These are the procedures performed by:
- Midwives, when related to nursing care,
- Speech Therapists,
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.
- 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.
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.
- in Monaco,
- in the Alpes-Maritimes,
- in France (excluding Alpes-Maritimes),
- outside Monaco and France.
A reimbursement rate is applied to the selected tariff:
- This rate is generally 80%, with the remaining 20% share to be paid by the insured and commonly known as the " patient contribution".
- However, the rate is 100% if the insured comes under one of the case for exemption from patient contribution.