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

The CLEISS keeps the list of France’s bilateral social security agreements: Nigeria does not appear in it. With no agreement, no coordination exists between the French and Nigerian schemes: no European card, no aggregation of periods, no cross-coverage. France Diplomatie (the French foreign ministry) adds that the French embassy cannot cover any medical costs and describes as imperative taking out an assistance contract covering medical costs, hospitalisation and repatriation.

Four payers may be involved: the Nigerian scheme (NHIA), the French scheme kept in place (secondment), the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help you compare offers. How care is organised is presented in the guide to the Nigerian healthcare system.

The employee on a local contract may be enrolled with the National Health Insurance Authority by their employer. The NHIA states that beneficiaries do not advance costs at the counter, apart from a 10% co-payment on medicines, and that the contribution covers the employee, their spouse and up to four biological children. The conditions for an expatriate, the contribution amounts and the list of providers are checked with the NHIA and the employer; private complementary cover opens direct access to the private sector and to evacuation. See the glossary entry on the local contract.

The seconded employee sent by a French employer remains affiliated to the French scheme for 3 years, renewable once, i.e. 6 years at most (CLEISS). Contributions are paid in France, and local contributions may remain due. Care is covered up to the French benefits for the same care: paid invoices are sent with form S 3125c to the fund of affiliation. The CLEISS suggests private complementary insurance when care is expensive locally. Sick leave is sent to the fund within 48 hours, and a work accident to the employer within 24 hours. See seconded or expat and the glossary entry on the seconded employee.

The self-employed person or digital nomad has no Nigerian employer to enrol them with the NHIA. They choose between the CFE, a voluntary body open to French nationals, and international insurance covering hospitalisation, outpatient care and medical repatriation. See digital nomad insurance.

The student obtains a CERPAC whose fees, as announced by the Nigeria Immigration Service, are USD 600. Before age 30, the CFE offers its youth plan (with a contribution that depends on age and the plan chosen); some universities or programmes also require their own cover, to be requested before departure. See student insurance abroad.

The retiree is not covered by form S1, which is valid in Europe. The CLEISS indicates that, with no agreement, the retiree finds out what share the local scheme covers, joins the CFE or takes out private insurance. The CFE offers its retirees’ plan (with a contribution that depends on age and the plan chosen). During a temporary stay in France, cover requires a pension from a French basic scheme corresponding to at least 15 years of insurance; retirees of the general scheme outside the European Union fall under the CNAREFE. If tax residence is no longer in France, the CSG, the CRDS and the Casa are no longer withheld; a health insurance contribution of 3.2% on the basic pension and 4.2% on the complementary pension applies in case of dependence on a French scheme. See the guide to retirees’ health insurance abroad and the page on retiring in Nigeria.

The spouse and children of the seconded employee are covered on the same terms as them and also send their invoices and form S 3125c (CLEISS); the dependants of an employee enrolled with the NHIA are covered within the limits indicated above; the CFE and international insurers offer family contracts. See expat family insurance.

Abroad, the CFE reimburses according to a rate or flat amount specific to the country of care, applied to the amount actually spent. Example given by the CFE: a GP consultation under the national agreement at €25 in France is reimbursed at 70%, i.e. €21, and the CFE reimburses the same amount for the same consultation abroad. When the local price exceeds the basis used, the difference remains payable by the member: the guide to CFE reimbursements details this mechanism.

• Benefits: consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines, including during stays of less than three months in France.
• Waiting period: care is covered immediately if enrolment takes place before departure or within three months of settling; beyond that, three months before age 45 and six months from age 45. No health questionnaire.
• Maternity: conception must be after enrolment or after joining as a dependant.

On returning to France, an employee who resumes work is affiliated from the first hour worked. Without activity, a 3-month waiting period is in principle provided for countries with no agreement, and a CFE member may, under conditions, receive the benefits of the expatriates’ scheme during the 3 months following the return (CLEISS). See the guide to reducing the waiting period and the page on returning to France.

International health insurance at first-euro level reimburses actual costs within its ceilings, after any excess, waiting periods and contract exclusions. It gives access to private facilities with direct billing and organises medical evacuation, which France Diplomatie considers essential. Contracts are compared on the annual ceiling, the coverage zone, evacuation, maternity and the handling of medical history.

The tourist is reimbursed by Assurance Maladie (the French national health insurance), on their return, only for urgent and unforeseen medical care, on paid invoices and form S3125, at the flat-rate French tariffs in force; a medical adviser decides whether the situation was urgent, with no appeal if refused, and daily allowances are not paid outside the European Union (Assurance Maladie). Travel insurance with assistance therefore remains necessary: see long-stay travel insurance.

• Consultation: NHIA-approved provider for a member; payable by the patient in the private sector unless covered by a contract; reimbursed by the CFE on its country rate; actual costs with a first-euro contract; French tariffs for the seconded employee.
• Hospitalisation: NHIA within its network; French scheme for the seconded employee; CFE with third-party payment in France and reimbursement abroad; international contract with direct billing and evacuation.
• Medicines: 10% co-payment payable by the NHIA-insured person; reimbursed by the CFE on its country rate; covered within the ceilings of an international contract.
• Dental: included with the CFE according to its rates and in most international contracts within an annual ceiling; the extent of NHIA cover is checked with the authority.
• Optical: glasses and lenses fall mainly under international contracts, with ceilings per period; to be read in the table of benefits.
• Maternity: CFE if conception follows enrolment; international contracts generally with a waiting period; NHIA benefits to be checked with the authority.

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