The Healthcare System in Monaco: Organisation, Access for French Nationals and Emergencies

In Monaco, health cover depends on professional situation. A private-sector employee is affiliated to the CCSS, which covers sickness, maternity, disability, death and family benefits for the insured person and their dependants, including when they live in France or Italy. The self-employed person affiliates to CAMTI (sickness, maternity, accidents, family benefits) and to CARTI (old age). Civil servants and State employees come under a third structure, the Direction des Prestations Médicales de l’État (Caisses Sociales de Monaco, MonServicePublic).

The Principality’s public health indicators read as follows: life expectancy at birth is about 86 years and current health spending about 3% of GDP, of which about 8% remains a direct charge on households (World Bank). Reimbursement bases and differences by status are detailed in the page healthcare reimbursement in Monaco.

The locally hired employee is automatically affiliated to the CCSS from the first day of activity, when the hiring authorisation is requested. The cross-border worker who works in Monaco and lives in France comes under the CCSS on the basis of employment, under the state-of-employment principle of the agreement of 28 February 1952 (CLEISS, the French centre for European and international social security liaison). The seconded employee in principle keeps their French scheme under conditions. The self-employed person affiliates to CAMTI and CARTI from the start of their activity.

A retiree of a French scheme who settles in Monaco with no Monegasque entitlement can be covered under the agreement: they register with the CCSS with their proof of residence in Monaco, their pension certificate and a certificate from their pension fund establishing their right to care (CLEISS). The situation of a resident without activity and without a pension should be checked directly with the Caisses Sociales de Monaco. France Diplomatie (the French foreign ministry) recalls that the embassy cannot pay healthcare costs.

The CCSS covers maternity and family benefits for the insured person and their dependants, including those who live in France or Italy; the precise arrangements for a pregnancy begun before settling should be requested from the CCSS before departure. In retirement, the CAR (employees) and CARTI (self-employed) pay pensions, whose age conditions are presented in the page retiring in Monaco. A child, spouse or dependent parent is covered as a dependant according to the conditions of the holder’s affiliation fund, to be checked at registration.

The patient freely chooses their general practitioner or specialist. For procedures performed by doctors, midwives and biologists, the CCSS reimburses on its reference tariff, whatever the price paid: the usual rate is 80%, the remaining 20% being the co-payment, and 100% for insured persons exempt from this co-payment. The contracted fee schedule (NGAP) indicates, for a general practitioner consultation, €35.00 or €42.00 depending on the applicable scale, i.e. €28.00 or €33.60 reimbursed at 80%. Non-contracted practitioners set their fees freely, reimbursement remaining calculated on the tariff of the CCSS, of another scheme or of the competent authority.

For outpatient care, the patient usually advances the costs and is reimbursed. The amounts in the schedule change: the Caisses Sociales publish the tariff in force, more recent than that of CLEISS’s country sheet.

The Centre Hospitalier Princesse Grace (CHPG) is the Principality’s public hospital. Its emergency reception and treatment department, open 24 hours a day, handles adult medical, psychiatric, surgical and trauma emergencies; paediatric emergencies have a separate line. The switchboard is +377 97 98 99 00, adult emergencies +377 97 98 97 69 and paediatric emergencies +377 97 98 95 33. In an emergency, the CHPG recommends dialling 18 or going directly to the emergency department.

Rescue services and firefighters can be reached on 18 or 112, the police on 17, and 141 gives the on-call doctors and pharmacies at night, at weekends and on public holidays (MonServicePublic). In public hospitals, including the CHPG and French public hospitals, the insured person benefits from third-party payment: they pay only the co-payment and any single-room supplement. In a private clinic, they generally advance the stay and the surgeon’s fees, reimbursed within the limit of the public hospital tariff; direct payment may exceptionally be requested before admission.

The Caisses Sociales de Monaco distinguish stays in a public establishment, with third-party payment, from stays in a private clinic. The public establishments concerned are the CHPG, French public hospitals and the Monaco Cardio-Thoracic Centre: the patient does not advance the cost of the stay and pays only the co-payment and any single-room supplement. In a private clinic, the stay and the surgeon’s fees are in principle advanced by the patient, then reimbursed within the limit of the public hospital tariff.

Hospitalisation invoices are presented paid, within the limit of the tariffs of the CHPG or of the Nice university hospital (CLEISS). Proximity to France allows insured persons to be treated across the border; reimbursement of scheduled care in France depends on the affiliation fund and the place of residence, and should be confirmed with the CCSS before the care. For a retiree of the French scheme registered with the CCSS, unforeseen care during a stay or a passage in France remains covered and is reimbursed by the Monegasque fund (CLEISS).

Monegasque State employees and their dependants are reimbursed by the Direction des Prestations Médicales de l’État. For hospital care, the normal rate is 80%, with 100% cover for categories such as ambulance transport, daily stay costs and stays of more than thirty days (MonServicePublic). These rules differ from those of the CCSS on certain points: the insured person should find out from their own body before being treated. A newcomer who is not a State employee comes under the CCSS or CAMTI, depending on their status.

At night, at weekends and on public holidays, 141 gives information on open pharmacies. A chronic treatment is prepared before settling: an up-to-date prescription, sufficient quantities for the transition period, and contact with a contracted doctor. The rules for reimbursement of medicines by the CCSS should be checked on the Caisses Sociales website, as the list and rates may change.

A member of the French scheme on a stay in Monaco will find the procedure to follow in the CLEISS sheet devoted to care in Monaco. For stays of less than three months by a French visitor, France Diplomatie recommends requesting the European health insurance card from your fund at least 15 days before departure. See the page long-stay travel insurance.

France Diplomatie asks travellers to check that the vaccinations of the French schedule are up to date (diphtheria, tetanus, polio, whooping cough, measles) and to consult a doctor or an international vaccination centre before departure. The Principality lies in a zone of medium seismicity (level II), with no alarm system because an earthquake remains unpredictable; swimming is considered safe at the Larvotto beach, protected by anti-jellyfish nets, and cycling is discouraged because of dense traffic.

An insurance or assistance contract covering medical costs, hospitalisation and medical repatriation is recommended, hospitalisation costs abroad being potentially very high. See repatriation and assistance and expat health insurance.