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

The CLEISS keeps the list of States bound to France by a social security agreement. Mongolia is not on it: among Asian countries, the list shows Korea, India, Japan and the Philippines, as well as Israel and Turkey. No coordination therefore exists between the Mongolian and French schemes: no European card, no cross-coverage, no totalisation of periods. The French embassy recalls that the French State does not cover healthcare costs in case of hospitalisation, care or medical repatriation abroad.

Four players can be involved: the Mongolian scheme, the French scheme kept in place (secondment), the CFE and international health insurance. The notions of reimbursement base and out-of-pocket cost help compare offers. The care offer is described in the page on the healthcare system in Mongolia.

The local-contract employee is compulsorily insured in the Mongolian social security scheme if they work for an employer in Mongolia, including if they are a foreigner, unless a treaty provides otherwise: pensions, benefits (sickness, maternity), unemployment and workplace accidents. The law specifies that the health insurance rate falls under the health insurance law: ask the employer which care and establishments are covered. Many employers add private insurance to access private hospitals, which France Diplomatie strongly recommends. See the page on working in Mongolia and the glossary entry on the local contract.

The seconded employee of a French employer remains affiliated to the French scheme, under domestic law, for three years renewable once (CLEISS). Contributions are paid in France as if the employee worked there; staying in the scheme does not exempt you from any contributions due in Mongolia. Care is reimbursed within the limit of what France reimburses for the same care: the employee pays up front, then sends their paid invoices and form S 3125c to their fund. Sick leave must be declared within 48 hours. A supplementary contract covers the gap with private hospital rates and evacuation. See seconded or expatriate employee and the glossary entry on the seconded employee.

The self-employed person or investor has no employer to affiliate them: the CFE or international insurance are the usual routes, because Mongolian social insurance presupposes a relationship with an employer or a voluntary registration whose conditions are confirmed with the body. See digital nomad insurance.

The student chooses between their institution’s insurance, international insurance for students and, before age 30, the CFE youth offer; see student insurance abroad. The spouse and children follow the holder’s visa; the CFE and international insurers both offer family contracts, CFE maternity requiring conception after joining. See expat family insurance.

The CLEISS reserves form S1 for retirees of the French scheme who settle in the European Union, the European Economic Area or Switzerland. In Mongolia, the retiree cannot be treated at France’s expense: they choose the CFE (offer for retirees who draw a pension from a French basic scheme, with no medical questionnaire) or international insurance. See the guide to retiree health insurance abroad and the page on retirement in Mongolia.

The CFE is a voluntary social protection body. In France, it reimburses according to the principles of the Assurance Maladie (the French national health insurance), with direct billing in public and private hospitals; abroad, reimbursement depends on the country of care and the nature of the care, with a rate or a lump sum applied to the actual invoice. As an example taken from the page of its main offer, a GP consultation whose French rate is €25 is reimbursed €21 abroad. When the local price exceeds the base used, as in the private hospitals of Ulaanbaatar, the difference remains payable by the member: the guide to CFE reimbursements details this mechanism.

• Offers: the main offer (30 and over) and the youth offer (under 30), each with a contribution that depends on age and the plan chosen, the offer intended for retirees (with a contribution that depends on age and the plan chosen); prices depend on the country, age and family situation. They cover consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines, including stays of less than three months in France.
• Waiting period: none if you join before departure or within three months of settling; beyond that, three months before age 45 and six months from age 45.
• Maternity: conception must come after joining or after being attached as a dependant.

On returning to France, affiliation is acquired from the first hour worked; without a return to work, universal health protection (PUMa) is examined on a residence criterion, with in principle a three-month waiting period. A CFE member without activity benefits, under conditions, from the expatriate scheme’s benefits for the three months following their return (CLEISS). See the guide to reducing the waiting period and the page on returning to France.

International health insurance with first-euro cover reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions of the contract. It meets France Diplomatie’s requirement for a contract covering illness, hospitalisation and repatriation for the whole stay, ideally with administrative and medical correspondents in Mongolia, and it gives access to private hospitals with direct billing when the insurer offers it. Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of medical history.

The tourist stays up to 30 days without a visa (temporary exemption, to be checked before departure). France Diplomatie recommends comprehensive insurance covering the whole stay, and notes that winter frequently disrupts flights. Bank card assistance can supplement this arrangement, with ceilings to be checked. See long-stay travel insurance.

• Consultation: primary care free in family health centres for citizens; paid directly in the private sector; reimbursed by the CFE on its country scale; at actual cost with a first-euro contract; under French rules for the seconded employee.
• Hospitalisation: Mongolian scheme for a member in the establishments concerned; French scheme for the seconded employee; CFE with the country scales; international contract with direct billing when the insurer offers it. The costs of private hospitals in Ulaanbaatar can be extremely high.
• Medicines: to be bought at a pharmacy on prescription, never in the street; reimbursed according to the contract; for regular treatment, bring enough to cover the whole stay.
• Dental: included at the CFE according to its scales and in most international contracts up to an annual ceiling.
• Optical: falls mainly under international contracts, with ceilings per period; to be read in the benefits table.
• Maternity: the CFE requires conception after joining; international contracts generally apply a waiting period to maternity.

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