Monaco has a two-tier system consisting of a national health insurance scheme, the Caisses Sociales de Monaco or CSM, and private health insurance either in the form of comprehensive private cover with an international provider, or as top-up cover via a mutuelle.If you are registered with the CSM, either as an employee, a self employed resident, a retiree or a dependent of someone who is covered by the CSM, then you will be able to access public healthcare.
Personalising Your Health Insurance Cover
If you are an expat working in Monaco, you will be covered under the mandatory national system as long as you and your employer are paying contributions. The state scheme covers:
• doctors’ visits
• medical procedures
• prescriptions
• some dental treatment
• rehabilitation
• pregnancy/childbirth
• some hospitalizations
If you do not have any form of insurance, you will still be entitled to free hospital treatment in the case of a life-threatening emergency.
Monégasque public health insurance operates on a reimbursement system, so if you are covered by the CSM you will need to make some up-front payments and then claim your costs back from the national scheme.
Selectable Options
Check the small print of any private health insurance policy to see whether it covers treatments that you may want to access, such as specialist surgical treatment or more advanced dental care, for example, crowns or dental implants.
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’ve 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.
Take a good look at any potential policy for any cover relating to healthcare which does not apply to you: some policies have provision for maternity care, for instance, and if you are not intending to become pregnant, or you prefer to rely on the cover provided by the Monégasque maternity system, then you may wish to reduce your policy costs by having such options removed.
Cost Sharing
You may also be able to reduce the cost of your premium through ‘cost sharing’: this means that you and your insurer will share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest.
Different insurers will have different ways of arranging cost sharing:
Co-pay: where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance: where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your co-insurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles: where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to a healthcare clinic. However, you would then have to pay the entire amount for 11 such visits (€1000/€85 = 11.8) before your insurance began to pay out to the doctor directly.
You may also need to take a look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met.
Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. You will thus pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000), or about 29 more visits (€500€17 = 29.4). At that point (40 total visits in a year), you would pay nothing more for the remainder of the plan year.
It’s worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
As so many variables have an effect on the cost of international private medical insurance in Monaco, it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle-tier plan, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.
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.
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