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

Four players may reimburse your care in Togo: the French scheme kept in place (secondment), the Togolese scheme (CNSS and AMU), the CFE and international health insurance. The France-Togo social security agreement, signed on 7 December 1971, coordinates invalidity, old age and survivors, maternity, family benefits and work accidents. It coordinates neither the sickness branch, nor death insurance, nor unemployment: the right to care is therefore built through a specific status or a dedicated contract.

Reimbursement always depends on two amounts: the payer’s reference tariff and the price billed. The gap is the out-of-pocket cost, which varies with the reimbursement basis. The French embassy reminds us that the French State does not bear the health costs of its nationals abroad. The orders of magnitude of prices are brought together in the Togo country profile.

An employee recruited on a local contract falls under the Togolese scheme: any French national carrying out a professional activity in Togo, outside a secondment, is subject to Togolese social security legislation (CLEISS). The CNSS pays the benefits of the pensions, occupational risks and family benefits branches. For health costs, the AMU has been effective for private-sector workers since 1 January 2024: a contribution of 10% of pay, 5% for the employer and 5% for the employee; 80% of the reference price of the procedure covered, with 20% remaining payable by the insured person; a waiting period of three months from registration; dependants: legal spouse and dependent children aged 21 or under (CNSS of Togo). The general conditions do not address the situation of foreigners: confirm it with the CNSS.

CLEISS also reminds us that the Labour Code requires every employer to take out for its workers an insurance contract covering sickness and non-occupational accidents. Many employers offer a group policy giving access to private provision. Ask in writing for the level of cover, the ceilings, the list of facilities, the coverage of dependants, medical evacuation and the position during your stays in France. See the guide to seconded or expat and the glossary entry on the local contract.

An employee sent by their French employer to Togo under the agreement remains attached to the French scheme. CLEISS indicates that they keep French health insurance and the coverage of care received in Togo, with no additional contribution. Paid invoices are sent to the affiliation fund with form S 3125c “care received abroad”. Family members who accompany them benefit from coverage of care; those who stay in France continue to receive French benefits. The maximum length of the secondment does not appear in the pages consulted: confirm it with the affiliation fund.

As health costs may be higher than in France, CLEISS advises adapting your complementary health policy. In practice, care is reimbursed on the basis of French tariffs, which leaves an out-of-pocket cost on consultations and above all on hospitalisation in a private facility. A complementary policy suited to expatriation or international insurance closes this gap.

• Self-employed: an activity carried out in Togo generally attaches you to the Togolese scheme. Since January 2024, the AMU has been open to self-employed workers, the informal economy and agricultural sectors, with the CNSS describing an offer dedicated to non-salaried workers. Voluntary enrolment in the CFE keeps rights to French health insurance; international insurance gives access to private provision with direct billing.
• Student: health insurance is not among the entry documents listed by France Diplomatie (the French foreign ministry), which states that cover for medical costs and repatriation is imperative. The agreement does not coordinate sickness: dedicated insurance with assistance is the suitable solution (see student insurance abroad).
• Spouse and children: for a seconded employee, the family that accompanies them is covered by the French scheme. For an employee on a local contract, the AMU covers the legal spouse and dependent children aged 21 or under; also check that the group contract includes dependants. See children’s cover abroad.

CLEISS reminds us that the 1971 agreement offers a French retiree no coverage of care in Togo. They voluntarily enrol in the CFE (for French nationals) or take out private insurance, with a medical questionnaire, ceilings and evacuation depending on the policy. With no tax residence in France, the French pension bears a health contribution of 3.2% on the basic pension and 4.2% on the complementary pension, and 7.1% for self-employed workers’ schemes, in place of the CSG, the CRDS and the Casa.

During temporary stays in France, care is covered if the pension reflects at least 15 years of insurance in France, comes from a French basic scheme and the retiree carries out no activity; hospitalisation beyond one month requires prior recognition of medical necessity. The spouse who accompanies them is not covered by this scheme. Details are in the guide to retirees’ health insurance abroad and on the page on retiring in Togo.

The CFE reimburses under French health insurance rules, with care received abroad reimbursed according to the country of care, with a rate or a flat amount applied to the actual bill. If you enrol before departure or within three months of settling, cover starts immediately; beyond that, a waiting period of three months applies before age 45 and six months from age 45. The co-payment (ticket modérateur) and extra-billing remain payable by the member or their complementary policy. Details are in CFE reimbursements.

International health insurance at first-euro level reimburses actual costs within its ceilings, without going through the French tariff or a local scheme, and often works with direct billing. The medical questionnaire, waiting periods and exclusions vary: compare with CFE or private insurance.

Repatriation and medical evacuation: these fall under an assistance policy, which France Diplomatie describes as imperative alongside cover for medical costs and hospitalisation, as the embassy cannot bear any of them. The general conditions of the AMU do not include care abroad, unless otherwise provided. Check the ceiling, the transfer destinations and the coverage of an accompanying person (page on repatriation and assistance).

Tourist or short stay: the agreement gives no right to reimbursement of care received in Togo during a trip. Travel insurance or expat insurance with assistance is the suitable solution (see long-stay travel insurance). An additional protocol maintains certain cash benefits of sickness insurance for 6 months at most on a transfer of residence (CLEISS).

Return to France: after stable and regular residence of 3 months, the opening of rights to universal health protection (PUMA) is requested from the local health insurance fund (CPAM) with form S1106; if you resume an activity in France, affiliation is acquired from the first hour worked (service-public.gouv.fr). To cover the waiting period, see insurance for returning to France.

• Consultation: the AMU covers general and specialist consultations at 80% of the reference price; the CFE applies the basis of the country of care; international insurance reimburses actual costs within the ceiling.
• Hospitalisation: the AMU covers hospitalisation in the health facilities of its network. To avoid advancing costs in a private facility, international insurance offers direct billing; the private room often remains payable by you.
• Medicines: the AMU reimburses essential medicines at 80% of the reference price; the CFE reimburses on its basis; international insurance according to its table of guarantees.
• Dental and optical: these items are not in the list of benefits read in the general conditions of the AMU; look at annual ceilings, waiting periods and renewal frequency in your CFE or international insurance contract.
• Maternity: the AMU covers pregnancy and childbirth, and the CNSS pays a maternity allowance for 14 weeks (CLEISS). International contracts frequently provide waiting periods: take out cover well before pregnancy.

Health is the item to secure before departure, and Expavy helps you compare these guarantees according to your profile.