Expat insurance and health insurance in Monaco

Monaco has no single national scheme: cover depends on professional status. Private-sector employees fall under the Caisse de Compensation des Services Sociaux (CCSS), funded exclusively by employer contributions (no employee share on the sickness branch) and run by the Caisses Sociales de Monaco. It covers sickness, maternity, disability, death and family benefits, for the insured person as well as their spouse and dependent children, including when they live in France or Italy. Self-employed workers (craftsmen, shopkeepers, professionals) fall under a separate mandatory scheme, with CAMTI for sickness-maternity and CARTI for old age, funded by a flat quarterly contribution. Monegasque civil servants and public employees fall under a third structure, the Direction des Prestations Médicales et Familiales.

The Centre Hospitalier Princesse Grace (CHPG) is the Principality's only public hospital and concentrates most of the care offering (emergencies, maternity, cardiology, oncology, surgery, imaging, paediatrics). It has obtained "Haute Qualité de soins" certification from the French Haute Autorité de Santé, a sign of the close connection between the two health systems, beyond mere geographic proximity.

• Entry and short stay (under 3 months): no visa required for a French national, a valid national ID card or passport is enough (a passport is recommended even with an extended ID card).
• Long stay (over 3 months): a residence card is mandatory, to be requested from the residents' department of the Direction de la Sûreté Publique.
• Seconded employee : staying on the French scheme remains possible under certain conditions set out in the bilateral agreement; care received in Monaco is reimbursed on presentation of form S 3125c to the French fund of registration.
• Locally hired employee ("expat"): automatic and mandatory CCSS registration from the first day of work, with no personal process needed with the Monegasque fund, but with a notification to make in France (CPAM, CAF, France Travail) to avoid undue French benefit payments.
• Self-employed worker: mandatory registration with CAMTI and CARTI, whatever their nationality, from the start of the activity.

No fine as such, but lacking CCSS registration (or the self-employed scheme) exposes you to bearing the full cost of medical care incurred in Monaco, with no help from the French embassy.

Monaco isn't an EU member: coordination with France therefore doesn't run through EU regulations 883/2004 and 987/2009 (unlike Luxembourg), but through a specific bilateral agreement : the France-Monaco social security agreement of 28 February 1952 (in force since 1 April 1954, administrative arrangement of 5 November 1954). Its scope is broad — sickness-maternity, disability, old age, workplace accidents and occupational diseases, family benefits, death — except for unemployment insurance, which isn't covered.

The principle adopted is that of the country of employment: an employee is registered with the scheme of the country where they work, with exceptions for seconded employees, employees of companies straddling the border and French public service agents posted in the Principality. Insurance periods completed on either side are totalled for opening rights.

• A CCSS insured person can receive planned care in France, subject to prior authorisation from their Monegasque fund — except for residents of Alpes-Maritimes, who are exempt from this authorisation.
• A pregnancy that started before moving to Monaco continues to be followed by the French fund until term.
• The agreement covers neither unemployment insurance nor mutuelle-type supplements: out-of-pocket costs depend on the individually taken-out contract.

1. Before departure, for a seconded employee: check with the employer the conditions for staying on the French scheme under the bilateral agreement.
2. When starting a locally hired job: the employer registers CCSS membership; check that you receive the registration certificate.
3. Notify your departure to CPAM, CAF and France Travail to avoid undue French benefit payments.
4. Beyond 3 months of stay: apply for a residence card at the residents' department, Direction de la Sûreté Publique, 3 rue Louis Notari, Monaco.
5. For planned care in France outside your department of residence, as a CCSS insured person: request prior authorisation from the CCSS (except residents of Alpes-Maritimes, who are exempt).
6. Registration with the roll of French nationals living abroad is recommended.