"Subsidiary medical cover" for foreign residents and Monegasques (from 1 January 2025): Law no. 1.562 of 2 July 2024 published

Law no. 1.562 of 2 July 2024 on subsidiary medical cover ("couverture médicale subsidiaire") (JDM no. 8705 of 26 July 2024) is the result of Bill no. 1089 received by the Parliament on 6 February 2024 and adopted in Public Session on 27 June 2024. Entry into force on 1 January 2025.

Presentation

The creation of subsidiary medical cover "is part of a better guarantee of the right to health enshrined both in article 26 of the Constitution and in the international commitments entered into by the Principality in the area of health, in particular through the Constitution of the World Health Organisation (WHO) and the International Covenant on Economic, Social and Cultural Rights". (Report on Bill no. 1089, p. 2).

The Commission for Social Interests and Miscellaneous Affairs ("Commission des Intérêts Sociaux et Affaires Diverses") renamed the benefit originally titled "State medical aid for payment" in order to avoid confusion with the (free) "State medical aid" provided for by Law no. 1.465 of 11 December 2018 on Monegasque family assistance and social aid, as amended (general social aid scheme). (ibid. p. 3)

All the more so as this mechanism is not designed "as social aid in the strict sense of the term, but as a system more akin to an "insurance" mechanism offered by the State, which is subsidiary and chargeable, aimed at compensating for the lack of cover provided by the private sector, regardless of the beneficiary's means". (ibidem)

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SYNTHESE

Subsidiary medical cover is available to Monegasque and foreign nationals residing in the Principality on a stable and regular basis for at least 5 years, who :

• are not covered by any Monegasque or foreign health insurance organisation;
• have had three refusals to take out an individual health insurance policy (full or partial cover) (within a period of less than or equal to 1 year prior to the date of application) with three insurers operating in Monaco or, if the applicant is Monegasque, with three insurers operating in the applicant's place of residence;
• would be ineligiblefor the "state medical aid" ("aide médicale de l’Etat") provided for in article 24 of Law no. 1.465 of 11 December 2018 on Monegasque family assistance and social aid, as amended,

This basic medical cover consists, in return for the monthly payment of a contribution (the amount of which is set by ministerial decree), of the assumption by the Social Welfare Office of medical expenses (defined by ministerial decree) in the event of maternity and illness, other than occupational illness or accident, disability or death.

Except in exceptional circumstances, this cover leaves the beneficiary of the benefits responsible for a minimum contribution to healthcare costs, which may not exceed 20% of the basis for reimbursement of healthcare costs. By decision of the Director of Social Action and Assistance, this minimum contribution may, depending on the beneficiary's situation, be limited or waived, or also be paid by the Social Welfare Office if the person does not have supplementary health insurance.

Subsidiary medical cover is granted by the Director of Social Action and Assistance for a maximum period of 1 year, renewable.

Failure to comply with the obligations laid down by the law may result in the modification or withdrawal of cover, or the repayment of sums unduly received, or even criminal penalties.

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