Healthcare and health insurance in Andorra

Andorran social security (CASS): who is covered?

The CASS (Andorran Social Security Fund) is Andorra’s social security system. It covers people who pay contributions through their work: employees, who pay 6.5% of their salary (the employer adding 15.5%), and the self-employed, who pay 22% of a base linked to the average wage. The spouse and dependent children are covered as “indirectly insured persons”. Holders of a CASS retirement pension are also covered, once they have acquired 500 points.

The right to reimbursement is not immediate. For ordinary illness, an employee must have paid contributions as follows:

Accidents at work and occupational diseases: cover from the first day. The same rules apply to the self-employed.

At the end of a contract, cover is extended for 60, 90 or 120 days depending on the length of contributions, provided you remain resident. A self-employed person is entitled to healthcare only if their contribution base reaches the minimum wage, or if they top it up. The details are in our guide to CASS contribution rates.

How much does the CASS reimburse?

The CASS reimburses a percentage of its own tariffs, called reference tariffs, not of the price actually charged. The rate depends on the pathway followed:

Percentages of the CASS reference tariffs, with professionals under agreement with the CASS (Llei 6/2019 amending Llei 17/2008 on social security). With a professional not under agreement: 20% of the reference tariffs.

The via preferent: how do you choose your referring GP?

The “via preferent” (preferential pathway) is organised by the regulation on access to public healthcare, approved by Decree 305/2026 of 29 July 2026. In practice:

1. 1

   Choose a referring GP

   Each insured person aged 16 or over chooses a family doctor or a paediatrician from among the primary care professionals under agreement with the CASS: at the doctor’s surgery, on the CASS website or at its offices. Parents choose for their minor children. The doctor must confirm; if they do not reply within 15 days, their agreement is presumed.

2. 2

   Choose a primary care centre

   People aged 16 or over choose a centre d’atenció primària (CAP), the local health centre. Each parish has at least one: see the services in each parish.

3. 3

   Go through your referring GP to see a specialist

   A referral to a specialist is valid for 18 months, for 12 consultations at most; this period went from 12 to 18 months on 1 October 2026. Gynaecology and obstetrics, ophthalmology, stomatology and dentistry remain directly accessible, provided you have a referring GP.

4. 4

   In an emergency, go straight to the emergency services

   Emergency care (116, the hospital emergency department, the out-of-hours medical service, urgent care at ski resorts or outside Andorra) is part of the pathway, without prior referral.

Another advantage: consultations with your referring GP qualify for third-party payment when they are billed electronically. The CASS then pays its share directly to the doctor, and you do not pay the reimbursed amount up front. For people aged 65 or over and people with disabilities, third-party payment extends to care within the pathway provided in Andorra and, under certain conditions, to medicines.

Top-up health insurance in Andorra: do you need it?

It is not compulsory for a person insured with the CASS, but it is common, for three reasons:

• even within the pathway, 25% of the tariff for a consultation and 10% of that for a hospital stay remain payable by you;
• reimbursement is calculated on the CASS tariffs: if the practitioner charges more, you bear the whole difference;
• outside the pathway, or with a practitioner not under agreement, the rates fall to 33%, 60% or 20%.

Before taking out a policy, compare several offers and check what each policy reimburses: the share the CASS leaves you to pay, charges above its tariffs, care outside Andorra, repatriation.

Passive residents: 100% private insurance

A passive resident does not contribute to the CASS through an activity. They must show insurance covering 100% of medical costs in Andorra, as well as incapacity and old age; for minors and people over 60, health cover is enough (Decree 407/2025). See the conditions for passive residency.

Hospital Nostra Senyora de Meritxell, emergencies and health centres

Andorra has a single hospital, the Hospital Nostra Senyora de Meritxell. It is run by the SAAS (Servei Andorrà d’Atenció Sanitària), the body that brings together the public health resources. Its emergency department operates 24 hours a day, every day of the year, and the SAAS advises calling 116 first to avoid unnecessary trips. There is also an emergency service in Pas de la Casa.

Routine care is provided through the centres d’atenció primària (CAP), present in every parish. Highly specialised care, which the regulation describes as “normally” provided outside the country, takes place in centres under agreement with the CASS in Catalonia, in the rest of Spain or in France: the referral goes through a specialist practising in Andorra, with the CASS’s authorisation.

France⁠–⁠Andorra agreement: getting treatment in France, and the EHIC?

Andorra is bound to Spain, France and Portugal by social security agreements. For a temporary stay in one of these countries, a person insured with the CASS obtains a form that covers immediately necessary care in the public network, for themselves and their dependent relatives:

Form to be requested before departure: in the private area of the CASS website, at the kiosks in its offices or at the offices of the comuns (parish councils). The stay may not exceed the entitlement period (60, 90 or 120 days), and six months at most per calendar year.

Without a form, the facility may apply its private rates. Scheduled consultations are excluded, except in France for CASS retirees living in Andorra and for students living in Andorra who study in France, if the form says so. Conversely, a CASS information sheet describes the reimbursement of Spanish, French and Portuguese insured persons treated during a stay in Andorra.

The European Health Insurance Card (EHIC) is not valid in Andorra

Andorra is not among the countries where the EHIC can be used: according to the CLEISS, the card issued by a French fund is valid only in the Member States of the European Union, Iceland, Liechtenstein, Norway, Switzerland and the United Kingdom. A person insured under a French scheme who is staying in Andorra therefore asks their fund (CPAM, MSA…) for form SE 130-04 before leaving, then presents it to the CASS if they need immediate care. The form also covers the members of their family listed on it. These rules derive from the France⁠–⁠Andorra social security agreement of 12 December 2000 (Article 17).

Families, students, retirees: special cases

• Dependants: the spouse and dependent children of an insured person are covered as indirectly insured persons; reimbursements are paid to the main insured person.
• Students abroad: a child who is an indirectly insured person and studies outside Andorra remains within the pathway without a referral from an Andorran doctor, on presentation of proof of studies.
• CASS retirees: the retirement pension gives entitlement to reimbursements once 500 points have been acquired.
• Retirees under a French scheme: their cover falls under the social security agreement between France and Andorra; ask your French fund and the CASS before leaving.

For all of a family’s formalities, see our pathway for moving to Andorra as a family; for retirees, the one for retiring in Andorra. The place of healthcare in the budget is covered in our guide to the cost of living in Andorra.