Healthcare Reimbursement in Montenegro: Who Pays for What Depending on Your Situation

Montenegro is not a member of the European Union: the European health insurance card is not valid there. CLEISS specifies that the general Franco-Yugoslav agreement of 5 January 1950, supplemented by the administrative arrangement of 23 January 1967, remains applicable between France and Montenegro under the agreement of 26 March 2003, which came into force on that date. It concerns employees of French or Montenegrin nationality and covers all branches except unemployment insurance, including sickness and maternity. Montenegro never formally confirmed the former agreements by exchange of letters, but CLEISS states that no new procedure is needed to maintain the existing ties.

The agreement opens specific rights depending on the situation, set out in the following sections; outside these cases, it is your status that determines the payer: Montenegrin fund, CFE or international insurance. The notions of reimbursement basis and out-of-pocket cost help with comparisons. How the fund works is presented in the guide Montenegrin healthcare system.

The employee on a local contract comes under the Montenegrin scheme, unless posted by their employer. They are affiliated to the fund (FZOCG) by their employer with a sickness-maternity contribution of 8.50% on the employee side and 2.30% on the employer side. Before departure they ask their French fund for form SE 21-02 so that their French insurance periods are taken into account. Their dependants with no French rights of their own can be covered through their Montenegrin job and register with the CPAM (local health insurance office) of their residence in France with form SE 21-08 issued by the Montenegrin insurer. See the glossary entry on the local contract.

The posted employee of a French employer keeps French health insurance with no additional contribution. For care received in Montenegro, two options are open: send the paid invoices with form S 3125c to the French fund, or send the Montenegrin body a request for cover with a copy of the certificate of coverage SE 21-01, which applies Montenegrin legislation. The family accompanying the employee follows the same options; the family who stay in France continue to come under the French fund. Daily allowances are paid by the French fund, with a sick-leave notice sent within 48 hours. CLEISS suggests checking with the supplementary insurer whether the contract needs adapting, as care may cost more than in France. See posted worker or expatriate and the glossary entry on the posted worker.

A self-employed person settled in Montenegro contributes to the fund on their declared gross income: 10.80% for sickness and maternity, within the total of 31.30% recorded by CLEISS. They can also choose the CFE or international insurance, particularly to gain access to private practitioners and repatriation. See digital nomad insurance.

The student is not mentioned by the CLEISS page on temporary stays. For a Montenegrin insured person, children remain dependants up to 26 if they are studying; a French student chooses before age 30 the CFE’s youth offer or student insurance. See student insurance abroad.

According to CLEISS, a French or Montenegrin national who receives a French employee pension can obtain health cover in Montenegro if they have no right under Montenegrin legislation. They receive no certificate before departure: they contact the social security fund of their place of residence in Montenegro, which checks whether local legislation covers them. If not, it sends form SE 21-34 to the French body that pays their basic pension, which issues either form SE 21-35 (certificate of entitlement) or SE 21-36 (notice of refusal). If agreed, the Montenegrin fund covers their care and that of their dependants who live with them, as if they came only under Montenegrin law.

With form SE 21-35, French law covers the retiree’s care during temporary stays in France; only the pensioner and their minor children are covered, a spouse living abroad not being covered, hence the value of private insurance. Hospitalisation of more than a month requires the prior agreement of the CPAM after a medical check. The CFE also offers a retirees’ offer. See the guide retirees’ health insurance abroad and the page retiring in Montenegro.

The CFE reimburses abroad on a rate or flat amount specific to the country of care, applied to actual expenses: the fund’s example is a French general practitioner consultation set at €25 and reimbursed at 70%, or €21. In France, it follows the principles of Assurance Maladie with direct payment, for stays of under three months. The contributions depend on age and the plan chosen, for the main offer, the youth offer and the retirees’ offer. No waiting period applies if membership takes place before departure or within three months of settling; after that, it is three months before age 45 and six months from age 45. Maternity requires conception after membership. See CFE reimbursements.

International health insurance on a first-euro basis reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. France Diplomatie (the French foreign ministry) recalls that the embassy cannot pay medical costs and that funds should be kept for hospitalisation, repatriation or evacuation.

The French tourist does not benefit from direct cover: CLEISS recalls that form SE 21-04 A, requested from the CPAM before departure, is intended only for Montenegrin nationals on a temporary stay during paid leave, French-Montenegrin dual nationality being excluded. Other insured people can ask their fund, on return, to reimburse unforeseen care on paid invoices, which CLEISS describes as a possibility and not an obligation; daily allowances are only paid on return, on sick leave issued by a doctor practising in France. See long-stay travel insurance.

On returning to France, a 3-month waiting period applies to a French national with no professional activity before affiliation to the CPAM under the PUMa (universal health cover); a CFE member with no activity benefits free of charge from retention of rights for the 3 months following return (Assurance Maladie). See reducing the waiting period and return to France.

• Consultation: contribution of about 20% at the general practitioner, 40% at the specialist for a fund insured person; reimbursed at the French tariff on invoice or under Montenegrin law for the posted worker; at the country scale for the CFE; at actual costs within the ceilings of a first-euro contract.
• Hospitalisation: on the general practitioner’s prescription within the fund’s network; CFE direct payment in France; direct cover possible with an international contract.
• Medicines: reimbursed if prescribed and on the fund’s list; CFE scales; contract ceilings.
• Dental: family dentist required for the fund insured person, with 20% contribution; included at the CFE according to its scales and in most international contracts according to an annual ceiling.
• Optical: mainly under international contracts, with ceilings per period.
• Maternity: care free during pregnancy, childbirth and 12 months after for the fund insured woman; the CFE requires conception after membership.

The reimbursement guide and the page expat health insurance give pointers; Expavy helps compare these options with your situation.