Healthcare Reimbursement in Western Sahara: Who Pays What Depending on Your Situation

The CLEISS lists Western Sahara neither among the social security agreements in force nor among those signed but not yet in force. Morocco is among the agreements in force; the pages consulted do not specify whether this agreement applies to the territory, and no CLEISS page is devoted to the latter. The reliable approach is to put the question in writing to the CLEISS (+33 1 45 26 33 41) or to your fund, then to reason according to the answer. This page describes the most prudent case, that of the country with no agreement, and recalls what changes if an agreement applies.

In the case of a country with no agreement, the CLEISS indicates that care abroad is entirely at the traveller’s expense unless the fund has given prior authorisation. Three players can step in depending on status: the maintained French scheme (secondment), the CFE and international health insurance. In all cases, France Diplomatie considers it essential, in its advice on Morocco, to have a contract covering medical costs, hospitalisation and medical repatriation, as the French embassy cannot pay them. The notions of reimbursement base and out-of-pocket cost help you compare offers. See also bilateral social security agreement.

A posted employee sent by their French employer remains affiliated to the French scheme. Without an applicable agreement, domestic law applies (articles L. 761-2 and R. 761-1 to R. 761-6 of the Social Security Code): three years renewable only once, then two years before a new secondment to the same country for the same company. Care is covered within what France would cover for the same care: they send their paid invoices, with form S 3125c, to their home fund, and the dependants with them do the same. If the cost of care is high, additional private insurance can be taken out. Sick leave is sent to the fund within 48 hours, and French family allowances are not paid for children who do not live in France. If an agreement applies, its rules and forms prevail. See the posted worker glossary entry.

An employee on a local contract leaves the French scheme: the CLEISS specifies that they “will no longer be covered by French social security” and must return their carte Vitale (the French health insurance card). Health cover comes through the local scheme, which the sources read do not describe, through a group policy from the employer, through the CFE (sickness, maternity, disability, work accidents and basic retirement) or through international insurance. See local contract and secondee or expatriate.

A self-employed person has no employer to cover them: the CLEISS indicates that the CFE protects expatriate self-employed workers for sickness and maternity. International insurance with hospital care and repatriation remains the most complete solution for a long stay; see digital nomad insurance.

A student is treated by the CLEISS according to the length of their stay in a country with no agreement. For less than six months, only article R. 160-4 of the Social Security Code can open a reimbursement: the fund may pay a flat sum, without being obliged to and with no right of appeal, for unforeseen care whose costs have been advanced, within French rates. Beyond six months, a student over 20 no longer comes under French health insurance; a student under 20 keeps the status of family member. In both cases, private insurance or the CFE (youth offer before age 30) completes the arrangement. See insurance for students abroad.

The spouse and children of a posted employee are reimbursed like them, with the same form. The non-working spouse of an expatriate may continue voluntary insurance if they were compulsorily insured in France for at least six months and if they apply within six months of the end of that insurance; an alternative route exists with a dependent child under 20 and at least five years of compulsory cover, according to the CLEISS. See expat family insurance.

According to the Assurance Maladie (the French public health insurance), a retiree who settles outside the European Union no longer has their healthcare costs covered by French health insurance, unless a bilateral agreement allows them to claim care on the spot. The Assurance Maladie cites Morocco in the list of these agreements; as its application to Western Sahara is not specified, the retiree has it confirmed by their fund or the CLEISS before leaving. Failing that, they join the CFE or take out private insurance. The CFE retirees’ offer is aimed at holders of a pension from the French basic scheme who no longer carry out any activity, with no health questionnaire. Form S1 concerns European countries, not this territory. For stays in France, a general scheme retiree registers with the national centre for French retirees abroad; in a country with no agreement, reimbursement requires 15 years of contributions to French schemes. See a retiree’s health insurance abroad and the page on retirement.

The CFE is a voluntary social protection body. In France, it reimburses under the principles of the Assurance Maladie, with direct payment in public and private hospitals; abroad, it reimburses according to the country of care through a rate or flat fee applied to the actual bill. As an example given by the CFE, a GP consultation priced at €25 is reimbursed €21 (70%). The scale applicable to the area of stay is read in the benefits table; the gap with the price charged remains the member’s responsibility (see CFE reimbursements).

• Offers: main offer (age 30 and over) and youth offer (under 30), each with a contribution that depends on age and the plan chosen, with no health questionnaire and no exclusion once a member.
• Waiting period: none if membership takes place before departure or within three months of settling; otherwise three months for those under 44 and six months for those over 45 (see waiting period).
• Maternity: conception must come after joining or after being attached as a dependant.

On returning to France, a person who takes up work again is covered for their healthcare costs from the first hour worked; without activity, they apply for the universal health protection (PUMa), with in principle a three-month waiting period (CLEISS). Periods of voluntary CFE membership may count, and the expatriate scheme’s benefits may be kept for up to three months under conditions. See reducing the waiting period and returning to France insurance.

International health insurance from the first euro reimburses actual costs within its limits, after any deductible, waiting periods and exclusions of the policy. For Western Sahara, the first criterion is the zone covered: the insurer confirms in writing that the territory is part of it and that assistance operates there. Next come the limits, medically supervised transport, the handling of medical history and direct payment, which avoids advancing costs that establishments may demand before the patient leaves (France Diplomatie).

A tourist relies on travel insurance. The CLEISS indicates that, in a country with no agreement, no cover on the spot is possible, that an optional reimbursement of unforeseen care can be requested after returning to France, that the Assurance Maladie does not cover medical repatriation and that a travel contract with limits matching local costs is recommended. Bank card assistance can complement this, with limits to check. See long-stay travel insurance.

The official sources read publish no care tariff for the territory: the amounts are therefore not given, and each item should be read in the chosen policy.

• Consultation: reimbursed on paid invoices within French rates for a posted worker; according to the scale of the country of care for the CFE; at actual cost within the limits for a first-euro policy.
• Hospital care: must be covered; full payment sometimes required before leaving; direct payment to be sought in the contract.
• Medicines: to be taken in the original packaging with a prescription in international non-proprietary form; reimbursement follows the rules of the status.
• Dental and optical: the CFE covers dental care according to its scales; optical comes mainly under international policies, with limits per period.
• Maternity: for a person insured in France who gives birth in a country not listed by the CLEISS, benefits are not paid; the CFE requires conception after joining.

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