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

The list of countries linked to France by a social security agreement, kept by CLEISS, does not include Peru: no coordination of schemes organises the resumption of rights, the aggregation of periods or the cross-border coverage of care. Each situation therefore has its own payer, determined by the person’s status.

Five players may be involved: the Peruvian scheme (EsSalud or SIS), the French scheme kept in place (secondment), the CFE, international health insurance and, for a short stay, travel insurance. The notions of reimbursement basis and out-of-pocket cost help you compare. How the networks work is presented in the guide to the healthcare system in Peru.

The employee on a local contract comes under EsSalud’s seguro regular, for dependent employees of a formal company: the rate is 9% of pay (Law No. 26790), borne by the employer, and cannot be lower than the minimum living wage. Cover extends to the spouse or partner, the minor child, the adult child with a disability and the expectant mother. See the glossary entry on the local contract.

The seconded employee sent by an employer established in France can remain affiliated to the French scheme under domestic law: CLEISS indicates a duration of three years renewable only once, a two-year gap before a new secondment to the same country for the same company, and a dual status: the employee remains affiliated to the French scheme while also coming under the host country’s scheme, whose compulsory contributions are due. Once the maximum period has passed, they become an expat and fall only under the local scheme. For complementary care, CLEISS cites private insurance and optional enrolment in the CFE; how care received on site is reimbursed should be confirmed with the affiliation fund. See seconded or expat and the glossary entry on the seconded employee.

The self-employed person or digital nomad cannot, for the moment, affiliate individually to EsSalud’s seguro potestativo: the official page states that new individual affiliations are suspended until 31 December 2027. They can rely on SIS, which requires a DNI or a carné de extranjería and no other insurance, on the CFE main plan (from €87 a month at age 30 and over) or on international insurance, which reimburses actual costs within its ceilings and asks for a medical questionnaire. See digital nomad insurance.

The spouse and children follow the status of the holder: the dependants of an employee affiliated to EsSalud are covered, those of a seconded employee follow French rules, and a CFE family plan or an international policy covers paediatrics and maternity according to its conditions. See expat family insurance and the guide to children’s cover abroad.

Assurance Maladie states that, for a retiree living outside the European Union, the European Economic Area, Switzerland and the United Kingdom, healthcare costs are no longer covered by the French scheme, except in twelve states or territories where an agreement provides for the coverage of retirees (Andorra, Quebec, Saint-Pierre-and-Miquelon, Serbia, Bosnia-Herzegovina, Montenegro, New Caledonia, French Polynesia, Kosovo, North Macedonia, Morocco, Tunisia). Peru is not one of them, and form S1 is specific to Europe. What remains is the CFE retirees’ plan (from €147 a month, with no health questionnaire, reserved for holders of a French basic scheme pension with no professional activity), SIS for a resident holding a carné and no other insurance, or international insurance.

Temporary stays in France: since 1 July 2019, a retiree who lives outside a country with an agreement is reimbursed during stays in France if they have contributed for at least 15 years to one or more compulsory French schemes; handling goes through the Cnarefe (the French national centre for retirees living abroad). See retirees’ health insurance abroad and the page retiring in Peru.

The student comes under the rule that Assurance Maladie describes outside Europe: when the conditions are met (an establishment preparing an official degree, a school enrolment certificate, a return to France at least once per academic year), urgent medical costs are reimbursed by the parents’ fund within the limit of French tariffs, on paid invoices. Beyond that, they turn to SIS (with a carné de extranjería), the CFE (youth plan, from €57 a month under age 30) or an international policy. See student insurance abroad.

• CFE member: the CFE reimburses on a rate or flat amount specific to the country of care applied to actual expenses, and following the principles of Social Security in France, with third-party payment in public and private hospitals. Cover is immediate if enrolment takes place within three months of departure; beyond that, the waiting period is three months before age 45 and six months from age 45. Maternity requires conception after enrolment. See CFE reimbursements.
• Insurance at first-euro level : reimburses actual costs within its ceilings, after any excess, waiting periods and exclusions, with direct billing possible in the network’s facilities.
• Tourist: France Diplomatie considers imperative an insurance policy covering medical costs, surgery, hospitalisation and evacuation, as private clinics in Lima ask for a bank card on admission. Outside Europe, Assurance Maladie reimburses, where applicable, only urgent and unforeseen care, at French flat-rate tariffs, with form S 3125. See long-stay travel insurance.

The CFE states, for its members, that there is no waiting period on return: you automatically rejoin the general scheme, provided you meet the conditions of work or stable and regular residence in France. No France-Peru agreement provides for the resumption of rights; the return follows the usual French rules, to be confirmed with the local primary fund of your place of residence. See the guide to reducing the waiting period and the page on return to France.

• Consultation: according to EsSalud’s cover for the regular insured person; according to the essential plan for SIS; on country scales for the CFE; at actual costs in a first-euro policy; on paid invoices and French tariffs for a tourist. The official sources consulted do not publish a private consultation tariff.
• Hospitalisation: in the private sector, payment is required in advance with a bank card on admission, according to France Diplomatie; an international policy allows direct billing within its network. The emergency law that governs life-saving emergencies is presented in the guide to the healthcare system in Peru.
• Medicines, dental and optical: the official sources consulted do not detail these items for EsSalud and SIS; they come under CFE scales or the annual ceiling of an international policy, to be read in the table of guarantees.
• Maternity: the expectant mother is among the dependants covered by EsSalud; the CFE requires conception after enrolment; international policies 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 test these options against your situation.