If you are an expat living and working in Monaco who is suffering from a chronic illness, then both the public and private sector healthcare systems will provide you with a range of options for treatment.Healthcare in Monaco is of an excellent standard and the country features highly in rankings by organisations such as the OECD and the WHO. If you are registered with the Monégasque national health insurance scheme (known as the Caisses Socialises de Monaco, or CSM), you will be able to access both primary and secondary care and treatment for your illness. If you have private health cover, then you will be able to access care in the private sector.
How does the Monégasque healthcare system work?
As a working expat, you will be registered for health insurance by your employer and contributions to the state insurance scheme will be deducted from your payroll. You will then be issued with a Carte d’Immatriculation / Carte F.S.E. and must sign up with a local GP who will be your primary care provider.
You will be able to discuss the requirements of your particular illness with your GP, and if necessary your doctor will be able to refer you to a specialist. If you are registered with the CSM, your specialist is likely to be in Monaco’s main public hospital, the Princess Grace. This is a world class institution.
If you are not in employment, you must take out private health insurance cover: this is a requirement for residency. You will need to discuss any pre-existing conditions in the case of chronic illness with your private health insurance provider.
You will need to ensure that your GP is contracted to the CSM if you want to be covered under the state system.
The Monégasque healthcare system and chronic illnesses
The national health insurance scheme in Monaco covers:
• doctors’ visits
• medical procedures
• prescriptions
• rehabilitation
• some hospitalizations
Monaco operates a reimbursement scheme for health insurance, so you may need to make some co-payments for any treatment and then claim back from the CSM. However, as a sufferer from a chronic illness, you ought to be able to claim back a higher percentage of your costs.
There are also legal professionals in the principality, many of whom are English-speaking, who can advise you on legal recourse to dismissal on the grounds of disability. If you are working in Monaco, you will be protected from disability discrimination by the Equality Act of 2010.
Applying for disability or sickness benefit
The law does not provide a right to sick leave, but it protects the employee in sick leave, as the illness cannot be a valid ground for dismissal, and provides rules for sick pay.
Active employees are entitled to benefits from daily allowances from the Social Security Department (CCSS) during sick leave. The amount of the daily sickness benefit is in most cases equal to half the average gross daily salary received by the employee over the 12 previous months within an annually fixed limit.
In addition, according to the Monaco National Collective Agreement Convention and after two years of seniority, employees must receive a replacement income paid by the employer.
In order to apply for a disability pension, you must be below 60 if you are living in Monaco or other parts of the Côte d’Azur and you must be assessed with a loss of 100% of working capacity (total disability) or the loss of 66.7% of your working capacity in the case of partial disability. You must have at least 12 months’ worth of coverage in the previous 15 months and at least 800 hours of employment in the previous 12 months, including 200 hours in the previous three months.
You will be entitled to 50% of your average monthly covered earnings in the 60 months before the disability began. In the case of partial disability, you will be paid 30% of your average monthly covered earnings in the 60 months before the disability began.
The minimum and maximum monthly pensions depend on your age and whether you receive any pension income from another source. Disability benefits are payable abroad.
In the case of sickness benefit rather than the disability pension, this consists of 50% of your average daily earnings in the last 12 months (66.6% from the 31st day if the insured has three or more dependent children), up to €138.33 is paid. The benefit is paid after a three-day waiting period for up to 360 days and it may be extended for three or four years for a chronic or recurring illness.
The benefit may be reduced during periods of hospitalization according to your income level and number of dependent children.
If your sick leave period is longer than six months, benefits are adjusted automatically twice a year (in January and in July) according to law.
Private cover for chronic illness
Remember to check if your potential policy covers pre-existing conditions: the definition of this will vary between insurers. Usually the term applies to any conditions which present symptoms or for which you have been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for diagnosis.
You may also want to check out whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You may need to discuss this directly with your insurer.
The cost of your private insurance will depend on your age and, also, on the precise nature of your illness: this is likely to affect your premiums.
Note that you can also consider the semi-private option of taking out top-up cover with a mutuelle in order to close any treatment gaps between the amount reimbursed by the CSM and the charges made by your healthcare provider. Some employers offer mutuelle policies as part of employment packages. Again, you will need to discuss any pre-existing conditions with a mutuelle.
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