Sri Lanka · Medical reimbursements

Healthcare Reimbursement in Sri Lanka: Who Reimburses What Depending on Your Situation

Key points

The carte Vitale does not work in Sri Lanka: the CLEISS (the French Social Security Centre for European and International Liaison) lists no social security agreement between France and this country, and it is your status that designates the payer. The seconded employee in principle keeps French health insurance for three years, renewable once, with reimbursement on paid invoices within the limit of French rates. The local employee, the self-employed person, the retiree and the student choose between the CFE (the French social security fund for expatriates), international health insurance and the country's public services, free at the point of delivery according to the Ministry of Health. The tourist relies on travel insurance with assistance. The summary table sets out each case, then the page details the care items.

No France-Sri Lanka social security agreement in the CLEISS list: no European card, no totalisation of periods.
Secondment outside an agreement: 3 years, renewable once; reimbursement on paid invoices with form S 3125c, at most within the limit of French rates (CLEISS).
CFE: contributions that depend on age and the plan chosen, for the main offer (30 and over), the youth offer (under 30), the offer intended for retirees.
CFE waiting period: none if you join before departure or within 3 months of settling; otherwise 3 months before age 45 and 6 months from age 45.
CFE example: a GP consultation at the French rate of €25 is reimbursed €21 abroad with the main offer (offer page).
Return to France: waiting period of 3 months in principle, with free continuation of CFE benefits for 3 months for a member without activity (CLEISS).

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The Principle: Your Status Designates the Payer

The CLEISS keeps the list of States bound to France by a social security agreement. Sri Lanka is not on it: among Asian countries, the list shows Korea, India, Japan and the Philippines, as well as Israel and Turkey. No coordination therefore exists between the Sri Lankan and French schemes: no European card, no cross-coverage, no totalisation of periods. The French embassy points out that its services cannot cover any medical costs.

Four players can be involved: the Sri Lankan public services, the French scheme kept in place (secondment), the CFE and international health insurance. The notions of reimbursement base and out-of-pocket cost help compare offers. The local care offer is described in the page on the healthcare system in Sri Lanka.

Local-Contract Employee and Seconded Employee

The local-contract employee contributes to the Employees’ Provident Fund, which is a retirement provident fund (12% employer and 8% employee at minimum), not health insurance. The official pages read do not describe any compulsory health cover specific to private-sector employees: public services are free at the point of delivery according to the Ministry of Health, and many employers add private health insurance. The employment-related residence visa mentions a health protection plan. See the glossary entry on the local contract.

The seconded employee of a French employer remains affiliated to the French scheme, under domestic law, for three years renewable once (CLEISS). Contributions are paid in France as if the employee worked there, and staying in the scheme does not exempt you from any contributions due in Sri Lanka. Care is reimbursed within the limit of what France reimburses for the same care: the employee pays up front, then sends their paid invoices and form S 3125c to their fund. Sick leave must be declared within 48 hours and French family allowances are not paid if the children live in Sri Lanka. A supplementary contract covers the gap with private-sector rates. See seconded or expatriate employee and the glossary entry on the seconded employee.

Self-Employed Worker, Remote Worker and Student

The self-employed or remote worker has no employer to affiliate them. The digital nomad visa requires international health insurance covering care in Sri Lanka: this proof is part of the file. The CFE is the alternative for protection close to the French scheme. See digital nomad insurance.

The student chooses between the insurance offered by their institution, international insurance for students and, before age 30, the CFE youth offer. The insurance requirements of the visa and the university should be checked before departure; see student insurance abroad.

Retiree, Spouse and Children

The retiree does not fall under form S1, whose CLEISS page reserves its use for retirees who settle in the European Union, the European Economic Area or Switzerland. They choose the CFE (offer for retirees who draw a pension from a French basic scheme, with no medical questionnaire) or international insurance. The residence programme for seniors itself requires health insurance valid in Sri Lanka. See the guide to retiree health insurance abroad and the page on retirement in Sri Lanka.

The spouse and children follow the holder’s visa as dependants. The CFE and international insurers both offer family contracts; maternity requires conception after joining the CFE. See expat family insurance.

CFE Member: Country Scales, Waiting Period and Return to France

The CFE is a voluntary social protection body. In France, it reimburses according to the principles of the Assurance Maladie (the French national health insurance), with direct billing in public and private hospitals; abroad, reimbursement depends on the country of care and the nature of the care, with a rate or a lump sum applied to the actual invoice. As an example taken from the page of its main offer, a GP consultation whose French rate is €25 is reimbursed €21 abroad. When the local price exceeds the base used, the difference remains payable by the member: the guide to CFE reimbursements details this mechanism.

Offers: the main offer (30 and over) and the youth offer (under 30), each with a contribution that depends on age and the plan chosen, the offer intended for retirees (with a contribution that depends on age and the plan chosen); prices depend on the country, age and family situation. They cover consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines, including stays of less than three months in France.
Waiting period: none if you join before departure or within three months of settling; beyond that, three months before age 45 and six months from age 45.
Maternity: conception must come after joining or after being attached as a dependant.

On returning to France, affiliation is acquired from the first hour worked; without a return to work, universal health protection (PUMa) is examined on a residence criterion, with in principle a three-month waiting period. A CFE member without activity benefits, under conditions, from the expatriate scheme’s benefits for the three months following their return (CLEISS). See the guide to reducing the waiting period and the page on returning to France.

First-Euro Insurance and the Tourist

International health insurance with first-euro cover reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions of the contract. It meets France Diplomatie’s requirement for cover of care, hospitalisation and repatriation, and it is requested by several residence visas. Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of medical history.

The tourist stays up to 30 days with the ETA. France Diplomatie considers it imperative to hold insurance or an assistance contract covering all medical costs, surgery, hospitalisation and medical repatriation. Bank card assistance can supplement this arrangement, with ceilings to be checked. See long-stay travel insurance.

Item by Item: Consultation, Hospitalisation, Medicines, Dental, Optical, Maternity

Consultation: free in public services according to the Ministry of Health; paid directly in the private sector; reimbursed by the CFE on its country scale; at actual cost with a first-euro contract; under French rules for the seconded employee.
Hospitalisation: public services free at the point of delivery; French scheme for the seconded employee; CFE with the country scales; international contract with direct billing when the insurer offers it.
Medicines: provided free by the State in its establishments according to the ministry; reimbursed according to CFE scales; covered within the ceilings of an international contract.
Dental: included at the CFE according to its scales and in most international contracts up to an annual ceiling.
Optical: glasses and lenses fall mainly under international contracts, with ceilings per period; to be read in the benefits table.
Maternity: the CFE requires conception after joining; international contracts generally apply a waiting period to maternity.

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

Summary: Who Reimburses Depending on Your Situation

Situation	Who reimburses first	Condition or step	Point of attention
Local-contract employee	Free public services; employer's insurance where applicable	Health protection plan requested in the visa file	The EPF is a retirement fund, not health insurance
Seconded employee	French scheme kept in place, French rules	Secondment outside an agreement: 3 years renewable once, form S 3125c	Gap with private-sector rates; supplementary cover useful
Self-employed, remote worker	CFE or international insurance	International health insurance required for the digital nomad visa	Hospitalisation and repatriation to be planned
Retiree	CFE (offer for retirees) or international insurance	No form S1 outside the EU-EEA-Switzerland	Health insurance required for the seniors residence programme
Student	Student insurance, CFE youth offer before age 30	Visa and institution requirements to be checked	Ceilings and waiting periods
Spouse and children	CFE family contract or international insurance	Visa as dependants	Maternity, paediatrics, waiting periods
CFE member	CFE: scale of the country of care	Join before departure or within 3 months to avoid the waiting period	Out-of-pocket cost if the local price exceeds the base
First-euro insurance	Insurer: actual costs within ceilings	Medical questionnaire	Deductible, waiting period, exclusions, medical history
Tourist (ETA, 30 days)	Travel insurance or bank assistance	Take out before departure	Ceilings and length of cover
Return to France	Social security; CFE kept 3 months under conditions	Affiliation from the first hour worked, otherwise PUMa on a residence criterion	3-month waiting period in principle without activity

Sources: CLEISS, CFE, France Diplomatie, Ministry of Health of Sri Lanka, Department of Immigration and Emigration, Central Bank of Sri Lanka.

Frequently asked questions

Does the carte Vitale work in Sri Lanka?

No: the CLEISS lists no social security agreement between France and Sri Lanka. A seconded employee can obtain reimbursement under French rules on paid invoices; other profiles go through the CFE or private insurance.

Are Sri Lankan public services free for a foreigner?

The Ministry of Health states that services provided by the State are free at the point of delivery, medicines and laboratories included. The arrangements for access by a foreigner are not detailed in the official pages consulted: confirm them on the spot, and keep insurance covering care and repatriation.

How does the CFE reimburse care in Sri Lanka?

On a rate or lump sum specific to the country of care, applied to the actual invoice; the difference with the price charged remains payable by the member. The main offer, the youth offer and the offer for retirees each have a contribution that depends on age and the plan chosen, according to the CFE home page.

What is the CFE waiting period?

None if you join before departure or within three months of settling. Beyond that, it is three months before age 45 and six months from age 45. Maternity requires conception after joining.

Is a seconded employee reimbursed as in France?

They are reimbursed within the limit of what France covers for the same care, on paid invoices and with form S 3125c. Secondment lasts three years, renewable once, and a supplementary contract covers the gap with local rates.

Do you need insurance for the digital nomad visa?

Yes: the digital nomad visa file includes international health insurance covering care in Sri Lanka. The residence programme for seniors also requires health insurance valid in the country.

What happens for health cover on returning to France?

Affiliation is acquired from the first hour worked. Without activity, universal health protection is examined on a residence criterion with, in principle, a three-month waiting period; a CFE member without activity can benefit, under conditions, from its benefits during the three months following their return.