A. Private Medical Insurance

It is NOT possible to voluntarily contribute to the CCSS (for employees) nor CAMTI (for self-employed) and benefit from their cover, one must be an employee or retired following employment in the Principality. If one does not fall under CCSS or CAMTI, the only option is to take out private medical, which we can obviously arrange. There are many schemes available, but as we are brokers, we will propose the most adapted solution to cover your needs.

B. Social Benefits for Employees and/or Self-employed Working in Monaco

The Monaco Social system covers Employees for the following:
1. State scheme
Although coverage provided by the local social system in Monaco (generally named C.C.S.S. for “Caisse de Compensation des Services Sociaux”, CAMTI for “Caisse Assurance Maladie et Maternité des Travailleurs Indépendants) is very similar to the one applied in France (except for self-employed where France is not as good), there are a few differences which in some cases make it more “attractive” to Employees. These are as follows:

• Medical expenses are covered, whether due to illness and/or accident (not accidents at work nor to/from work as this is covered by specific mandatory insurance), up to 80% of the “Tarif de Convention”. The latter is a scale provided by the C.C.S.S. which provides the accepted cost of medical treatment received whether doctors fees, medicine, surgery, glasses, dental treatment etc. When the classification of the treatment received reaches K50 (usually surgery level), reimbursements increase to 100% of the “Tarif de Convention”. [The “Tarif de Convention” is issued with your “Carte d’Immatriculation” annually.]

• Each employee is classified according to one of three groups, “Verte” (green), “Rose” (pink) or “Bulle” (beige). This classification is determined by the level of salary and marital status. Although the reimbursement from the Caisse de Compensation (CCSS) will always be limited to 80% (100% in certain cases of surgery) of the “Tarif de Convention”, the amount charged by Doctors who have accepted the convention will vary. They will charge 100% of the conventional tariff if the employee is considered “Verte”, 120% if he is “Rose” and anything else if he is “Bulle”.

Important facts to know:

• Contributions paid by both Employer and Employee will enable the family of the Employee to benefit from medical coverage.

• To benefit from medical coverage, an employee must have worked 120 hours during the month or 30 days prior to receiving treatment.

• The CCSS is entitled to refuse covering an employee of family member in the event of medical history or continued treatment prior to arrival in Monaco.

• The CCSS will provide you with an annual card stating your card colour, which may show different levels for general medical and dental.

• French Doctors should apply “Tarif de Convention”.

• Medical treatment received outside Monaco or France may not be reimbursed. Two cases where they could be: if due to an emergency or if the employee obtained approval from the CCSS to get reimbursed prior to leaving for the country of destination where treatment is to be received.

• If treatment is received in the public sector at the Centre Hospitalier Princesse Grace or at the Centre Cardio-Thoracique in Monaco, the CCSS, upon demand, can settle the majority of the expenses incurred directly. If, on the other hand, treatment is received in the private sector, clinic, then in most cases, the CCSS will not pay directly.

• Dental and optical treatment are not well reimbursed as the “Tarif de Convention” is very low to start with.

• It is NOT possible to voluntarily contribute to the CCSS (for employees) nor CAMTI (for self-employed) and benefit from their cover, one must be an employee or retired following employment in the Principality. If one does not fall under CCSS or CAMTI, the only option is to take out private medical, which we can obviously arrange.

2. Private medical

As the State medical scheme does not reimburse expenses in full, there are many private medical schemes to complement these basic state reimbursements. Most medical “top up” schemes (as they are called), will state the total percentage of reimbursement in comparison to the “Tarif de Convention”, this percentage including the share of the CCSS or CAMTI. For example, if the private “top up” states 150% for General Practitioners, this means a total of 150%, in other words 80% for CCSS or CAMTI and 70% for the private medical. One important point to know is that the “top up” will ONLY reimburse if the basic State scheme accepted costs incurred and reimbursed its share.

For details on all possible options, contact us.

3. Claim Forms - “Feuille de Maladie”.

• Doctors/Dentists will complete a “Feuille de Maladie”. If you have medicines prescribed this form must be taken to the Pharmacist who will stamp it and detail medicines and apply labels from medicine boxes on prescription. Same applies for x-rays, physio etc.

• 2 photocopies should be made of the “Feuille de Maladie” and any prescriptions whether for medicines, x-rays, physio etc. The originals to be sent to the CCSS, 1 x copy self.

• The CCSS will then re-pay you according to the above rules. The confirmation of this payment will be sent to the claimant direct and will show the amounts paid out and the reimbursements paid back by the CCSS. This document should be photocopied once for your records, the original being sent to private top-up medical Insurers.

P.S. Above explanations apply whether employed or self-employed.