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

According to CLEISS (the French centre for European and international social security liaison), health insurance benefits are paid by the CPAM in mainland France and by the general social security funds (CGSS) in the overseas departments. Universal health coverage covers people who carry out an activity or live in France on a stable and lawful basis, including in Réunion. The CGSS of Réunion presents on its website the services of the Assurance Maladie, the Assurance Retraite, the URSSAF and the MSA. No international coordination formality is needed for a stay within French territory.

Reimbursement rests on three tiers: the general scheme reimburses on the basis of its rates; the co-payment (ticket modérateur), the hospital daily charge and extra-billing fall to supplementary health cover; the Complémentaire Santé Solidaire covers the supplementary share, subject to means. The out-of-pocket cost therefore depends as much on the supplementary cover as on the compulsory scheme. How the care offering is organised is described in the guide healthcare system in Réunion.

The employee, whether coming from mainland France or recruited on the spot, does not have to show a minimum period of activity: carrying out a professional activity is enough to open their rights (ameli). They benefit from reimbursement of care at the general scheme rates, from daily allowances in case of sick leave according to national rules and from benefits linked to maternity and work accidents. They present their Vitale card to every healthcare professional and update it at least once a year and after any change of situation.

The civil servant transferred to Réunion comes under the compulsory scheme for public employees. IEDOM (the overseas issuing institute) specifies that civil servants’ pay is increased in the DROM (overseas departments and regions) and that the rules on leave and travel costs are adjusted because of remoteness. The sources consulted do not detail who manages the health insurance of an employee transferred to the island: this should be confirmed with their managing department and the CGSS before arrival, along with the transfer of the file and the updating of the address.

The self-employed person is covered from the start of their activity (ameli). Reimbursement follows the general scheme rates; contribution terms and entitlement to daily allowances should be confirmed with the competent fund.

The retiree: according to ameli, a former employee receiving a pension is entitled to reimbursement of healthcare costs in case of illness and maternity throughout retirement, with no particular procedure after retiring other than updating the Vitale card. They contact their fund if they receive several pensions or the minimum old-age benefit. The guide retiring in Réunion details the pension procedures.

The person with no occupation comes under the condition of stable and lawful residence in France alone. CLEISS specifies that the opening of rights is not automatic in this case and that form S1106 must be sent to the fund of the place of residence; it mentions residence of at least 3 months, while ameli indicates that in case of inspection you must be able to show 6 months of residence in France over the last 12 months. CLEISS also notes that a subsidiary health contribution of 6.5% may be owed by people with no professional activity; its conditions should be confirmed with the fund.

The student becomes an insured person at 18; before that, they are generally covered as a parent’s dependant. Ameli indicates that students starting their studies who meet the residence condition come under universal health coverage on presentation of a document proving their status, with no procedure if they are already covered. Cover is provided by the fund of the place of residence; a working student comes under the scheme of their job. The choice of supplementary cover is free: the parents’ can continue to cover an adult dependent child, a student mutual insurer is possible and the Complémentaire Santé Solidaire is open subject to means. For studies abroad, see student insurance abroad.

The spouse with no occupation keeps their own rights on the basis of their residence; an adult dependant can request affiliation as an insured person on a residence criterion with form S1110. Children are dependants until they come of age, or at the latest until 30 September of the year they turn 18; minors are exempt from the €2 flat-rate contribution and the medical deductible (CLEISS, ameli).

The mainland resident on a short stay remains covered by the general scheme: social security legislation is the same as in mainland France. The sources consulted do not describe a practical rule specific to people insured with another fund who are passing through (use of the Vitale card, third-party payment): it is prudent to ask your fund before departure. The consultation tariff applicable in Réunion (€36 for a sector 1 general practitioner) differs from that of mainland France.

A trip to another country (Mauritius, Madagascar, Seychelles, Comoros, South Africa) is a stay abroad. According to ameli, for a stay outside Europe, only urgent and unforeseen medical care can possibly be covered on return: you must pay on the spot, keep the receipts and request reimbursement with form S3125; the medical adviser assesses urgency, reimbursement is made on the basis of flat-rate French tariffs, there are no daily allowances and a refusal cannot be contested. An assistance policy covering medical costs and medical repatriation is recommended in countries where care is expensive. See repatriation and assistance.

Returning to mainland France means informing the CGSS and requesting the opening of rights with the fund of the new place of residence; CLEISS specifies that this opening is not automatic on a change of situation and that form S1106 must then be sent. See also insurance on return to France.

The Caisse des Français de l’Étranger offers a main offer, an offer for under-30s and an offer for retirees, intended, according to its website, for expatriates who live and work abroad. As long as a French citizen lives in Réunion, they come under the general scheme: CFE membership only becomes useful if they leave France. The CFE guide details the conditions.

The Complémentaire Santé Solidaire covers the supplementary share of costs (consultations, medicines, transport, tests, hospitalisation, dental, optical, hearing aids) and is generally free at the point of service with the Vitale card, provided the care pathway is followed. The public service publishes, for the overseas departments including Réunion, an annual income ceiling of €11,599 for a single person for free cover (from €11,599 to €15,659 with a contribution), €17,398 for two people (up to €23,488), €20,878 for three (up to €28,185) and €24,358 for four (up to €32,883). First-euro private insurance is not needed for basic reimbursement; it can fund extra-billing, the hospital daily charge and assistance abroad.

• Consultation: 70% of the approved tariff within the care pathway. For Réunion, ameli publishes €36 for a sector 1 general practitioner (€23.20 reimbursed), €31.80 for a sector 1 specialist (€20.26), €62.40 for a psychiatrist for over-25s (€41.68). Outside the pathway, €12.60 is reimbursed for a sector 1 general practitioner; the amounts include the deduction of the €2 flat-rate contribution.
• Hospitalisation: 80% in a public hospital or approved clinic, 100% for major procedures, after 30 consecutive days, for maternity (last 4 months of pregnancy, delivery, 12 days after) and for long-term conditions. The hospital daily charge of €23 a day (€17 in psychiatry) is never reimbursed by the Assurance Maladie; it is not due by recipients of the Complémentaire Santé Solidaire or by pregnant women in these periods.
• Medicines: 65%, 30% or 15% depending on medical benefit, 100% for irreplaceable and very expensive medicines; €1 deductible per box (ameli, summary table).
• Dental and optical: 60% (dental surgeon consultation and optical); the Complémentaire Santé Solidaire covers notably dental prostheses, glasses in most cases and hearing aids within price ceilings (ameli). The rules of the 100% Santé scheme can be read on ameli.
• Maternity: consultations reimbursed at 100% from the 6th month of pregnancy within the pathway, hospitalisation at 100% (last 4 months, delivery, 12 days after); for a woman living more than 45 minutes from a maternity unit, accommodation of €80 a night and transport at 100% subject to prior approval.
• Medical transport: 55% of approved tariffs, or 100% in 12 listed cases, with a €4 deductible per transport capped at €8 a day; prior approval for plane and boat, more than 150 km, or remote maternity.
• Medical evacuation or transfer: transport covered subject to prior approval equivalent to a medical prescription; medical costs and companion’s costs according to the exemption conditions; one-off financial help possible (ameli).