Procedures practised by doctors, midwives and biologists

To receive payment of their medical expenses, the insured, member or beneficiary must satisfy the basic eligibility conditions stipulated by the health insurance

Définition

This refers to procedures performed in private practice or cooperative health centres.
These procedures include:

  • Consultations,
  • Home visits,
  • All diagnosis and treatment procedures (technical, radiology and biology procedures).

What fee amounts can I reclaim?

  • If the practitioner is not contracted to the Caisses Sociales de Monaco, they are under no obligations with regards fees.

It is therefore important to check with the practitioner regarding their fees, before the treatment begins.

  • If the practitioner is contracted to the Caisses Sociales de Monaco, they must:
    • apply the  standard tariff for insureds in the green category,
    • not exceed the upper limits set by agreements for insureds in the pink and buff categories.

See the maximum fee amounts that can be applied by contracted practitioners 

If you do not know which category (green, pink or buff) applies to you, refer to your registration card which shows the category.

How will I be reimbursed?

Three tariffs are used as a basis for the reimbursement of non-hospital treatments:

The tariff is determined based on the practitioner's contractual situation with the fund and the place where the treatment is dispensed.

See the table of standard tariffs and the reimbursement rates 

A reimbursement rate is applied to the selected tariff:

Some procedures can only be reimbursed if the fund has  agreed to cover themprior to their execution and on the advice of the Medical Examination Department.

Special case of home visits by GPs