The Healthcare System in Uruguay: Organisation, Access for Foreigners and Emergencies

The National Integrated Health System (SNIS), overseen by the Ministry of Public Health (MSP), provides medical cover through public and private providers (CLEISS). The public provider is the State Health Services Administration (ASSE), which runs the public hospitals and health centres. The private providers are the collective medical assistance institutions (IAMC, usually called mutual providers) and the particular private medical assistance institutions (IAMPP).

FONASA (the National Health Fund) is not a care provider but a funding body, managed with the Social Welfare Bank (BPS). The declared worker is affiliated to it and chooses their provider: the ASSE network or a mutual provider. Covered care includes consultations, tests, medicines, surgery and hospitalisation with the chosen provider, with a BPS contribution towards glasses, contact lenses and hearing or orthopaedic aids (CLEISS).

The page on expat insurance in Uruguay gives the general overview; the page on healthcare reimbursement in Uruguay details who pays depending on status.

According to CLEISS, those covered are pensioners, employees from their first day of work, the self-employed, the unemployed for the three months following dismissal and recipients of social assistance. For a worker, opening rights requires monthly pay of at least 1.25 BPC (around 8,200 pesos), or 13 days worked in the month at 8 hours a day, or cover through unemployment insurance or sickness or maternity benefits. Dependants are children under 18 in the insured person’s care (with no age limit in the case of disability) and the spouse or partner with no entitlement of their own.

The BPS publishes the FONASA rates. The personal contribution is 3% for pay up to 2.5 BPC, whatever the family situation without a spouse, and 5% with a spouse or partner without cover of their own. Beyond 2.5 BPC, it rises to 4.5% with no spouse or children, 6% with no spouse but with children, 6.5% with a spouse and no children and 8% with a spouse and children. The employer contribution is 5%, increased by the mutual-fee supplement where it applies. The BPS page shows an old update: these rates are to be confirmed with the body before any calculation.

For a foreigner, access follows the same path as for an Uruguayan: declared employment opens affiliation and the choice of a provider. The legal residence file also requires a work health card and a vaccination certificate issued by an authorised provider in Uruguay (decree 136/2018). Without declared employment, a mutual provider subscription or international insurance takes over, because the France-Uruguay agreement does not provide for reimbursement of care received locally by a retiree.

In the SNIS, the care pathway goes through the provider to which you are affiliated: you see a doctor in its network, who refers you to a specialist, a test or a hospital stay in the same provider’s establishments. Members of a mutual provider generally pay a co-payment per procedure and per prescription; these amounts are found in the fee schedule of the chosen provider. ASSE members go to public centres and hospitals, such as the Maciel hospital in Montevideo, where the ASSE has set up a departure base for the SAME 105 mobile emergency service.

CLEISS specifies that the BPS pays the sickness allowance: 70% of base pay (the average of earnings over the 180 days before the leave), after three waiting days and subject to three months of contributions in the last twelve months. The maximum duration is one year, extendable. Maternity gives 6 weeks of leave before the birth and 8 weeks after, 14 weeks at most, and paternity leave for employees is 17 days paid at 100%. These amounts correspond to the values published by CLEISS.

The page on budgeting for your health abroad helps you work out the cost of the subscription, co-payments and out-of-pocket costs.

9-1-1 is the general emergency line, which centralises calls to the police, the fire service and mobile medical emergency teams (Ministry of the Interior). 105 is the out-of-hospital medical emergency service (SAME), attached to the ASSE, which also coordinates transfers to intensive care. An official app, Emergencia 9-1-1, geolocates the caller: the phone’s GPS must be switched on to use it.

Without affiliation to a provider, the cost of care remains payable by the patient, hence the importance of an assistance contract. The French embassy in Montevideo (avenida Uruguay 853, +598 21705 0000) cannot cover these costs, France Diplomatie reminds readers. The steps for medical repatriation are explained in the guide to how a medical repatriation works.

France Diplomatie recommends taking only the medicines you need, in their original packaging, with a prescription stating the international non-proprietary name, and checking that they are authorised in Uruguay, where the entry of medicines is particularly controlled. For a chronic treatment, it is prudent to confirm with your usual doctor before departure that the drug is available in Uruguay.

On vaccines, the sheet asks you to be up to date with the French vaccination schedule (diphtheria, tetanus, polio, whooping cough, measles) and suggests, depending on the conditions of the stay, hepatitis A, typhoid fever, hepatitis B, rabies for young children and rural areas, and chikungunya and dengue for a long stay. France Diplomatie publishes occasional alerts, for example on measles in the Americas.

The health risks cited are dengue, reported as far as Montevideo and in the departments bordering the Uruguay River (Colonia, Soriano, Río Negro, Paysandú, Salto, Artigas), chikungunya, zika, typhoid fever and rabies. Prevention rests on protection against mosquitoes, food hygiene and safe or bottled water. Anti-inflammatory drugs are to be avoided if dengue symptoms appear, and pregnant women see a doctor before travelling because of zika.

Beyond care, the Uruguayan scheme pays allowances that complement cover. The sickness allowance is calculated on the average of earnings over the 180 days before the leave and capped at around 65,000 pesos a month, excluding the annual bonus, according to CLEISS; in the case of a work accident or occupational disease, compensation is shared between the work-accident insurer (66.67%) and the BPS (3.33%). CLEISS specifies that the peso values are readjusted regularly, hence the value of confirming them with the BPS before any calculation.

The maternity allowance is generally paid in one go, on the basis of the average of the last six months, and cannot be lower than the minimum wage. Paternity leave is 17 days for employees, the first three payable by the employer and the next fourteen by the BPS, paid at 100% of average pay; it is 15 days for self-employed people whose contributions are up to date. The unemployed remain covered for the three months following dismissal.

For a family settling in, children under 18 and the spouse with no cover of their own are dependants of the employee, with a contribution rate that takes their presence into account, as the BPS scale shows. In the event of death, the scheme provides for reimbursement of funeral costs, with a claim to be filed within 180 days. A family that stays in France has no right to Uruguayan health insurance and turns to its French health insurance fund (CLEISS).

The Uruguayan system is open to declared residents, but a new arrival does not always have cover from day one: the time it takes to assemble the residence file, or a non-salaried status, can leave a gap with no protection. An assistance or insurance contract covering care, hospitalisation, surgery and medical repatriation is considered essential by France Diplomatie.

The expat health insurance comparison presents the possible plans, and the CFE (Caisse des Français de l’étranger, the French expatriate health fund) is the other option cited by CLEISS for long-term residents. Expavy helps you weigh these choices against your profile, your budget and your medical history.