Healthcare Reimbursement in Serbia: Who Pays for What Depending on Your Situation

Serbia is not a member of the European Union: the European health insurance card is not valid there. France and Serbia do, however, apply the social security agreement of 6 November 2014 and its administrative arrangement of 15 March 2018 (CLEISS). It opens specific rights depending on the situation: urgent care during a temporary stay, retention of the French scheme for posted workers, registration with the local fund for certain retirees. Outside these cases, it is your status that determines the payer: the Serbian scheme, the CFE or international insurance. The notions of reimbursement basis and out-of-pocket cost help with comparisons. How the RFZO works is set out in the guide Serbian healthcare system.

The local employee is affiliated to the RFZO by their employer, with a 5.15% sickness contribution on the employee side and 5.15% on the employer side; rights open after 3 months of continuous contributions or 6 discontinuous months over the last 18 months. The care provided for in the fund’s package is covered in public establishments and in contracted private establishments, with a patient contribution (see below). Care in a non-contracted clinic remains at the insured person’s expense: private supplementary cover opens direct access to this sector. See the glossary entry on the local contract.

The posted employee of a company established in France keeps French affiliation with no additional Serbian contribution. They hold the certificate SE 21-01/SRB-FR 101 and the certificate SE 21-09/SRB-FR 128. Two options are open to them: present these forms to the Serbian fund, which registers them and gives them a local card, so that they are treated under Serbian rules; or pay for the care and send the paid invoices with form S 3125c to their French fund. A family living on site follows the same options, while a family that stayed in France continues to use the French fund. Daily allowances are paid by the French fund, with a sick-leave notice sent within 48 hours. CLEISS recommends checking with the supplementary health insurer whether the contract needs to be adapted, as care may cost more than in France. See posted worker or expatriate and the glossary entry on the posted worker.

A self-employed person settled in Serbia registers and contributes directly to the RFZO: 10.30% for sickness, maternity and accidents, within the total of 35.05% recorded by CLEISS. They can also choose the CFE or international insurance, particularly to gain access to private clinics and repatriation. A self-employed person posted from France comes under the bilateral agreement like a posted employee. See digital nomad insurance.

The student is not mentioned by the CLEISS page on temporary stays. The Serbian Ministry of the Interior requires, for the study residence permit, proof of health cover, which can be an insurance policy. Before age 30, the CFE offers its youth offer; student insurance contracts complete the picture. See student insurance abroad.

The spouse and children of an employee or self-employed person affiliated to the RFZO are dependants: married spouse or partner, children under 18 (26 if they are studying) and other dependent family members. For the family of a posted worker, see above. The guides expat family insurance and living in Serbia complete the picture.

CLEISS distinguishes three situations: French pension only, French and Serbian pensions, French pension with activity in Serbia. For the retiree who receives only a French pension and has no rights in the Serbian scheme, the France-Serbia agreement opens local health cover whatever their nationality. They request from the fund that pays their basic pension the form SE 21-08/SRB-FR 121, which certifies their entitlement to benefits in kind and that of their resident family, then register with the local Serbian fund; retirees of the general scheme use the “health care rights abroad” questionnaire of Assurance retraite (the French pension fund). State pensioners report their departure to their management centre, then the Nantes office issues the form.

During a temporary stay in France, the same form opens cover for urgent care; only the pensioner and their minor children are covered, and a spouse living abroad is not, hence the value of private insurance. The CFE also offers a retirees’ offer. See the guide retirees’ health insurance abroad and the page retiring in Serbia.

The CFE reimburses in Serbia on a rate or flat amount specific to the country of care, applied to actual expenses; the example given by the fund is a French general practitioner consultation set at €25 and reimbursed at 70%, or €21. In France, it follows the principles of Assurance Maladie, with direct payment in public and private hospitals, for stays of under three months. The contributions shown depend on age and the plan chosen, for the main offer (over 30), the youth offer (under 30) and the retirees’ offer. The waiting period is nil if membership takes place before departure or within three months of settling; after that, it lasts three months before age 45 and six months from age 45. Maternity requires conception after membership. See CFE reimbursements.

International health insurance on a first-euro basis reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. France Diplomatie (the French foreign ministry) points out that hospitalisation costs in Serbia can be very high and that the embassy cannot pay them: a contract covering surgery, hospitalisation and repatriation is the official recommendation.

The tourist insured in France presents form SE 21-05/SRB-FR 111, requested from their fund before departure: urgent care is then paid by the Serbian insurer under Serbian law, and daily allowances continue to be paid by the French fund. Without this form, the insured person can ask for reimbursement of unforeseen care on paid invoices, which CLEISS describes as “a possibility and not an obligation”. The form covers neither planned care nor repatriation: see long-stay travel insurance.

On returning to France, Assurance Maladie states that a 3-month waiting period applies to a French national with no professional activity before affiliation to the CPAM (local health insurance office) under the PUMa (universal health cover); a CFE member with no activity benefits free of charge from retention of rights for the 3 months following definitive return. See reducing the waiting period and return to France.

• Consultation: contribution of about 50 dinars for an RFZO insured person (CLEISS); country scale for the CFE; French or direct reimbursement under Serbian rules for the posted worker; actual costs for a first-euro contract.
• Hospitalisation: contribution of about 50 dinars per day for an RFZO insured person, emergencies fully covered in public and contracted private establishments; CFE direct payment in France; direct cover possible with an international contract.
• Medicines: contribution of 10% to 90% depending on the fund’s list; country rate or flat amount for the CFE; ceilings for an international contract.
• Dental: care covered by the RFZO, with no contribution rate specified by CLEISS; CFE scale; annual ceiling in most private contracts.
• Optical: glasses, hearing aids and dental prostheses are in the RFZO package, with a contribution of 10% to 35% depending on the device; ceilings per period in private contracts.
• Maternity: monitoring of pregnancy, childbirth and the following year free for the RFZO insured woman; the CFE requires conception after membership; waiting period common in private contracts.

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