Healthcare Reimbursement in Paraguay: Who Reimburses What, Depending on Your Situation

CLEISS publishes sheets for the countries bound to France by a social security agreement: Paraguay does not appear among them. The two countries therefore do not coordinate their schemes: no card giving access to care in both countries, no totalisation of insurance periods, no cross-coverage. ameli.fr (the Assurance Maladie website) reminds readers that a worker expatriated outside the European Union necessarily comes under the scheme of the country of work, which reimburses their medical costs, and that a specific contract can be useful, together with repatriation insurance.

Four players can come into play: the Paraguayan scheme (IPS for employees, the Ministry of Health network), the French scheme kept in place (secondment outside an agreement), the CFE and international health insurance. The notions of reimbursement base and out-of-pocket cost help you compare; the local organisation is described on the page on the healthcare system in Paraguay.

In practice, France Diplomatie specifies that, without an assistance contract or insurance covering medical costs (surgery, hospitalisation) and medical repatriation, access to care may be refused, even in a life-threatening emergency, and that the embassy cannot in any case cover these costs. Reimbursement claims rely on paid invoices, medical reports and prescriptions written with the international non-proprietary name, to be kept systematically.

Employee on a local contract. They are affiliated to the IPS from formal hiring; their contribution is 9% of pay and the employer’s is 16.5%. Their dependants are minor children, the spouse or partner and, under conditions, their parents; registration is free, on presentation of the Directorate of Migration card and legalised or apostilled civil status records. See the notion of a local contract.

Seconded employee. In a country without an agreement, the seconded employee remains affiliated to the French scheme for three years, renewable once. They are covered up to the benefits they would have received for the same care in France: they send their fund the paid invoices with form S 3125c, their dependants who accompany them follow the same procedure and those who stayed in France turn to the affiliation fund. A sick-leave certificate must be declared within 48 hours. See seconded worker.

Self-employed. They can affiliate voluntarily to the IPS, join the CFE, which covers sickness-maternity for a self-employed person, or take out international insurance. The conditions for voluntary IPS affiliation are checked with the institute.

Retiree. The S1 form, reserved for residents of the European Union, the EEA, Switzerland and the United Kingdom, does not apply. The retiree chooses between the CFE, international insurance and, under the institute’s conditions, the IPS. During a temporary stay in France, they are reimbursed for their care if they draw a pension from a basic scheme based on at least 15 years of insurance and have no activity; the spouse who accompanies them is not covered (CLEISS).

Student. In the absence of an agreement, CLEISS indicates that, for a stay of under six months, the French fund may reimburse unforeseen care on a flat-rate basis, on an optional basis and after the costs have been advanced. Beyond six months, a student over 20 is no longer covered by French health insurance and takes out cover locally, with the CFE or a private insurer. See student insurance abroad.

Spouse and children. They are IPS dependants if the holder is an affiliated employee, remain under the French scheme if they accompany a seconded worker, or have their own contract. See expat family insurance.

Tourist (up to 90 days). No visa is required, but France Diplomatie considers essential a contract covering care, hospitalisation and repatriation, since access to care may otherwise be refused.

The CFE offers its main offer (aged 30 and over), its youth offer (under 30) and a retiree offer, each with a contribution that depends on age and the plan chosen, with no health questionnaire. Cover is immediate if you join before departure or within three months of settling; otherwise the waiting period is three months before age 44 and six months beyond age 45. Abroad, reimbursement depends on the country of care and the procedure, with a rate or a flat amount applied to the actual expense; maternity requires conception after joining. See CFE contributions.

First-euro insurance reimburses actual costs within the contract’s ceilings, with direct payment to the establishment possible; excesses, waiting periods and exclusions determine the out-of-pocket cost. See first euro.

Return to France. A CFE member with no activity in France keeps their rights for up to three months after returning and affiliates to the CPAM of their place of residence with form S1106; an employee taking up a contract in France has rights from the start. With no agreement with Paraguay, the lifting of the waiting period does not rely on an agreement and is confirmed with the CPAM. See return-to-France insurance.

• Consultation: covered by the IPS for a member; free in principle in Ministry of Health establishments (law 5099, gradual implementation); payable by the patient in the private sector unless covered by a contract; according to the CFE’s country scale.
• Hospitalisation: IPS network for a member; French scheme for the seconded worker within the limit of French benefits; for the others, an international contract with direct payment, failing which access may be refused.
• Medicines: law 5099 provides for the free supply of essential medicines in the ministry’s establishments; reimbursed according to the CFE’s scales or the ceilings of an international contract.
• Dental: the extent of IPS cover is checked with the institute; the CFE and international contracts apply their own ceilings.
• Optical: mainly a matter for international contracts, with ceilings per period to be read in the benefits table.
• Maternity: covered by the IPS for insured women; the CFE requires conception after joining; international contracts generally apply a waiting period.

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