Stays in an establishment

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

Public hospitals and the Monaco Cardio-Thoracic Centre

If you are admitted to a public hospital, i.e. the Princess Grace Hospital Centre (C.H.P.G.) or a French public hospital or even the Monaco Cardio-Thoracic Centre, you do not have to pay all the costs up front because you can use the "third party payment system".

You must supply the establishment with:

  • a certificate of attendance completed by your employer or a statement of employment, if you are salaried,
    or
  • your registration card, if you are retired, disabled or self-employed.

The establishment sends a payment claim to the fund which then directly pays the establishment the share of the costs for which it is responsible.

You must then pay the establishment the following costs:

  • if you are covered for 80% of costs, the remaining 20%, called the " patient contribution",
  • any supplement for a private or twin room that is billable in some public hospitals if the insured requests specific accommodation for reasons of personal convenience.

Private practice at the Princess Grace Hospital Centre and French public hospitals

In these establishments, the insured can ask to be admitted under the private practice of one or more hospital practitioners. At the Princess Grace Hospital Centre (C.H.P.G.) this is done by signing a form called the "Patient's Choice Form" which must contain the names of the different practitioners selected by the patient. In this case, the costs of the hospital stay will be covered by the fund under the same conditions as for public hospitalisation. However in addition, the different practitioners, working privately, will invoice their fees. These will be reimbursed under the same conditions as non-hospital treatment (see "fees and reimbursement" chapter). This means that if the insured is in the pink or buff category, they are likely to have to pay additional charges that will not be reimbursed by the fund.

It is up to you whether you choose a private practice practitioner.

When several practitioners need to be involved and you wish to be treated by one or other of them under private practice, you do not have to choose private practice for the other practitioners.

Private clinics

If you are hospitalised under the private sector at the Princess Grace Hospital Centre or in a private clinic other than the Monaco Cardio-Thoracic Centre, in principle you will have to pay the costs for the hospital stay and the fees of the treating practitioners up front. However, insureds whose financial situation justifies can, on an exceptional basis and prior to hospitalisation, ask for the fund's agreement to pay the reimbursable amount for the costs of the hospital stay directly to the private clinic. The practitioners' fees are reimbursed under the same conditions as for non-hospital treatment (see "fees and reimbursement" section). The costs of the hospital stay are reimbursed up to the limit of the tariff for the Princess Grace Hospital Centre (C.H.P.G.) or, failing that, the Nice University Hospital Centre (C.H.U.).

Depending on the practitioner's contractual situation, your colour category and the rules of reimbursement above, the costs of the hospital stay and the fees for the private clinic may be significantly higher than the amount reimbursed.

You must therefore ensure that you understand the financial consequences of the choice of hospital sector into which you are admitted (hospital or private clinic). This choice is up to you!

Hospitalisation in France outside the Alpes-Maritimes

If an establishment based outside Monaco or the Alpes-Maritimes region is chosen for reasons of personal convenience, the costs of the hospital stay will be paid for the public sector or reimbursed for the private sector, up to the limit of the day rate for the Princess Grace Hospital Centre (C.H.P.G.) or, failing that, the Nice University Hospital Centre (C.H.U.).

If it is an emergency hospital admission, i.e. unscheduled treatment that cannot be delayed:

  • in the public sector, the fund provides cover and reimbursement is based on the tariffs of the Hospital Centre to which the insured has been admitted,
  • in the private sector, the fund reimburses the costs of the hospital stay up to the limit of the day rate of the public hospital closest to the establishment to which the insured is admitted.

For insureds residing in France, but outside the Alpes-Maritimes region, admitted to hospital in the region where they live, the fund applies the same reimbursement rules as for emergency cases.