Private Health Insurance monaco

We are aware that everybody is unique and therefore so are their needs.

We have structured a plan that allows you to design your own level of care.

The policy is built around 3 key features :

• In-patient
• Out Patient
• Dental

These revolve around the core feature, In-patient. You can elect this cover on its own or add out patient and then dental. There are variations on the level of care offered and the excesses available to help you work to a budget.

Please refer to our table of benefits to appreciate the extensive level of cover provided :

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Private Top-Up 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. We have designed our own scheme, but as we are brokers, we can propose other solutions to cover your needs.

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

The Monaco Social system covers Employees for the following:

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 said Tarif de Convention. [The Tarif de Convention is issued by the C.C.S.S. annually.]

Each employee is classified according to one of three groups, Verte (green), Rose (pink) or Bulle (beige), 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.

Private top-up 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

Claim Forms – Feuille de Maladie.

Doctors/Dentists will complete a Feuille de Maladie. The Chemist will stamp this form and apply labels from medicine boxes on prescription. Same applies for x-rays, physio etc.

The originals are to be sent to the CCSS.

The CCSS will then re-pay you according to the above rules. Confirmation will be sent to the claimant direct and show the amounts paid out and the reimbursements. This document should be photocopied for your file, the original sent to your top-up medical Insurers.

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

• If you are a French resident and not employed, CMU (Couverture Maladie Universelle : basic State health coverage) is mandatory. All you need is therefore a top up scheme. The same applies if you are an employee or self-employed.
• Some schemes may exclude chronic conditions. This is precisely the time when you need to be covered.
• Sexually transmitted diseases may be excluded. – Full coverage may be subject to time delay whereby some conditions may be excluded for a period of time: i.e. pre-existing conditions, pregnancy, dental, etc.
• If you benefit from State health coverage, the top-up scheme will only reimburse expenses on the condition that the State scheme does first.
• State health schemes may not cover you when travelling, or if they do, only in certain countries and under certain conditions. Take out travel insurance which should include repatriation.