How does medical coverage for social security and supplementary health insurance work in Andorra?
Expert of Augé Grup’s Immigration Department Olga Donskikh answers:
Employees are covered by the company depending on their salary; self-employed must pay a fixed monthly fee.
The coverage by the SS is 75% of the official rates in case of doctors who have signed the agreement with the CASS (Andorran Social Security Fund) and 33% in case of doctors who have not signed the agreement. The majority of doctors in Andorra have signed the agreement.
This in practice works as follows.
The citizen goes to the doctor and pays in cash for the visit and the medical acts. In two or three days, the CASS reimburses the insured through a bank transfer the amount corresponding to 75% of the CASS rate (33% in case of non-agreement). The visits to the family doctor and the common medical acts have the prices that coincide with the official rates, that is, you can expect the reimbursement of exactly 75% of the amount paid. In case of stomatological help, official rates are traditionally lower than the rates charged by dentists and the reimbursement is usually about 66% in common acts (professional cleaning, fillings).
In case of visits to the Emergency Department the patient does not pay the full amount of the invoice, only the 25% which is not covered by CASS.
The visits to the family doctor and to the emergency rooms are always covered; the visits to the specialists are covered with a previous report of the family doctor. A prior report is not necessary to go to the dentist and gynecologist.
The supplementary insurance in Andorra is a separate policy, a very common private health insurance in Andorra. It can be taken out by residents with CASS coverage. They pay about 40-60 € per month and cover the remaining 25% of the CASS fee (which is the usual amount) or the remainder of the invoice (less usual). How does this work in practice? The resident goes to the general practitioner and pays 22 € (the resident official rate, for general practitioner). The CASS, in two-three days, reimburses 75% of this invoice (which is 16.5 €) to the personal account. And in a couple of days or three more the supplementary insurance reimburses you the remaining € 5.5 (25%). If the doctor has charged more than € 22, the refund will also be € 22 in total, except the cases when the insurance agrees to reimburse the entire amount.