Expat insurance and health insurance in Paraguay

The Ministry of Public Health and Social Welfare (MSPBS) runs a national network organised into 18 health regions, ranging from "Unidades de Salud de la Familia" (local health posts) to regional and referral hospitals. Access to this public network has in principle been free or very low-cost since a series of measures taken by the MSPBS between September 2008 and the end of 2009, which progressively removed fees for consultations, hospitalisation, intensive care and diagnostic tests. In practice, several sources specialised in expat matters continue to report chronic underfunding, shortages of equipment and staff, and significant waiting times, particularly outside Asunción.

The Instituto de Previsión Social (IPS), created in 1943, is the social security body that covers employees in the formal sector and certain family members against illness, maternity, workplace accidents and retirement. The contribution totals 25.5% of gross salary: 9% paid by the employee and 16.5% paid by the employer, of which 14 points go to the IPS and 2.5 points to the MSPBS. Affiliation is automatic upon formal hiring; self-employed people can also join voluntarily. The IPS network relies notably, in Asunción, on the Hospital Central "Dr. Emilio Cubas", a high-complexity referral centre for all insured members nationwide.

The private sector, concentrated in Asunción neighbourhoods such as Villa Morra and Carmelitas, offers markedly shorter appointment times and a level of equipment comparable to European standards; it is widely favoured by foreign residents, through a local "prepaga" (private health subscription) or international insurance. Private clinics generally require payment or a payment guarantee upon admission for a non-member patient.

• Tourist stay (under 90 days): no visa required for holders of a French passport, subject to a passport valid for the entire length of stay. France Diplomatie nonetheless describes insurance covering all medical expenses and repatriation as "essential", since the embassy cannot cover any medical costs.
• Entry and exit stamps: when crossing a land border post, France Diplomatie recommends checking that the passport does receive an entry and exit stamp, since the absence of a stamp can lead to fines when leaving the country (amount not specified in the sources consulted).
• Stay of more than 90 days: an extension is possible through the Paraguayan migration department (Dirección General de Migraciones). No working holiday programme (PVT) agreement has been identified between France and Paraguay, unlike several South American neighbours such as Brazil, Chile, Argentina, Colombia, Ecuador, Peru or Uruguay.
• Yellow fever vaccination: not required for a stay limited to Asunción, but recommended elsewhere in the country. A vaccination certificate is required for any traveller aged one year or older arriving from Brazil, Bolivia, Peru or Venezuela, or having transited for more than 24 hours through an airport in these countries (Institut Pasteur).
• Seconded employees and residents under local contracts: in the absence of a bilateral agreement, a secondment cannot rely on any social security coordination recognised by Paraguay. An employee hired locally must be affiliated to the IPS upon formal hiring, with an employer contribution of 16.5% charged to the employer.
• Minors: a child born or residing in Paraguay needs judicial authorisation to leave the country alone or with only one of their two parents (France Diplomatie).

No official quantified fine has been identified for a simple lack of health cover, apart from the case of missing entry/exit stamps. The documented risk is full billing of care in the private sector, with payment or a payment guarantee required upon admission.

No social security agreement has been signed between France and Paraguay: Paraguay does not appear on the list of country factsheets published by CLEISS, which only covers countries that have concluded a coordination agreement with France — unlike Argentina, Brazil, Chile, Colombia and Uruguay, its neighbouring South American countries under agreement.

• In the absence of a bilateral agreement, no totalisation of insurance periods between the two countries is possible for opening pension rights.
• No coordination mechanism allows even partial coverage of care received in Paraguay under a French affiliation, nor the reverse for care received in France under an IPS or MSPBS affiliation.
• An employee affiliated to the IPS through their Paraguayan employer benefits from local coverage, but this does not replace any French social protection and is not recognised as such upon return to France.

In the absence of an agreement, for any French national settling in Paraguay — an employee affiliated to the IPS, a self-employed person or a retiree — voluntary enrolment with the Caisse des Français de l'étranger (CFE) or taking out international health insurance remain the only ways to have cover recognised in France, in addition to any local coverage.

• Before departure: take out insurance covering medical expenses, hospitalisation and medical repatriation, whatever the planned length of stay.
• Before departure, if the trip includes passing through Brazil, Bolivia, Peru or Venezuela: check with the Institut Pasteur or an approved vaccination centre whether a yellow fever vaccination certificate is required, and get vaccinated at least 10 days before departure.
• When crossing a land border post: check that the passport does receive an entry stamp, to avoid any fine when leaving the country.
• For a stay of more than 90 days: start an extension or residence procedure with the Dirección General de Migraciones, since no working holiday programme exists between the two countries.
• As soon as you start formal employment in Paraguay: check affiliation to the Instituto de Previsión Social (IPS) with your employer.
• As soon as possible after arrival: register with the roll of French nationals living abroad at the French Embassy in Asunción (free, valid 5 years, recommended).
• In the absence of a bilateral agreement: voluntary enrolment with the CFE or taking out international health insurance from the moment you settle.