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

Turkmenistan does not appear in the list of social security agreements concluded by France, published by CLEISS. There is therefore no European card, no posting certificate provided for by an agreement, no totalisation of periods and no cross-coverage. France Diplomatie (the French foreign ministry) reminds that the embassy does not pay medical costs, that without a contract covering all costs and repatriation access to care can be refused, including in a life-threatening emergency, and that many international insurances do not cover Turkmenistan.

Four players can be involved: the Turkmen public system, whose costs are borne by the foreign patient, the retained French scheme (secondment), the CFE and an international health insurance. The notions of reimbursement basis and out-of-pocket cost help with comparison. How the local system works is in the guide Turkmenistan’s healthcare system. Before taking out a contract, ask both the CFE and the insurer for written confirmation that the country is covered.

The local-contract employee works on a visa based on the host organisation’s invitation letter. The pages consulted present no compulsory insurance scheme accessible to a foreign employee: contributions, access to public care and reimbursements should be confirmed with the employer, who normally funds private insurance with repatriation. See the glossary entry on the local contract.

The seconded employee sent by a French employer remains, in principle, attached to French Social Security during their assignment; in the absence of an agreement, this retention falls under French law on secondment outside an agreement. Duration, conditions and contributions should be checked with the Urssaf (the French social security contributions collection body) and CLEISS before departure. Costs are then reimbursed under French rules, on paid invoices, whatever price is asked on the spot; employers generally add a group assistance contract. See posted worker or expatriate and the glossary entry on the posted worker.

The self-employed person or digital nomad has no employer to fund their insurance: the CFE or an international contract forms the foundation, with repatriation and written confirmation that the country is covered. See digital nomad insurance.

The student chooses between the CFE (youth offer before age 30) and international student insurance; the host institution specifies its requirements. See student insurance abroad.

The spouse and children follow the status of the holder; the CFE and international insurers offer family contracts, with maternity and paediatrics depending on the contract. See expat family insurance.

The retiree is not covered by form S1, valid in the European Union. The CFE offers its retirees’ offer to holders of a pension from a French basic scheme, with no health questionnaire. See the guide health insurance for retirees abroad and the page retiring in Turkmenistan.

The CFE is a voluntary social protection body. In France, it reimburses according to Social Security principles; abroad, reimbursement depends on the scale of the country of care, applied as a rate or a flat amount to actual expenses. When the price asked exceeds the basis used, the difference remains payable by the member: the guide CFE reimbursements details this mechanism.

• Offers: the main offer (over 30, excluding retirees), the youth offer (under 30) and the retirees’ offer; the contribution is calculated on the simulator at cfe.fr.
• Waiting period: immediate cover if membership takes place before departure or within three months of settling in; beyond that, three months’ waiting, then six months from age 45.
• Maternity: conception must take place after membership or attachment.

On returning to France, without resuming work, a three-month period with stable residence applies before rights open; a CFE member without professional activity benefits free of charge from retention of rights for the first three months. See the guide reducing the waiting period and the page return to France.

International health insurance at the first euro reimburses actual costs within its limits, after any deductible, waiting periods and exclusions of the contract. It guarantees the medical repatriation that France Diplomatie judges necessary for serious cases: the contract is compared on written confirmation that Turkmenistan is covered, the annual limit, the coverage zone, evacuation and the handling of medical history.

The tourist travels with a visa and an invitation letter, often through a travel agency. France Diplomatie advises checking the terms of your insurance and having funds for hospitalisation or evacuation; bank card assistance can supplement it, with limits to be read. See long-stay travel insurance.

• Consultation: borne by the foreign patient in public facilities, unless covered by a contract; CFE on its country scale; actual costs for a first-euro contract.
• Hospitalisation: care, accommodation, linen, medicines and meals borne by the foreign patient; French scheme for the seconded employee; international contract with medical repatriation.
• Medicines: the quality of local medicines is not assured; take regular treatments with the prescription; CFE scales; limits of an international contract.
• Dental: according to the CFE scale and the annual limits of international contracts; to be checked before departure.
• Optical: mainly falls under international contracts, with limits per period; plan for spare glasses.
• Maternity: the CFE requires conception after membership; international contracts generally apply a waiting period; childbirth is prepared with the assistance provider, given the infrastructure.

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