Healthcare system in Andorra: a guide to understanding the CASS and how it works

Moving to Andorra means quickly understanding how its healthcare system works. At the heart of it is the CASS, the Andorran Social Security Fund, which provides healthcare coverage and, more broadly, social protection for affiliated individuals.

For an employee arriving in the Principality, a self-employed person starting their activity there, or a family preparing to move, the same questions often arise: how does the CASS work? How much of the medical costs remains to be paid? Is supplementary insurance necessary? How do you see a specialist? And what happens when you are simply staying in Andorra without being a resident?

The system is relatively straightforward once its main mechanisms are understood. However, it is important to distinguish between each person’s status, as rights, procedures, and levels of coverage are not necessarily the same for an employee, a self-employed person, a resident without professional activity, or a visitor.

How does the healthcare system in Andorra work?

The Andorran healthcare system is based on an organisation that combines public and private actors. The CASS is one of its main pillars: it manages, in particular, health insurance for affiliated individuals and contributes to the reimbursement of part of their healthcare expenses.

Unlike a system in which health insurance systematically pays the entire bill directly to the healthcare professional, patients may have to pay part of the costs upfront. The CASS then reimburses the expense according to the type of care, the applicable reference rate, and compliance with the healthcare pathway.

For certain routine medical consultations, coverage may therefore amount to around 75% of the regulated rate. It may be higher for certain hospital treatments and reach 100% in certain specific situations provided for by regulations.

This distinction is important. Saying that a treatment is reimbursed at 75% does not necessarily mean that 75% of any bill will be reimbursed. The calculation depends in particular on the reference rate used by the CASS and the conditions under which the care was provided.

The Principality’s small size also makes it possible to concentrate a significant part of the healthcare offering within a limited area. Patients can access various healthcare professionals and facilities, but choosing a practitioner affiliated with the system and following the coordinated healthcare pathway can have a direct impact on reimbursement.

Who must register with the CASS?

Registration specifically concerns people who carry out professional activities in Andorra. For an employee, much of the process is normally handled through the declaration submitted by the employer. The situation is different for a self-employed worker, who must complete the formalities corresponding to their status themselves and pay the applicable contributions.

When first moving to Andorra, several supporting documents may be required to establish the insured person’s situation: identity, residence, professional activity, and, where relevant, household composition. The exact documents required nevertheless depend on the person’s status. It is advisable to consult the official procedure corresponding to your situation.

Coverage for a spouse and children must also be assessed in light of the insured person’s family and professional situation. It should not be assumed that registration automatically grants identical rights to every member of the household.

Residents without professional activity are another specific case. Depending on the residence permit concerned, private health insurance may be specifically required. This point should be anticipated before moving, as having the right to reside in Andorra does not necessarily mean being covered under the same conditions as an employee affiliated with the CASS.

Once registration is effective, the insured person receives a registration number allowing them to manage their rights and administrative procedures. They must also report any changes that may affect their situation, particularly a change in professional activity or family circumstances.

What are the CASS reimbursement rates?

Reimbursement depends on the type of care involved and the applicable coverage conditions. As a general indication, medical consultations may be covered at around 75% of the reference rate, while the reimbursement level for certain hospital treatments may be higher.

Prescription medicines and other healthcare services are also subject to their own rules. Certain procedures or medical situations may benefit from enhanced coverage.

For patients, the key point is therefore not to consider the percentage alone. Before undergoing costly treatment, planned hospitalisation, or repeated care, it is useful to know the regulated rate, the applicable reimbursement rate, and the actual out-of-pocket cost.

Supplementary insurance can then cover all or part of the amount not reimbursed by the CASS, depending on the coverage provided by the policy.

Is supplementary health insurance necessary in Andorra?

Being affiliated with the CASS does not necessarily mean that all medical expenses will be fully reimbursed. This is why some residents choose to add supplementary health insurance to their mandatory coverage.

The value of such insurance depends greatly on the insured person’s profile. Someone who rarely visits a doctor and is comfortable with out-of-pocket costs may not have the same needs as a family with children, someone undergoing regular treatment, or someone who wants more extensive coverage during hospitalisation.

The cost of private insurance depends in particular on age, the level of coverage, deductibles, the number of people insured, and the geographical scope of the coverage. Rather than relying on an average price, it is more relevant to request several comparable quotes.

You should also look beyond the monthly premium. Annual limits, waiting periods, exclusions, deductibles, hospitalisation conditions, and rules applying to care received outside Andorra can make a considerable difference when a health issue arises.

Local supplementary insurance should also not be confused with international health insurance. The latter may be more suitable for people who travel frequently, work in several countries, or wish to receive regular medical care outside the Principality.

The referring doctor and the healthcare pathway

The referring doctor, or family doctor, plays a central role in the organisation of healthcare in Andorra. They provide general patient care and can refer patients to other professionals when their condition requires specialised treatment.

For an adult, this is commonly a general practitioner. For a child, the role may be fulfilled by a paediatrician. This approach has an obvious medical benefit: the professional who knows the patient’s medical history can centralise information, monitor the progress of a treatment, and prevent multiple courses of care from being carried out without coordination.

It also has an administrative dimension. Following the pathway established by the system may determine the level of reimbursement obtained from the CASS. Consulting a professional directly outside the applicable pathway may affect the financial coverage provided.

The distinction between affiliated and non-affiliated healthcare professionals should also be checked before a consultation. Fees and reimbursement arrangements are not necessarily the same. In the event of a medical emergency, access to care naturally remains the priority. Ordinary referral rules should not delay urgent medical treatment.

Seeing a specialist in Andorra

Depending on the specialist required and the applicable healthcare pathway, referral by the referring doctor may play a role in the coordination of care and the level of reimbursement. For patients, the appropriate approach is to check the coverage conditions before booking an appointment directly, especially when it is not an emergency.

Waiting times naturally vary depending on the specialty, practitioner, and time of year. It would be misleading to present a fixed waiting time that applies throughout the country. Some appointments may be available quickly, while other specialties experience greater demand.

The proximity of France and Spain also plays a role in the Andorran healthcare system. For certain treatments that cannot be provided in the Principality, care abroad may be considered within a defined framework. Here again, a medical referral and prior authorisation may be required to benefit from the applicable coverage.

Healthcare for expatriates and new residents

For someone moving to Andorra, healthcare coverage should ideally be arranged at the same time as the residence and professional activity procedures.

A newly hired employee is not in the same situation as an entrepreneur. The same applies to a resident without professional activity or an unemployed family member. Before assuming that you are covered, it is preferable to check that your registration has actually been completed and to know the date from which your rights take effect.

This precaution is particularly important during a transition period between two countries. Temporary private insurance can be useful when there is a gap between arriving in Andorra and the effective start of the coverage corresponding to the new status. For a family, this check should be carried out for each member, not only for the person who is working.

What healthcare coverage is available to tourists in Andorra?

A visitor passing through does not have the same rights as a person affiliated with the CASS. Before travelling, it would be advisable to check precisely what their personal insurance covers in Andorra.

This point deserves particular attention for European travellers, given that Andorra is not a member of the European Union. It would be unwise to assume that European healthcare arrangements automatically work in the same way as they do during a stay in a country belonging to the European Union or the European Economic Area.

Appropriate travel insurance may cover emergency medical care, hospitalisation and, depending on the policy, assistance or repatriation. The exact conditions should be checked with the insurer before the trip. This precaution is particularly relevant for a stay involving skiing, mountain biking, hiking, or other sporting activities. Some insurance policies include specific exclusions concerning sports, rescue services, or activities considered to involve particular risks.

Where can you receive emergency medical care?

Hospital Nostra Senyora de Meritxell is the main hospital in the Principality. It provides care for a wide range of emergencies and medical specialties.

In an emergency, it is preferable to rely on the emergency contact details and numbers published by the Andorran authorities at the time of your stay. Practical information of this kind may change, and an incorrect number can be particularly problematic when someone genuinely needs help.

In the event of a serious medical situation, you should obviously not wait to find out the exact level of reimbursement before seeking medical care. Insurance and reimbursement matters can be dealt with afterwards using the documents provided by the healthcare facility.

How much does healthcare cost in Andorra?

It is difficult to give a single price for a consultation or treatment. The amount varies depending on the healthcare professional, their agreement with the CASS, the specialty, the examinations required, and the treatment provided. However, general medical consultations can cost a few dozen euros, while some specialist consultations are more expensive. Dental care, imaging, technical procedures, and hospitalisation are subject to different pricing structures.

To determine the actual cost, it is above all necessary to distinguish between three amounts: the price charged, the amount taken into account by the CASS, and the reimbursement actually paid. The difference between these elements determines the patient’s out-of-pocket cost.

When a significant expense is expected, asking the healthcare professional for the price of the treatment and checking the reimbursement conditions beforehand can help avoid discovering the out-of-pocket cost only after the treatment has been provided.

How can you get reimbursed for your healthcare expenses?

The procedure depends on the healthcare professional consulted and the system used. In some situations, the insured person pays for the care upfront before receiving the corresponding reimbursement. Administrative procedures may now be handled digitally or simplified depending on the healthcare professional and the services concerned.

It remains important to keep documents relating to the care received, especially when reimbursement is not processed automatically. An itemised invoice, prescription, or other medical documentation may be required to exercise your rights. If in doubt, it is better to check the procedure directly with the CASS rather than wait several weeks only to discover that a document is missing from the file.

The same principle applies to healthcare received outside Andorra. Treatment abroad may be subject to specific rules and, depending on the situation, may require a referral or prior authorisation.