Reimbursement rate

Reimbursement is usually calculated on the basis of 80% of the applicable cost; the remaining 20% is to be paid by the insured person. This is the portion commonly known as the "ticket modérateur" (patient contribution).

However, 100% of costs will be reimbursed for the following insured persons:

  • Insured persons who are:
       - Current civil servants and other Government and Commune officials 
       - Retired permanent civil servants of the State or Commune who are resident in Monaco 
       - Officials of the State or Commune with cumulative service of two years’ full-time employment within the public sector 
  •  Insured persons or dependents who are exempt from the patient contribution

 

The 100% reimbursement rate is applied to these insured persons in the following cases:

  • For medical procedures (excluding dental and biological procedures) which, coded according to the Classification Commune des Actes Médicaux (CCAM, Common Classification of Medical Procedures), have a reimbursement rate equal to or greater than:
       - €140.14, where fees are fixed according to the standard rate 
       - €91.00, where procedures are carried out in outpatient departments of French public hospitals 
    Where such procedures require a hospital stay, exemption from the patient contribution is extended to cover all medical costs incurred during the hospital stay

 

  • Ambulance transport

 

  • Daily charges

 

  • Medicines not on the approved list

 

  • Large prosthetics and medical aids

 

  • Costs of stay for a continuous period of hospitalisation lasting more than thirty days 

 

  • Care provided for premature babies in a specialist department or hospital 

 

  • Hospitalisation of new-born babies within thirty days following birth 

 

  • Purchase or repair of prosthetics or orthopaedic aids (large) 

 

  • Certain medicines or products of human origin 

 

  • Orthodontic treatments 

 

  • Health expenses incurred by people with disabilities 

 

  • Health expenses related to an accident at work or occupational disease 

 

  • Reimbursement of certain medical costs for pregnant women, from the first day of the sixth month of pregnancy until the day before birth 

 

  • Reimbursement of the costs of staying in a hospital or clinic during childbirth, within the limits of statutory rates 

 

  • Reimbursement for flu vaccines where the beneficiary is aged over 65 

 

  • Examinations required to diagnose and treat infertility

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