You are moving abroad and, thanks to our guide on health insurance for expatriates, you understand how to protect yourself internationally. Now you need to choose the best mutual health insurance for expatriates. To do this, should you take out first euro health insurance or rather CFE supplementary insurance? And what are the advantages of international health insurance compared to local private health insurance?
1. ‘First euro’ insurance or ‘CFE supplement’ insurance: what is the difference?
Choosing the right health cover when moving abroad is one thing, but understanding which one is best for you is another. French expatriate health insurers generally offer a choice between two types of policies:
- ‘First euro’ insurance means that the insurer reimburses your medical expenses from the first medical bill, without going through a basic organisation (Sécu or CFE). This is a comprehensive, stand-alone solution that is particularly suitable for first-time expatriates and expatriates who want to simplify their lives and avoid lengthy reimbursement procedures.
Conversely, ‘CFE supplementary insurance’ is based on a two-tier protection system: the Caisse des Français de l’Etranger (CFE) provides basic reimbursement (like the French social security system), and the international expatriate policy supplements this coverage in the same way as a mutual insurance company would. This is known as CFE supplementary insurance. This solution is generally suitable for those who wish to maintain a link with the French system and comprehensive social protection, including basic pension, for example.
The choice then depends on what is most advantageous for your destination, your family situation, your budget, but also your repayment habits and coverage requirements. In most cases, the same package will be available in both management modes.
A first euro plan offers more flexible international management, while a CFE supplementary contract may be more economical in the long term, especially for families or expatriates in countries where medical costs are moderate.
2. International health insurance or local private insurance?
With private health insurance available in your host country, you may legitimately wonder whether it is worthwhile taking out expatriate health insurance in this case.
Local private insurance is often attractive due to its competitive rates and coverage integrated into the local healthcare system. However, it has several limitations for expatriates: coverage restricted to the country of expatriation, reimbursement limits that are sometimes low or particularly numerous, frequent exclusions, a mandatory healthcare network, no repatriation guarantee, and the possibility of annual termination by the insurer. These policies most often meet the needs of local residents, not necessarily those of expatriates, even those who are well established (source: https://www.international-sante.com/assurance-expatrie/dossiers/trouver-meilleure-assurance-sante-internationale/ ).
Conversely, international health insurance is specifically designed for expatriates. It offers worldwide coverage, including the country of residence, the country of origin, and more, depending on the coverage area chosen.
Expatriate insurance from the first euro or as a supplement to CFE also gives you access to the doctors of your choice without an imposed network (except in the USA), flexible and comprehensive cover according to your needs, a level of reimbursement adapted to private sector rates, and practical services and options such as teleconsultation, repatriation assistance, preventive care, and even civil liability. Provident insurance policies are also available to cover accidents and protect your future abroad.
This is the most flexible solution for mobile expatriates who work remotely, but also for those who reside in countries with inadequate healthcare facilities or, conversely, particularly high healthcare costs. Or for those who simply wish to maintain the same level of health cover they are used to in their country of origin.
3. The legal framework: an advantage for expatriate insurance under French law
Beyond medical coverage, the legal framework of the expatriate contract is a decisive factor.
By choosing international health insurance governed by French law, you benefit from the most protective framework for policyholders.
The French Insurance Code requires, in particular, the pooling of risk. This means that premiums cannot be adjusted individually based on your state of health or medical history over time. While you may be subject to a premium increase or partial exclusion upon enrolment, once you have been accepted under these specific conditions, premium increases are applied collectively, based on the overall performance of the expatriate insurance product. This contrasts with the practice generally followed by insurers abroad, which operate on an ‘experienced rated’ basis.
Another significant advantage is the lifetime guarantee. As long as you pay your premiums, the insurer cannot terminate your contract, even in the event of serious illness or an increase in risk over the years. Conversely, many local or even international insurance companies not subject to French law can revise your terms and conditions at each renewal: exclusion of certain conditions, increase in the excess, sharp rise in premiums, or worse, refusal to renew.
It should also be noted that the Caisse des Français de l’Etranger (CFE) is a unique organisation that provides basic cover without medical selection and offers specific cover for long-term conditions; a French exception that has no equivalent.
In summary, an expatriate health insurance policy under French law offers stability, transparency and long-term security. This is a major advantage for long-term expatriation.
4. Frequently Asked Questions
Do I need to complete a health questionnaire?
Yes, all expatriate health insurance policies require a medical questionnaire upon enrolment. This allows the cover to be tailored to your medical history and any potential treatment costs. Unlike the CFE, which does not require one, supplementary health insurance schemes also require it.
Am I covered in my country of origin?
With international health insurance, yes: you are generally covered both in your country of residence and in your country of origin, if the latter is part of the same geographical zone or a lower zone. You are often covered in an emergency if it is in a higher zone.
Are there any waiting periods?
Some policies have waiting periods for non-urgent care (approximately 3 months), maternity (9 to 12 months) or optical and dental cover (6 to 9 months). However, emergencies and accidents are generally covered immediately. As a supplement to the CFE, an expatriate policy cannot start until the CFE waiting period has expired, so it is possible to start your membership from the first euro.
Is there a minimum membership period?
Yes, most international insurance policies require a minimum term of one year, which is automatically renewable. Some hybrid or flexible policies, which are less common, may accept stays of only a few months.
Can I take out a policy at any age?
Most insurers usually accept new policyholders up to the age of 65 or even 70. Beyond that, the options become more limited, so it is advisable to take out a policy before reaching the age limit for expatriate insurance.
Am I covered in my private and professional life?
Yes, international health cover from the first euro protects you for care related to your private and professional life, except in specific cases of accidents at work or occupational risks requiring separate insurance. This is also the case with CFE supplementary cover, if the ‘professional’ options are taken out.
Choosing the best expatriate health insurance means accurately assessing your healthcare needs. Whether you choose 1st euro or CFE supplementary cover, the benefits will often be identical; the difference mainly lies in how reimbursements are managed and the price (which may be more advantageous depending on your profile). Comparing offers with an international health insurance expert is still the best way to make an informed choice. Well-chosen health cover is one of the keys to a successful expatriation.
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