Healthcare Reimbursement in the Dominican Republic: Who Reimburses What Depending on Your Situation

France Diplomatie reminds travellers in its health advice that there is no social protection agreement between France and the Dominican Republic, and CLEISS does not mention the country in its list of states linked to France by an agreement. As a result, no coordination of schemes organises the resumption of rights, the aggregation of periods or the cross-border coverage of care: each situation has its own payer, determined by the person’s status.

Five players may be involved: the Dominican scheme (the Dominican Social Security System, or SDSS), 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 the Dominican Republic.

The employee on a local contract is registered with the contributory scheme of the SDSS, like a Dominican employee. The TSS publishes a health contribution of 10.13% of salary, or 3.04% paid by the employee and 7.09% paid by the employer, with a contributable salary ceiling of 232,230 pesos a month since 1 February 2026. The TSS specifies that a foreigner obtains their affiliation number with a work visa, a migration card or a regularisation card. See the glossary entry on the local contract.

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

The self-employed person or digital nomad does not automatically join the SDSS; they can rely on the SeNaSa Larimar voluntary plan, which the public insurer SeNaSa opens to foreigners holding a passport, on the CFE main plan (from €87 a month from age 30) or on international insurance, which reimburses actual costs within its ceilings and requires a medical questionnaire. See digital nomad insurance.

The spouse and children follow the status of the holder: the local employee registered with the SDSS falls under the contributory scheme, the dependants of a seconded employee follow French rules, and a CFE family contract, SeNaSa Larimar (the application requires the marriage certificate and, for minors, the birth certificate) or an international contract covers paediatrics and maternity according to its conditions. See expat family insurance and the guide to children’s cover abroad.

Assurance Maladie indicates that, for a retiree living outside the European Union, the European Economic Area, Switzerland and the United Kingdom, health 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-et-Miquelon, Serbia, Bosnia-Herzegovina, Montenegro, New Caledonia, French Polynesia, Kosovo, North Macedonia, Morocco, Tunisia). The Dominican Republic is not one of them, and the S1 form is specific to Europe. What remains is the CFE retirees’ plan (from €147 a month, with no health questionnaire, reserved for holders of a pension from the French basic scheme with no professional activity), the SeNaSa Larimar plan or international insurance.

Temporary stays in France: since 1 July 2019, a retiree living 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; it is managed through the Centre national des retraités de France à l’étranger (Cnarefe, the French national centre for retirees living abroad). See retirees’ health insurance abroad and the page on retiring in the Dominican Republic.

The student falls under the rule that Assurance Maladie describes outside Europe: when the conditions are met (establishment preparing an official qualification, enrolment certificate, 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 the local plan, to the CFE (youth plan, from €57 a month under age 30) or to an international contract. 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 under the principles of French social security, with direct billing 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 establishments of the network.
• Tourist: France Diplomatie considers a policy covering medical costs, surgery, hospitalisation and repatriation to be essential; the embassy reminds travellers that the French State does not bear these costs and that some bank cards cover hospitalisation for stays of less than 90 days, subject to exclusions. Outside Europe, Assurance Maladie only possibly reimburses urgent and unforeseen care, at French flat-rate tariffs, with form S 3125. See long-stay travel insurance.

The CFE indicates, for its members, 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-Dominican Republic agreement provides for the resumption of rights; the return follows the usual French rules, to be confirmed with the local primary health insurance fund of your place of residence. See the guide to reducing the waiting period and the page on return to France.

• Consultation: in the SeNaSa Larimar plan, consultations are unlimited, with a variable co-payment; on country scales for the CFE; at actual costs in a first-euro contract; on paid invoices and French tariffs for a tourist.
• Hospitalisation: Larimar indicates 100% cover up to 3,000 pesos per day of hospitalisation and 100% of emergencies in contracted centres; private clinics require payment or proof of insurance, according to France Diplomatie. An international contract allows direct billing within its network.
• Medicines: 80% at the pharmacy up to 4,000 pesos a year with Larimar; according to CFE scales or the annual ceiling of an international contract.
• Dental and optical: the official sources consulted do not detail these items; they depend on the contracts and their ceilings, to be read in the table of guarantees.
• Maternity: Larimar indicates 100% cover; 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 test these options against your situation.