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

The CLEISS keeps the list of States bound to France by a social security agreement. Nepal 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 Nepalese and French schemes: no European card, no cross-coverage, no totalisation of periods. According to the French embassy, the French State does not cover the healthcare costs of residents abroad.

Four players can be involved: the Nepalese national programme, 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 Nepal.

The local-contract employee falls under the national health insurance programme: the Health Insurance Board states that registration is compulsory for employees of the organised sector, with a contribution presented as equal to 1% of income. Benefits depend on the benefits package published by the Board and on affiliated establishments; an employer often adds private insurance to access out-of-network establishments. The work visa is applied for with the employer: see the page on working in Nepal 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 Nepal. 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 local rates and, above all, evacuation. See seconded or expatriate employee and the glossary entry on the seconded employee.

The self-employed person or investor has no employer to register them in the national programme: the CFE or international insurance are the usual routes. For the mountains, check that the contract covers illness at altitude and not only accidents. See digital nomad insurance.

The student chooses between their institution’s insurance, international insurance for students and, before age 30, the CFE youth offer. The insurance requirements of the visa are confirmed with the Department of Immigration; 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 Nepal, 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. The Nepalese national programme pays the premium for elderly people of Nepalese nationality; access for a foreigner is not described. See the guide to retiree health insurance abroad and the page on retirement in Nepal.

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, 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. France Diplomatie considers it indispensable: it must cover all medical costs, including surgery and hospitalisation, as well as medical repatriation, and, for a stay at altitude, mountain search and evacuation. Check that stays of more than three months are not treated as an expatriation by your contract.

The tourist or trekker takes out insurance before departure, gives the contract details to their trek agency and keeps the insurer’s file number on them. The insurer’s agreement is needed before any measure, including evacuation, the choice of establishment and tests or treatments. See long-stay travel insurance and the guide to the course of a medical repatriation.

• Consultation: covered according to the benefits package for a member of the national programme; paid directly in an out-of-network establishment; reimbursed by the CFE on its country scale; at actual cost with a first-euro contract; under French rules for the seconded employee.
• Hospitalisation: national programme in affiliated establishments; French scheme for the seconded employee; CFE with the country scales; international contract with direct billing when the insurer offers it.
• Medicines: to be bought at a pharmacy on prescription, never from street vendors; reimbursed according to the contract.
• 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.
• Mountain evacuation and search: to be expressly checked; some contracts cover accidents but not illnesses, such as altitude sickness.

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