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 be issued with a Carte d’Immatriculation/Carte FSE, which will hold administrative rather than clinical information, and you can then sign up with a local GP.

If you are not in employment, you must take out private health insurance cover: this is a requirement for residency.

All citizens of Monaco are covered by law under the state insurance scheme. Anyone who is registered and making contributions will be eligible for state healthcare, including expats. If you are French or Italian, you will be able to access treatment if you have been making contributions to the health insurance system in your own country.

Under the state scheme, you will be reimbursed 70% of your medical costs. In order to receive 100% reimbursement, you can take out an additional policy, available from banks and insurance companies, called an Assurance Complimentaire.

Monaco is not a member of the EU, so you will probably be unable to use your EHIC card in the country unless you are a student, but check this with individual medical providers.

If you are in one of the following categories, you will not be required to pay healthcare contributions to CSM but will still be covered under the national health system:

• on long-term sickness benefit or maternity leave
• a pensioner
• unemployed

You will need to ensure that your GP is contracted to the CSM if you want to be covered under the state system.

Your employer will register you with the CSM and provide you with a Carte d’Immatriculation/Carte FSE. Once you have received this, you can take it along to a local health centre and register with a doctor there.

If you are self-employed, you can register yourself with the Social Security Fund for the Self-Employed (Caisse d'Assurance Maladie, Accident et Maternité des Travailleurs Indépendants/CAMTI). You will probably receive the paperwork to set this up to your business address automatically, but if it does not come through then you can pick one up at your local Social Security Contributions Collection Office.

Fill in the form and return it to the Social Security Funds address, which will be included with the form. You will need to include the following with your application:

• The NIS number or VAT number for your business Your family record busienss, or a certificate of civil status An RIB from your bank showing your account details

You must register with CAMTI within one month of arriving in Monaco if your business is already running; or within one month of your business’ setup date if you have recently started your own company.

The national health insurance scheme in Monaco covers:

• doctors’ visits
• medical procedures
• prescriptions
• some dental treatment
• rehabilitation
• pregnancy/childbirth
• some hospitalizations

Monaco operates a reimbursement scheme for health insurance. The rates applied by clinics and hospitals are divided into the following categories, based on income and family size:

• a standard rate
• a rate that is 20% above the standard rate
• a fee set by prior agreement with the service provider

If you are an expat retiree, you will be covered by national insurance if you are making contributions. If you are not working, and are not eligible to register with the CSM, you will need to take out private cover.

If you are a student from an EU state, you will be covered by your EHIC card in Monaco.

If you are not from an EU member state, you will need to take out private insurance. The International University of Monaco states that it will need records of your health insurance if you are studying at the university and that your insurance will need to provide cover for Monaco and also for your country of residence if you are living elsewhere.

Your family will be covered by your insurance. This includes spouses and dependent children.

Basic dental treatment is covered under national health insurance but for anything more advanced, such as crowns, you will need to take out private cover. Check whether your local dentist is contracted to the CSM, since not all of them are.

Your employer must contribute around 24-26% of your gross salary and you must make a contribution of 15%, which will be deducted directly from your payroll.

Expats may choose to take out private cover for speed of diagnosis and treatment, or to access more comfortable facilities.

Private cover includes:

• doctors’ visits
• hospital treatment
• more advanced dental care
• elective cosmetic surgery

Now Health International quotes a range of policies from $26 - $206 per month.

Ascoma Insurance, which is based in Monaco, offers a policy for students from €45 per month.

For those seeking international private medical insurance (iPMI) cover for multiple countries including Monaco, numerous variables can have an impact on the cost.

The most important variables are:

• age (the higher the more expensive)
• area of cover (i.e. in addition to Monaco, which other areas is coverage required in? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
• product choice (higher end insurance products are more expensive)

Other variables include:

• deductibles
• co-insurance
• payment frequency
• gender
• nationality
• country of residence

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/product, 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.

The main international insurance companies provide cover in the region, including:

• Ascoma
• Cigna Global
• Eric Blair Network
• Foyer Global Health
• Now Health International
• Pacific Prime

Assurance Complimentaire – a top-up insurance policy designed to allow you to claim 100% of your health costs

Caisse d'Assurance Maladie, Accident et Maternité des Travailleurs Indépendants/CAMTI - Social Security Fund for the Self-Employed

Caisses Socialises de Monaco or CSM – the national health insurance system

Carte d’immatriculation/Carte F.S.E - health insurance card