Procedures practised by paramedics

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

Définition

These are the procedures performed by:

  • Midwives, when related to nursing care,
  • Speech Therapists,
  • Orthoptists,
  • Physiotherapists,
  • Podiatrists,
  • Nurses,

As part of their private practice or as an employee of another practitioner.

Prior agreement formalities

The procedures performed by medical auxiliaries can be reimbursed provided that, for certain procedures, particularly functional rehabilitation, nursing care, speech therapy and orthoptics, etc., the fund has agreed to cover them, prior to their execution and on the advice of the  Medical Examinations Department.

For any prior agreement request must be sent to the Medical Examination Department and include:

  • the original prescription from the doctor specifying the nature of the procedures, their location and the number of sessions to be performed, this last condition not being compulsory for functional rehabilitation procedures,
  • the prior agreement form, duly completed by the insured (surname, first name, fund registration number, treatment recipient, address where the recipient can be visited, signature) then by the medical auxiliary dispensing the treatment (nature and quote for treatment, identification of the treatment recipient, identification of the auxiliary, date of request, stamp and signature).

Treatment can only be dispensed after agreement to cover this treatment, except in the event of a medical emergency.

Fees and reimbursement

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 them, prior to their execution and on advice of the Medical Examination Department.