Healthcare Reimbursement in Uruguay: Who Reimburses What, Depending on Your Situation

France and Uruguay are bound by a social security agreement signed in Montevideo on 6 December 2010 and in force since 1 July 2014 (CLEISS). It covers sickness, maternity, paternity, work accidents, old age, invalidity, survivors and family benefits, and organises the totalisation of insurance periods. It does not create a card giving access to care in both countries: the general rule is affiliation to the scheme of the country where you work, and CLEISS indicates that the family that stayed in France has no rights on the basis of the activity in Uruguay.

Four players can therefore come into play depending on your profile: the Uruguayan scheme (FONASA and the chosen provider), the French scheme kept in place (secondment), the CFE and international health insurance. The notions of reimbursement base and out-of-pocket cost help you compare offers; the page on the healthcare system in Uruguay explains the local organisation.

Employee on a local contract. They are affiliated from the first day of work, contribute 18.10% of pay, of which 3% for sickness in the CLEISS table, and choose a provider (ASSE or mutual provider). Their dependants are children under 18 and the spouse or partner with no cover of their own. See the notion of a local contract.

Seconded employee. They keep French health insurance for 24 months at most, with no additional contribution. Care received in Uruguay is reimbursed under French legislation: they send their fund the paid invoices with form S 3125c, and their dependants who accompany them follow the same procedure. A sick-leave certificate must be sent to the fund within 48 hours. CLEISS advises contacting the supplementary health insurer to adapt the contract, because Uruguayan healthcare costs can exceed French ones. See seconded worker.

Self-employed. They are covered by the Uruguayan scheme for sickness and maternity, with a contribution of 8% for sickness. The scheme provides neither unemployment insurance nor family benefits, and income protection as well as cover outside a provider are completed by international insurance.

Retiree. CLEISS is explicit: the France-Uruguay agreement provides no reimbursement of care received in Uruguay on the basis of a French pension. Two options exist: voluntary membership of the CFE, or insurance with a private company. During a temporary stay in France, a retiree with at least 15 years of insurance, who draws a pension from a basic scheme and has no professional activity, is reimbursed for their care; the spouse who accompanies them is not covered. A retiree of the general scheme is handled by the CNAREFE, attached to the CPAM of Seine-et-Marne. A levy of 3.2% on the basic pension, 4.2% on the supplementary pension and 7.1% on the self-employed pension may apply in place of the CSG (the generalised social contribution), if tax residence is outside France.

Student. According to CLEISS, for a stay of under 6 months, the French fund may reimburse unforeseen care on a flat-rate basis, on an optional basis and after the costs have been advanced. Beyond 6 months, a student over 20 is no longer covered by French health insurance and takes out cover locally, with the CFE or a private insurer; under 20, they keep their status as a family member. See student insurance abroad.

Spouse and children. If they live in Uruguay with an affiliated employee, they are FONASA dependants; if they accompany a seconded worker, they remain under the French scheme; if they stayed in France, they turn to the CPAM of their place of residence. See expat family insurance.

Tourist (stay of up to 90 days). No insurance is required on entry, but France Diplomatie considers essential a contract covering care, hospitalisation, surgery and repatriation, since the embassy cannot cover these costs.

The CFE offers, according to its website, its main offer (with a contribution that depends on age and the plan chosen) for those aged 30 and over, its youth offer (with a contribution that depends on age and the plan chosen) for those under 30 and a retiree offer (with a contribution that depends on age and the plan chosen). It is open without a health questionnaire. If you join before departure or within three months of settling, cover is immediate; otherwise the waiting period is three months before age 44 and six months beyond age 45. Abroad, reimbursement depends on the country of care and the procedure, with a rate or a flat amount applied to the actual expense. Maternity requires conception after joining. See CFE contributions.

First-euro insurance reimburses actual costs within the contract’s ceilings, with direct payment to the provider possible; excesses, waiting periods, exclusions and pre-existing conditions determine the out-of-pocket cost. See first euro.

Return to France. The CFE member keeps their rights for up to three months after returning, the time it takes to affiliate to the CPAM of their place of residence with form S1106. According to ameli (the Assurance Maladie website), the waiting period applicable to people without activity can be lifted where a social security agreement exists with the country of residence, which is the case for Uruguay: confirmation is requested from the CPAM. See return-to-France insurance.

• Consultation: covered by the provider for a FONASA member, with a co-payment depending on the mutual provider; reimbursed under French legislation for a seconded worker; according to the CFE’s country scale.
• Hospitalisation: within the provider’s network for a member; French scheme for the seconded worker; CFE or international contract for a retiree; for a stay without cover, the invoice is payable in full by the patient.
• Medicines: included in the benefits in kind of the Uruguayan scheme (medical, surgical and pharmaceutical care); reimbursed according to the CFE’s scales or the ceilings of an international contract.
• Dental: the extent of cover depends on the chosen provider and the contract; check the benefits table before joining.
• Optical: the BPS contributes towards glasses, contact lenses and hearing or orthopaedic aids for members (CLEISS); international contracts set ceilings per period.
• Maternity: leave of 6 weeks before and 8 weeks after the birth, with an allowance paid by the BPS; the CFE requires conception after joining, and international contracts generally apply a waiting period.

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