CFE or First-Euro Insurance in Thailand: How to Choose?

Introduction

One of the most common misconceptions among French nationals moving to Thailand is that their French health coverage will follow them abroad. It does not. France has no bilateral social security agreement with Thailand, which means that the moment you establish residence in Thailand, your French Securite Sociale coverage ceases to apply.

This leaves you with a critical decision: how do you ensure adequate health coverage while living in the Land of Smiles? The two main options are the CFE (Caisse des Francais de l'Etranger) and first-euro private insurance. Understanding the strengths and limitations of each is essential for protecting your health and your finances.

French Social Security Does Not Cover You in Thailand

Let us be clear on this point from the outset. Unlike countries within the European Union or nations with bilateral agreements (such as Canada, Morocco, or Tunisia), Thailand has no reciprocal healthcare arrangement with France. This means:

• Your Carte Vitale is not valid in Thailand
• You cannot claim reimbursement from the French Securite Sociale for care received in Thailand
• Even if you maintain a French address, your coverage will lapse after a period of residence abroad

This is why having a dedicated expatriate health insurance plan is not just advisable but essential. Our health insurance advisory service can help you find the right coverage for your situation.

What Is the CFE?

The Caisse des Francais de l'Etranger is a public body that allows French nationals living abroad to voluntarily continue their affiliation with the French Social Security system. It was created specifically to offer expatriates and retirees abroad access to French-style health coverage.

How the CFE Works

• You pay quarterly contributions based on your age, income, and chosen coverage category
• The CFE reimburses healthcare expenses at French Social Security rates (typically 70% for consultations, 80% for hospitalization)
• Reimbursement is based on French tariffs, not on the actual cost of treatment in Thailand
• You can use any doctor or hospital in Thailand (no network restrictions)
• The CFE also offers voluntary coverage for workplace accidents and maternity

CFE Advantages

• Maintains your connection to the French Social Security system
• Periods of contribution count toward your French healthcare rights if you return to France
• Familiar reimbursement structure for those used to the French system
• Can be combined with a complementary (top-up) insurance for better coverage

CFE Limitations

• Reimbursement is based on French tariff rates, which are often far below the actual cost of private hospital care in Thailand
• For example, a consultation at a Bangkok private hospital may cost 2,000 to 5,000 THB, but the CFE reimburses based on the French tariff of roughly 25 EUR (approximately 950 THB)
• No direct billing: you pay upfront and then submit claims for reimbursement
• Processing time for reimbursements can be several weeks
• Contributions increase significantly with age

What Is First-Euro Insurance?

First-euro insurance (assurance au premier euro) is a private international health insurance plan that covers you from the very first euro of medical expense, without relying on a public scheme like the CFE.

How First-Euro Insurance Works

• You choose a plan from a private insurer specializing in expatriate coverage
• Coverage starts from the first euro (or baht) of expense
• Plans typically include outpatient care, hospitalization, emergency evacuation, and often dental and optical coverage
• Many plans offer direct billing at partner hospitals, meaning you do not have to pay upfront
• Premiums vary based on age, coverage level, and deductible chosen

First-Euro Advantages

• Coverage is based on actual costs in Thailand, not French tariff rates
• Direct billing at private hospitals eliminates the need for upfront payment
• Comprehensive plans with customizable options (dental, optical, wellness)
• Often includes emergency medical evacuation
• Faster claims processing than the CFE

First-Euro Limitations

• No link to the French Social Security system: periods of coverage do not count toward French healthcare rights
• Premiums can be significantly higher than CFE contributions, especially for comprehensive plans
• Pre-existing conditions may be excluded or subject to waiting periods
• Premiums increase with age, and some insurers may decline renewal past a certain age

CFE vs First-Euro: Side-by-Side Comparison

What insurance is mandatory for the O-A retirement visa?

If you hold or are applying for a Non-Immigrant O-A visa (the standard retirement visa), Thailand requires you to carry health insurance meeting specific minimum coverage levels:

• Outpatient coverage: minimum 40,000 THB (approximately 1,050 EUR)
• Hospitalization coverage: minimum 400,000 THB (approximately 10,500 EUR)

This insurance can be a Thai policy or an international policy, as long as it meets the minimum thresholds and is accepted by Thai Immigration. Some insurers provide a certificate specifically formatted for Immigration purposes.

Neither the CFE alone nor most basic first-euro plans automatically satisfy these requirements, so it is important to verify that your chosen coverage includes a compliant certificate.

The Thai Healthcare System: An Overview

Understanding the local healthcare landscape helps you make informed insurance decisions.

Hospital-Centric System

Thailand's healthcare system is hospital-centric. Unlike France, where general practitioners and specialists operate in independent clinics, in Thailand most medical care is delivered within hospital settings. Even routine consultations, blood tests, and minor procedures typically take place at a hospital.

Public vs Private Hospitals

• Public hospitals offer affordable care but may have long waiting times, limited English-speaking staff, and basic amenities
• Private hospitals (such as Bumrungrad, Bangkok Hospital, Samitivej) provide international-standard care with English-speaking doctors, modern facilities, and shorter wait times, but at significantly higher costs
• Most French expatriates choose private hospitals for their day-to-day care

Emergency Services

In case of emergency, call 1669 (Thai national emergency number). Ambulance services will transport you to the nearest hospital. For non-emergency situations, you can walk into any hospital's outpatient department directly.

Can a Thai Spouse Benefit from the CFE?

The CFE is reserved for French nationals and, under certain conditions, their dependents. A Thai spouse can potentially be covered as a dependent (ayant droit) if:

• You are legally married
• You are both covered by the CFE
• You pay the additional dependent contribution

However, the reimbursement rates remain based on French tariffs, which may not provide adequate coverage for private hospital care in Thailand. Many couples find it more practical for the Thai spouse to carry a separate Thai health insurance policy or a first-euro plan.

Which insurance plan should you choose?

Retirees Planning to Return to France Eventually

If you plan to return to France in the coming years, the CFE combined with a complementary insurance is often the best choice. It maintains your French Social Security rights and ensures a smooth transition back into the French system.

Long-Term Residents with No Plans to Return

If Thailand is your permanent home, a first-euro insurance plan typically offers better value. You benefit from coverage aligned with actual Thai healthcare costs, direct billing, and comprehensive protection without paying for a link to a system you may never use again.

Couples with a Thai Spouse

Consider a hybrid approach: the French spouse on the CFE (to maintain rights) with a complementary plan, and the Thai spouse on a local Thai insurance policy or a separate first-euro plan tailored to their needs.

Budget-Conscious Retirees

The CFE basic coverage is the most affordable option, but be aware of the gap between reimbursement levels and actual costs. A high-deductible first-euro plan can offer a middle ground with lower premiums while protecting against catastrophic expenses.

How Siam Visa Services Can Help

Choosing the right health insurance is one of the most important decisions you make as an expatriate. Our team can:

• Assess your personal situation and healthcare needs
• Compare CFE, first-euro, and Thai insurance options
• Ensure your insurance meets O-A visa requirements
• Assist with enrollment and document preparation
• Help with insurance claims and hospital liaison

We work with your best interests in mind, providing clear and unbiased guidance so you can enjoy your life in Thailand with peace of mind.

Frequently Asked Questions

Can I have both the CFE and a first-euro insurance?

You can, but it is generally not cost-effective. The CFE with a complementary top-up plan, or a standalone first-euro plan, usually provides better value.

Does the CFE cover emergency evacuation?

No. The CFE does not include medical evacuation. You would need a separate evacuation policy or a first-euro plan that includes this benefit.

Can I join the CFE at any time?

Yes. There is no enrollment window. You can join the CFE at any point during your time abroad. However, a waiting period of 3 months may apply before coverage begins.

What if I have pre-existing conditions?

The CFE covers pre-existing conditions without exclusion. First-euro insurers may exclude or impose waiting periods on pre-existing conditions, depending on the provider and plan.

Is Thai public hospital care free for foreigners?

No. While Thai public hospitals are affordable, foreigners are charged higher rates than Thai nationals. Public hospital care is not free for non-Thai residents.

Will my insurance cover dental and optical care?

The CFE reimburses dental and optical care at French tariff rates (which are very low). First-euro plans may include dental and optical coverage depending on the plan level, often as an add-on.