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

The CLEISS keeps the list of France’s bilateral social security agreements: Rwanda does not appear in it. With no agreement, no coordination exists between the French and local schemes: no European card, no aggregation of periods, no cross-coverage. France Diplomatie (the French foreign ministry) adds that the French embassy cannot cover any medical costs and describes as imperative an assistance contract covering medical costs, hospitalisation and repatriation; without cover, access to care may be refused, even in a life-threatening emergency.

Four payers may be involved: the local scheme, the French scheme kept in place (secondment), the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help you compare offers. How care is organised is presented in the guide to the Rwandan healthcare system.

The employee on a local contract relies on the Rwanda Social Security Board (RSSB) system. For the community-based health insurance (CBHI), the RSSB indicates that citizens and residents not covered by another scheme may enrol, per household, with an annual contribution per person of between RWF 4,000 and 20,000 depending on the income category; care is covered in approved public and partner facilities, and some private facilities may accept it under agreement. The page does not specify the situation of foreigners: it is checked with the RSSB. Complementary private insurance opens direct access to private facilities and to evacuation. See the glossary entry on the local contract.

The seconded employee sent by a French employer remains affiliated to the French scheme for 3 years, renewable once, i.e. 6 years at most (CLEISS). Contributions are paid in France, and local contributions may remain due. Care is covered up to the French benefits for the same care: paid invoices are sent with form S 3125c to the fund of affiliation. The CLEISS suggests private complementary insurance when care is expensive locally. Sick leave is sent to the fund within 48 hours, and a work accident to the employer within 24 hours. See seconded or expat and the glossary entry on the seconded employee.

The self-employed person or digital nomad has no local employer to enrol them in a scheme: they choose between the CFE, a voluntary body open to French nationals, and international insurance covering hospitalisation, outpatient care and medical repatriation. See digital nomad insurance.

The student: the RSSB describes enrolment in the community health insurance per household; the situation of a foreign student is checked with the RSSB and the host institution. Before age 30, the CFE offers its youth plan (with a contribution that depends on age and the plan chosen). See student insurance abroad.

The retiree is not covered by form S1, which is valid in Europe. The CLEISS indicates that, with no agreement, the retiree finds out what share the local scheme covers, joins the CFE or takes out private insurance. For the K permit (assured income, retirees who do not work), Rwandan immigration asks for local Rwandan health insurance, to be taken out before filing the application. The CFE offers its retirees’ plan (with a contribution that depends on age and the plan chosen). During a temporary stay in France, cover requires a pension from a French basic scheme corresponding to at least 15 years of insurance; retirees of the general scheme outside the European Union fall under the CNAREFE. If tax residence is no longer in France, the CSG, the CRDS and the Casa are no longer withheld; a health insurance contribution of 3.2% on the basic pension and 4.2% on the complementary pension applies in case of dependence on a French scheme. See the guide to retirees’ health insurance abroad and the page on retiring in Rwanda.

The spouse and children of the seconded employee are covered on the same terms as them and also send their invoices and form S 3125c (CLEISS); the CFE and international insurers offer family contracts, with paediatrics and maternity depending on the contract. See expat family insurance.

Abroad, the CFE reimburses according to a rate or flat amount specific to the country of care, applied to the amount actually spent. Example given by the CFE: a GP consultation under the national agreement at €25 in France is reimbursed at 70%, i.e. €21, and the CFE reimburses the same amount for the same consultation abroad. When the local price exceeds the basis used, the difference remains payable by the member: the guide to CFE reimbursements details this mechanism.

• Benefits: consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines, including during stays of less than three months in France.
• Waiting period: care is covered immediately if enrolment takes place before departure or within three months of settling; beyond that, three months before age 45 and six months from age 45. No health questionnaire.
• Maternity: conception must be after enrolment or after joining as a dependant.

On returning to France, an employee who resumes work is affiliated from the first hour worked. Without activity, a 3-month waiting period is in principle provided for countries with no agreement, and a CFE member may, under conditions, receive the benefits of the expatriates’ scheme during the 3 months following the return (CLEISS). See the guide to reducing the waiting period and the page on returning to France.

International health insurance at first-euro level reimburses actual costs within its ceilings, after any excess, waiting periods and contract exclusions. It gives access to private facilities with direct billing and organises medical evacuation, which France Diplomatie considers essential. Contracts are compared on the annual ceiling, the coverage zone, evacuation, maternity and the handling of medical history.

The tourist is reimbursed by Assurance Maladie (the French national health insurance), on their return, only for urgent and unforeseen medical care, on paid invoices and form S3125, at the flat-rate French tariffs in force; a medical adviser decides whether the situation was urgent, with no appeal if refused, and daily allowances are not paid outside the European Union (Assurance Maladie). The free 30-day tourist visa is issued on arrival (France Diplomatie). Travel insurance with assistance therefore remains necessary: see long-stay travel insurance.

• Consultation: covered in approved facilities for a scheme member (from RWF 200 according to the RSSB); payable by the patient in the private sector unless covered by a contract; reimbursed by the CFE on its country rate; actual costs with a first-euro contract.
• Hospitalisation: public and partner facilities for a scheme member; French scheme for the seconded employee; CFE with reimbursement abroad; international contract with direct billing and evacuation.
• Medicines: under the scheme’s arrangements for a member; reimbursed by the CFE on its country rate; covered within the ceilings of an international contract; no purchases in the street (counterfeits).
• Dental: included with the CFE according to its rates and in most international contracts within an annual ceiling; the extent of the scheme’s benefits is checked with the RSSB.
• Optical: glasses and lenses fall mainly under international contracts, with ceilings per period; to be read in the table of benefits.
• Maternity: CFE if conception follows enrolment; international contracts generally with a waiting period; the scheme’s benefits to be checked with the RSSB.

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