for a seconded employee in Mayotte. Affiliation comes under the rule of the law of 11 August 2025 (professional activity or stable and lawful residence in Mayotte). Before departure, the employer and the employee ask the home fund and the CSSM to confirm the competent body, the supporting documents to provide and the transfer date.

The self-employed person comes under the CSSM for health insurance; the Urssaf collects their contributions (see the guide working in Mayotte). The retiree is affiliated on the basis of stable and lawful residence in Mayotte; their pension continues to be paid by the schemes in which they contributed (see the guide retiring in Mayotte). The person with no activity is affiliated on a residence criterion: the decree of 30 June 2026 holds a main residence in Mayotte where the person actually lives there for more than six months in the calendar year, without having transferred their residence outside Mayotte.

The CSSM asks to be told of changes of situation (marriage, divorce, move, change of bank) and for the Vitale card to be updated at least once a year.

The student: the Assurance Maladie indicates that healthcare costs are reimbursed by the fund of the place of residence and that a student who is already covered generally stays on their home scheme, free of charge, until age 24. For a student coming from the mainland to study in Mayotte, the fund of the place of residence is the CSSM: how this fits with the home fund is to be confirmed with the CSSM before departure. The page student insurance abroad is for studies outside France.

The spouse who lives in Mayotte on a stable and lawful basis is affiliated in their own right. Children are dependants up to age 18 according to the CSSM; a 16-year-old can apply for individual affiliation, the Vitale card being issued from age 16, and from age 12 at the parents' request (CLEISS).

The visitor from the mainland on a short stay keeps their home fund. The CSSM describes the situation of its own insured persons on national territory: present the certificate of entitlement or the Vitale card, third-party payment possible, ticket modérateur to be sent to their mutual insurer. How it works for an insured person of another fund passing through is not described in the sources consulted: ask your fund before departure. Medical evacuations require a certificate of entitlement from the CSSM, the MGEN or the MSA: an assistance and repatriation policy is to be arranged for a visitor from another scheme.

Care outside national territory (Comoros, other countries): according to the CSSM, only urgent and unforeseen care can be covered, under certain conditions, with invoices and proof of payment. Returning to the mainland means informing the CSSM, then requesting the opening of rights with the fund of the new place of residence using form Cerfa S1106: the Assurance Maladie specifies that the opening is not always automatic (CLEISS).

The Caisse des Français de l'Étranger offers its plans (main, youth, retiree) to expatriates who live and work abroad; its home page specifies no rule for a resident of Mayotte, who comes under the general scheme applicable to Mayotte. Any eligibility is to be asked of the CFE.

The complémentaire santé solidaire is free under a ceiling of annual income that depends on household composition and payable up to a second ceiling, according to the tables applicable to Mayotte and revised each year (service-public.gouv.fr). Private first-euro insurance is not needed for basic reimbursement, but it can fund the out-of-pocket cost and assistance outside the territory.

• Consultation: 70% for a GP or a specialist; the remaining 30% is payable by the insured person or their supplementary insurance (CSSM, Assurance Maladie). The flat-rate contribution and deductible amounts applicable in Mayotte are to be confirmed with the CSSM.
• Hospital stay: 80% of the general scheme reimbursement base; the CSSM requires no upfront payment at the Mayotte hospital centre. The order of 22 July 2026 provides for full coverage of care at Mayotte's public health establishment from 1 January 2028.
• Medicines: 65% for major or important medical benefit, 30% for moderate benefit, 15% for low benefit, 100% for irreplaceable and very costly medicines (Assurance Maladie).
• Dental and optical: 60% for dental surgeons and for optical care according to the general scheme table (Assurance Maladie); the out-of-pocket cost then depends on supplementary health insurance.
• Maternity: covered at 100% from the 6th month of pregnancy until delivery for all benefits (CSSM); daily allowances capped at a daily amount revised each year, paid from the first day (CLEISS).
• Transport and medical evacuation: transport covered at 65% on the basis of social security tariffs with prior approval; medical evacuation borne by the CSSM (transport, accompaniment and any accommodation), after the opinion of a medical commission (CSSM, CLEISS).