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

CLEISS publishes a sheet for each country bound to France by a social security agreement; its list of 94 countries or territories does not include Panama. In practice, the carte Vitale does not work on site, and insurance periods are not totalised between the two countries. CLEISS points out that, in a country with no agreement, an expatriate employee loses their status as insured under the French scheme, joins the local scheme and can, if they wish, take out cover with the CFE or private insurance.

Five players may be involved: the CSS (local scheme), the French scheme kept in place (secondment), the CFE, international health insurance and, for a short stay, travel insurance. The notions of reimbursement base and out-of-pocket cost help you compare. How the public and private network works is presented in the guide to the Panamanian healthcare system.

The locally employed worker is affiliated to the CSS: the requirements sheets of the National Migration Service (SNM) demand proof of affiliation for a foreign employee, and the employer pays 13.25% of salaries from the April 2025 contribution month to the February 2027 one (Law No. 462 of 18 March 2025). The CSS covers the sickness and maternity risk and the disability, old-age and death risk; the employee’s share and access times should be confirmed with the fund. See the glossary entry on the local contract.

The seconded employee sent by a company established in France remains affiliated to the French scheme for three years, renewable once, in a country with no agreement. CLEISS indicates that they then have dual affiliation: the French scheme, and the local scheme if it is compulsory, the employer paying the corresponding contributions. Care reimbursements remain limited to the French level; for the family, only the benefits of children living in France apply. An employee already seconded for the maximum period cannot be seconded again to the same country until after a period of two years. As local healthcare costs may exceed French rates, supplementary cover is worth discussing with the employer. See secondment versus expatriation and the glossary entry on the seconded employee.

The self-employed person can join the CSS voluntarily: group G, for contributing self-employed people, proves their activity and their latest income return, while group B2, open to foreigners, requires a minimum monthly taxable base of B/.500, proof of address and medical examinations, the full cost of which the foreigner pays. They can supplement it with the CFE main plan (from €87 a month from age 30, with no health questionnaire) or with international insurance, which reimburses actual costs within its ceilings but requires a medical questionnaire.

The digital nomad (remote worker visa) provides a copy of a health insurance policy that covers national territory for the whole duration of their stay; this private policy is the reference cover for this status. See digital nomad insurance.

The spouse and children follow the status of the holder. The jubilado pensionado proves B/.250 a month of additional solvency per dependant, spouses being able to add their pensions together, and dependent children receive a temporary permit up to age 25 if they study full time. The dependants of a seconded employee follow French rules, with the limit recalled above for children. A CFE or international family contract covers paediatrics and maternity depending on the contract. See expat family insurance and the guide to children’s health cover abroad.

Assurance Maladie reserves coverage of retirees living outside Europe to twelve states or territories that have signed an agreement: Andorra, Quebec, Saint-Pierre-et-Miquelon, Serbia, Bosnia and Herzegovina, Montenegro, New Caledonia, French Polynesia, Kosovo, Macedonia, Morocco and Tunisia. Panama is not one of them, and form S1 applies only in Europe. The jubilado pensionado permit of the SNM provides for no CSS affiliation: the retiree chooses voluntary insurance (group B2), the CFE retirees’ plan (from €147 a month), reserved for holders of a pension from the French basic scheme, with no professional activity and no health questionnaire, or international insurance.

Temporary stays in France: the retiree registers with the National Centre for Retirees of France Abroad (Cnarefe). Since 1 July 2019, living outside an agreement country gives access to reimbursement in France only if the person has contributed at least 15 years to one or more French schemes; people affiliated before 2019 who can show at least 10 years of contributions keep their rights. See the guide to retirees’ health insurance abroad and the page on retiring in Panama.

The student falls under the rule that Assurance Maladie describes outside Europe: before age 20 or for studies of under six months, urgent medical costs are reimbursed by the parents’ fund (institution preparing for an official qualification, enrolment certificate and return to France at least once per academic year required); beyond that, they register with the host country’s scheme and can supplement with the CFE (youth plan, from €57 a month before age 30). See student insurance abroad.

• CFE member: abroad, the CFE reimburses according to the country of care, through a rate or a flat amount applied to actual expenses; in France, according to the principles of social security, with direct payment (tiers payant) in public and private hospitals. Cover is immediate if enrolment takes place before departure or within three months of settling in; beyond that, the waiting period is three months before age 45 and six months from age 45. Maternity requires a date of conception after enrolment. See CFE reimbursements.
• First-euro insurance: reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions, with direct payment possible in network facilities; France Diplomatie (the French foreign ministry) points out that several local hospitals have agreements with French insurers allowing admission without a payment guarantee. Contracts are compared on the annual ceiling, the coverage zone and evacuation.
• Tourist: France Diplomatie considers an assistance or insurance contract covering all medical costs, including hospitalisation and repatriation, essential. Outside Europe, Assurance Maladie reimburses, at most, only urgent and unforeseen care, at French rates, on paid invoices with form S 3125. See long-stay travel insurance.

The CFE indicates, for its members, no waiting period on return: they automatically rejoin the general social security scheme, provided they meet the conditions of work or stable and regular residence in France. A French national who has not joined the CFE resumes their rights under the usual French rules, which may include a waiting period; the arrangements should be confirmed with the local primary insurance fund (caisse primaire) of the place of residence. See the guide to reducing the waiting period and the page on returning to France.

• Consultation: covered by the CSS for insured persons under the fund’s rules; in the private sector, paid in advance then reimbursed by the CFE on its country scale, by an international contract at actual cost within its ceilings, or by the fund of affiliation on the French rate for a seconded employee.
• Hospital stay: direct payment is possible with an international contract in its network, which avoids advancing costs, whereas the CFE reimburses after payment according to the country scale; where there is no agreement between the hospital and the insurer, private care is billed to the patient.
• Medicines: the official sources consulted do not detail the lists of medicines covered by the CSS; the CFE covers medicines, and an international contract reimburses them within its ceiling.
• Dental: dental care is part of the CFE main plan cover; an international contract reimburses it according to its annual ceiling and waiting periods, to be read in the table of benefits.
• Optical: the official sources consulted do not detail this item; it falls mainly under international contracts, with ceilings per period.
• Maternity: the CSS covers the maternity risk within the sickness and maternity risk; the CFE requires conception after enrolment; international contracts generally apply a waiting period to be confirmed before pregnancy.

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