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

Monaco is among the states linked to France by a social security agreement in force (CLEISS list of agreements). The agreement of 28 February 1952 adopts the principle of the state of employment: the employee is affiliated to the scheme of the country where they work, with exceptions for seconded employees. It covers neither unemployment insurance nor supplementary health insurance: the out-of-pocket share depends on the contract taken out individually. The glossary explains the notion of a bilateral agreement, of reimbursement base and of out-of-pocket share.

Reimbursement is calculated on the fund’s reference tariff, whatever the price paid. A non-contracted practitioner sets their fees freely; the patient then bears the difference between the price invoiced and the base. How care works is presented in the page healthcare system in Monaco.

The locally hired employee is automatically affiliated to the CCSS from the first day of activity. It reimburses 80% of the reference tariff for outpatient care, 100% for insured persons exempt from the co-payment, and settles stays in public hospitals directly. The cross-border worker who lives in France comes under the CCSS on the basis of their employment, and their spouse and dependent children who live in France remain covered (CLEISS). See the glossary entry on the local contract.

The self-employed person is affiliated to CAMTI for sickness, maternity, accidents and family benefits, with a fixed quarterly contribution (amount set for each financial year, Caisses Sociales de Monaco). The spouse and children are covered as dependants of the employee or self-employed person according to the fund’s conditions; those who live in France are attached to the insured person’s Monegasque fund. See expat family insurance.

An employee of a company established in France can be seconded to Monaco while keeping their French scheme under conditions (CLEISS). According to the CLEISS page for employers, the initial secondment covers assignments of one year or less, with a possible extension of a further 12 months; an exceptional derogation may be requested beyond that. Care received in Monaco is reimbursed under French rules on paid invoices, and as Monegasque tariffs may exceed French bases, you should check with the supplementary health insurer whether the contract needs to be adapted. See the guide seconded or expatriate and the glossary entry on the seconded employee.

The retiree of a French scheme who settles in Monaco with no entitlement open in the Monegasque scheme registers with the CCSS to obtain reimbursement of their care, as do their relatives living with them. The file includes proof of residence in Monaco, the pension certificate (or a certificate) and a certificate from the French old-age fund establishing their right to care. As they are no longer attached to the French scheme, their pension no longer bears French social levies; they remain subject to a Monegasque health insurance contribution. Unforeseen care during a stay in France remains covered and is reimbursed by the Monegasque fund (CLEISS). See the page retiring in Monaco and the guide health insurance for retirees abroad.

The student has no scheme of their own identified in the sources consulted: they are attached as a dependant of an affiliated parent, or must take out individual insurance. The rules specific to studying outside France are on the CLEISS website. See student insurance abroad.

The CFE is a voluntary social protection body for French expatriates; its reimbursement conditions, scales and waiting periods should be checked on cfe.fr and in the guide CFE reimbursements. International health insurance with first-euro cover reimburses actual costs within its ceilings, after the deductible, waiting periods and exclusions; it gives access to private clinics, whose stays are otherwise advanced by the patient.

The tourist or French visitor relies on travel insurance: France Diplomatie (the French foreign ministry) recommends a contract covering care, hospitalisation and medical repatriation, and invites French visitors to request the European health insurance card from their fund at least 15 days before departure. See long-stay travel insurance.

On return to France, the CFE maintains rights for at most 3 months after the return, subject to prior notification. An employee who takes up a contract in France is covered from the start; without a contract, three months of stable residence are required (form 1106 for the CPAM, the French health insurance fund). See the guide reducing the waiting period and the page return to France.

• Consultation: 80% of the reference tariff at the CCSS; contracted general practitioner consultation at €35.00 or €42.00 depending on the scale, i.e. €28.00 or €33.60 reimbursed; the patient generally advances outpatient costs.
• Hospitalisation: third-party payment at the public hospital, with the co-payment and single-room supplement borne by the patient; private clinic advanced then reimbursed at the public hospital tariff; 100% for ambulance, daily costs and stays of more than thirty days under the State employees’ scheme.
• Medicines: CCSS rate and list to be checked on the Caisses Sociales website; 141 gives the on-call pharmacies.
• Dental and optical: no rate was found for these items in the sources consulted; they often fall under supplementary insurance or an international contract, with ceilings to be read in the benefits table.
• Maternity: covered by the sickness-maternity branch of the CCSS for the insured woman and dependants; arrangements and deadlines to be confirmed with the fund before pregnancy.

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