Mondassur explains how CFE reimbursements work, depending on the type of treatment, how to join CFE and how CFE supplements work. See also our article on the CFE rates to be added to the price of a Mondassur top-up to the CFE essential worldwide.
What are CFE’s geographical zones for calculating your healthcare reimbursement?
CFE has divided the world into 5 geographical zones, from the least expensive (zone 1) to the most expensive (zone 5), including the United States, the United Kingdom and Norway. This classification is based on the medical costs encountered in different countries around the world. In the USA, medical costs are the highest in the world. We also note that some countries, such as Italy, have very high medical costs. Africa and Asia are divided mainly between Zone 1 and Zone 2 countries. There are a few exceptions in zone 3 due to the need to leave the country to receive proper treatment. Brazil, Australia, Canada and Mexico will also be in zone 3. Singapore is in zone 4 and Hong Kong in zone 5.
How is CFE reimbursed for hospitalization?
CFE reimbursements for hospitalization and routine medical care will depend on your geographical location, with reimbursements ranging from 19% to 80%. The higher your geographical location, and therefore the higher your medical costs, the lower the percentage covered by CFE. In the USA, for example, CFE will pay 19% of your actual hospital costs, or 20% of your actual chemotherapy costs. In Mexico, your hospitalization will be covered up to 42%. Given these reimbursement percentages, it becomes essential to supplement your CFE coverage with complementary CFE insurance such as GoldExpat CFE. Otherwise, you run the risk of having a very high out-of-pocket expense.
How is CFE reimbursed in the event of maternity?
When it comes to maternity cover, CFE will take a different view of maternity with Caesarean section than of maternity without surgery. The maximum ceiling for maternity, all zones combined, is around 2,800 euros. Here again, complementary CFE insurance is essential, especially for countries with high medical costs. With the Maternity Plus option, Mondassur also offers enhanced maternity cover to ensure that your out-of-pocket expenses are not too high.
Here are the maximum maternity ceilings for CFE reimbursement only:
- vaginal delivery: €2985.74
- Cesarean delivery: €3372.17
- IVG: €954.84
How is CFE reimbursed for medical expenses abroad?
In the case of routine medical treatment, CFE always bases its reimbursement on the standard French social security rates, which are used in particular for doctors’ consultations.
For consultations with a general practitioner or specialist, CFE will reimburse 70% of the amount spent, capped at the conventional rate, i.e. 26.50 euros for a general practitioner or specialist, for a maximum reimbursement of 18.55 euros. It’s easy to understand that your out-of-pocket expenses will always be high, even in countries with low medical costs. Here again, we strongly advise you to take out complementary CFE insurance.
For other routine medical treatments, such as X-rays, MRIs, scans, laboratory tests, pharmacy and dental care, CFE will cover between 10% and 60% of actual costs, depending on the type of treatment. For example, for all imaging, which can be very costly, reimbursement will be between 15% and 55%, depending on the region, and between 10% and 30% for dental care. The table below gives details of reimbursements for each procedure.
The CFE reimbursement levels have been published in the Journal Officiel. They apply universally to all CFE contributors for health cover. Please note that there may be a waiting period of 3 to 6 months during which the CFE will not cover you at all, so you can take out insurance for the 1st euro initially.
How do I join CFE and what are the waiting periods for CFE?
If you join CFE before your departure or within three months of your arrival abroad, coverage for your medical expenses begins immediately. Otherwise, your treatment will be reimbursed after 3 months if you are up to age 44, and 6 months from age 45.
You can join CFE at any age, without an online health questionnaire. For the Mondassur CFE top-up, enrolment is done in parallel. If the CFE does not cover you, your complementary CFE will not be able to supplement it. When you sign up for Mondassur’s complementary CFE insurance, we can discuss the options available for your coverage during this period.
Please note that during the CFE waiting period, you will not be covered even for emergency treatment. Initially, you can take out insurance for the 1st euro.
What reimbursement is available with CFE supplementary insurance?
Supplementary insurance supplements CFE reimbursements. A refund can never be paid beyond what you have actually spent.
Examples:
- If you have a €250 scanner in Italy, the CFE will cover 20% of this €250. If your complementary CFE mutual insurance company, such as Goldexpat, reimburses you at 90% of your actual expenses, you will be reimbursed a total of 225 euros, split between 50 euros from the CFE and 175 euros from the mutual insurance company.
- If you have purchased medication in the USA, you will be reimbursed 45% of the cost of the medication in the USA, and your CFE complementary health insurance will reimburse the remainder up to the maximum amount covered, if applicable.
- If you buy 500 euros worth of medicines, the CFE will reimburse 225 euros and the 90% complementary insurance will reimburse 225 euros, for a total reimbursement of 450 euros.
With Mondassur insurance, you can claim your healthcare reimbursements via your CFE space. CFE will then forward your request to us so that you receive a single CFE + Mondassur reimbursement. A one-stop shop for your healthcare reimbursements.
How am I reimbursed by CFE for medical care in France?
The CFE covers part of your medical expenses incurred in France during your temporary return. MONDASSUR supplements these reimbursements according to the cover provided by your CFE complementary contract. It is now possible to use your carte vitale or to obtain a carte vitale for your treatment in France: your claims for reimbursement will then be sent by teletransmission to the CFE and to MONDASSUR if you have taken out supplementary insurance with the CFE.
How does complementary CFE insurance work with CFE reimbursements?
Complementary health insurance to the CFE will offer the great advantage of not having to pay out any money if you need to be hospitalized, as is the case if you only benefit from the CFE.
You’ll also be able to send your claims to your supplementary insurance company if it operates as a one-stop shop. Otherwise, you will have to wait until you receive your CFE statement to obtain the additional reimbursement.
Do I need a CFE top-up?
It is essential to take out complementary insurance to the CFE. Even if you take out supplementary insurance with low levels of cover, you can still benefit from direct payment in the event of hospitalization. You can also benefit from worldwide repatriation assistance. So, whether you’re in a country with high or low medical costs, it’s essential to take out complementary insurance to the CFE. CFE will never pay 100% of your healthcare costs, and may pay less than 20% depending on the country you live in.
You can ask for a free quote to find out the cost of complementary CFE insurance, and compare it with expatriate 1st euro insurance, which reimburses you without CFE involvement.
