Healthcare Reimbursement at the Holy See: Who Reimburses What Depending on Your Situation

The CLEISS lists no social security agreement between France and the Holy See, and Italy, which applies the European coordination regulations, does not make the Vatican a territory covered by these regulations. The Holy See is not a member state of the European Union. For member states, the European Commission reminds us that cover depends on economic situation and place of residence, not on nationality: a French national who lives in Rome therefore falls under Italian and European rules, whereas an employee of a Vatican entity also falls under their employer’s rules. Three players can be involved: the Vatican employer’s scheme (FAS), the Italian scheme for residence in Rome and the CFE or international insurance.

The notions of reimbursement basis and out-of-pocket cost help compare offers. How the system works is presented in the Holy See’s healthcare system; the Italian framework in healthcare reimbursement in Italy.

The lay employee of an administration of the Holy See or the Governorate falls under the rules of their employer, including the health assistance fund (FAS), based at the Palazzo del Belvedere. The FAS publishes a service charter, pages on direct and indirect assistance, a single desk, an online desk, statutes and regulations. Beneficiaries, rates and ceilings can be read in these documents, no official source read publishing the amounts in the pages consulted. Private supplementary insurance can complement the cover for care in Rome and evacuation. See the glossary entry local contract.

A seconded employee of a French employer remains affiliated to French social security during their assignment, under the conditions of secondment outside an agreement: duration, conditions and contributions should be checked with the Urssaf (the French social security contributions collector) and the CLEISS before departure. Costs are reimbursed under French rules, on paid invoices. See seconded or expatriate and the glossary entry seconded employee. A member of the clergy or a religious assigned by a sending authority depends first on the cover of that institution.

A self-employed person working from Rome falls under the system of the country of residence: Italy; the pages on Italy detail voluntary affiliation and tickets. They can also choose the CFE or international insurance. See digital nomad insurance.

A student under 30 can join the CFE youth offer or take out student insurance; access to the Italian system depends on their student status. See student insurance abroad.

The spouse and children follow the policyholder’s cover when it provides for dependants; the CFE offers family contracts, for the main offer, with a quarterly contribution that depends on the ages of the household members (current amounts on cfe.fr), and the FAS regulations specify any dependants. See expatriate family insurance.

According to the Assurance Maladie (the French national health insurance), a retiree of the general scheme who settles permanently in a European Union state requests the E 121/S1 form from their pension fund before departure; they use it to register with the social protection body of the country where they live, which covers them under its rules. This mechanism applies to residence in Rome, in Italy, and not to residence in Vatican City, which is not a member state: a retiree housed by an institution of the Holy See relies on that institution, on the CFE (retiree offer; current contribution on cfe.fr) or on private insurance. During a stay in France, a retiree keeps their rights and can use their Carte Vitale if they have kept it. See the guide S1 form: how to use it, health insurance for retirees abroad and the page retiring at the Holy See.

The CFE reimburses abroad according to a rate or flat amount specific to the country of care applied to the actual expense; the gap with the invoice remains payable by the member (CFE reimbursements). Cover is worldwide, including stays of less than three months in France. The waiting period is zero if joining takes place before departure or within three months of settling in; beyond that, it is 3 months before age 45 and 6 months from age 45. For maternity, conception must come after joining or after attachment as a dependant.

First-euro insurance reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions; with direct billing, it avoids the advance of costs in Rome facilities. The tourist or pilgrim stays in Italy: France Diplomatie advises requesting the European Health Insurance Card at least fifteen days before departure and taking out a contract covering all costs, repatriation included; see long-stay travel insurance.

On return to France, the CFE applies no waiting period; the reopening of rights is requested from the CPAM (the primary health insurance fund) with form S1106 (Assurance Maladie). See return to France and reducing the waiting period.

• Consultation: covered under the FAS for its beneficiaries, or under the Italian scheme for a Rome resident; reimbursed by the CFE on its country scale; actual costs within the ceilings of a first-euro contract.
• Hospitalisation: direct or indirect FAS assistance for its beneficiaries, Italian scheme for a Rome resident, French scheme for a seconded employee, CFE or international contract for the others.
• Medicines: the Vatican pharmacy supplies the territory; reimbursed according to the CFE scale or within the ceilings of an international contract.
• Dental: to be checked in the FAS charter; included at the CFE according to its scale and in most international contracts, with an annual ceiling.
• Optical: mostly covered by international contracts, with per-period ceilings to be read in the table of benefits.
• Maternity: covered under the FAS regulations for its beneficiaries or the Italian scheme; the CFE requires conception after joining; usual waiting period in international contracts.

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