Health Insurance in Andorra: A Guide for Foreign Workers

If you are moving to Andorra to work, sorting out your health insurance is one of the first things to get right. It is not just about your health — health insurance is mandatory for all residents, a valid arrangement is a documentary requirement for your residence and work permit, and it affects your legal status. This guide walks you through how the public system works, what it actually covers, your private options, what it costs, and exactly what foreign workers and professional drivers need.

The short version: once you are legally employed in Andorra, you and your employer contribute to CASS, the national social security fund, which reimburses a large share of your medical costs. Most people add a small private top-up to cover the rest. If you do not work here — a passive resident — the rules are different, and private cover becomes compulsory.

How health insurance in Andorra works

Andorra runs a social insurance model built on co-payment rather than a fully state-funded service. One body sits at the centre of it: the Caixa Andorrana de Seguretat Social, universally known as CASS, established in 1968. It collects contributions from employers, employees and voluntary participants, and it reimburses a defined percentage of your medical costs while you pay the rest. Membership is compulsory for all employees exercising a professional activity and for the large majority of residents — around 92 per cent of the population is covered through it. The system is efficient and well regarded: household out-of-pocket payments accounted for just 11 per cent of total health expenditure in 2023, among the lowest shares anywhere in the WHO European Region.

The types of cover you will come across.

There are two layers, and most working residents use both. The first is CASS itself, the public scheme funded by contributions, which reimburses most of the cost of care. The second is complementary private insurance, taken out to cover the CASS co-payment shortfall and services the public scheme does not fully fund, such as dental and optical care and treatment abroad. A distinct third situation applies to passive residents — people who live in Andorra without working here — for whom qualifying private health insurance is a legal requirement in its own right, because they do not contribute to CASS through employment.

Who actually needs health insurance?

Everyone residing in Andorra. The government requires all residents to hold health insurance, either through the public CASS system or through private medical insurance, and the form that requirement takes depends on your residency type and employment. Employed residents are registered with CASS automatically through payroll and contribute by deduction. Self-employed residents must register and pay contributions directly. Passive residents, who do not work in Andorra, must hold qualifying private insurance. There is one important gap to plan for: private health insurance is mandatory for all applicants until they become eligible to enrol in CASS, so even future CASS members usually need private cover in the interim. At the same time, residency and employment are being established. Failure to hold insurance can lead to a fine or refusal of entry.

What the public system covers

CASS covers the essentials well. Care is delivered at the Hospital Nostra Senyora de Meritxell, the country’s single hospital in the capital, and through a network of primary health care centres. Coverage includes emergency care, maternity, general medical care, specialist care and hospital treatment. To get the best reimbursement, you generally follow a referral pathway, starting with a general practitioner. One notable strength is cross-border access: thanks to social security agreements with France, Spain and Portugal, CASS covers you when visiting those countries, which matters greatly in a small landlocked country whose most specialised treatment is often provided across the border. Before travelling, you request a certificate from the CASS office or online portal, then submit the medical bills for reimbursement.

What it costs

Social security contributions in Andorra are low by European standards. The total is around 22 per cent of salary, split between the employee at roughly 6.5 per cent and the employer at roughly 15.5 per cent — well below Spain at about 33 per cent or France at about 40 per cent. That single contribution funds healthcare, pensions, maternity and paternity leave, disability and more. On the reimbursement side, CASS typically refunds around 75 per cent of outpatient costs such as doctor visits, specialists and diagnostics, with the patient paying the remaining 25 per cent, and around 90 per cent of hospital stays, with the patient paying 10 per cent. Prescription drugs are reimbursed at 40 to 100 per cent depending on the medication, and chronic-condition medicines are nearly free. Services not authorised by CASS are reimbursed at a standard 33 per cent.

Why do most foreign workers add private cover?

Because the co-payment adds up, and private cover is inexpensive here. A complementary policy reimburses the 25 per cent you would otherwise pay on outpatient care, covers dental and optical treatment that CASS funds only partly, and extends protection abroad beyond the emergency cover of the cross-border agreements. Premiums are modest — commonly around 30 to 110 euros a month per person, with many basic top-up policies around 40 to 50 euros — and roughly a quarter of the population holds one. Usefully, you are allowed to seek treatment in public facilities even when covered by private insurance, so the private layer adds options rather than replacing the public one.

Health insurance for your residence permit

Health cover is checked at the immigration stage, and the requirement depends on your route. For an employed residence and work permit, your CASS registration through your employer is the backbone. Still, because enrolment is not instant, you will typically need private cover valid from arrival until CASS eligibility begins. For passive residence, the rules are explicit: applicants must hold medical, disability and retirement insurance with coverage in Andorra, reimbursing medical expenses at the CASS rate and at arranged centres in Spain, though minors and those over 60 need only medical insurance. Whatever your category, keep the policy valid for the whole permitted stay, since a lapse can affect renewal.

Health insurance for truck and transport drivers

Professional drivers have needs a standard resident policy may not meet. If you drive internationally — and from Andorra almost all freight movement is cross-border, since the country is landlocked between France and Spain — you want cover that follows you along your routes rather than stopping at the border. CASS provides emergency cover in France, Spain and Portugal under the social security agreements, but confirm the certificate procedure before each trip and consider a private policy with wider on-road and repatriation cover. Check that accident and rehabilitation care, and treatment during long stays away from Andorra, are included.

Using your insurance day to day

In routine use, the system is straightforward. Register with a general practitioner and start there for non-emergencies, since the referral pathway secures the best reimbursement. You generally pay the provider and claim CASS reimbursement, with a complementary private policy covering the balance—some arrangements settle the private share directly. Keep your CASS documentation and, if travelling, download the cross-border certificate in advance. For an emergency, go straight to the hospital or call the emergency services; urgent care is provided regardless.

Choosing a private insurer

Choose an insurer authorised to operate in Andorra, with a clear complementary product that plugs the CASS co-payment and, if you need it, cross-border and repatriation cover. Compare the monthly premium against how often you actually use care, check whether dental and optical are included, and confirm the network of clinics you can use. For passive residents, the policy must meet the specific legal requirements for that status, including coverage at the CASS rate and at arranged Spanish centres, so verify it qualifies before you rely on it.

For professional drivers in Andorra

Andorra is a microstate of about 80,000 people in the Pyrenees, landlocked between France and Spain, with no airport and no railway — everything arrives by road, over the two mountain passes. That makes road transport genuinely important to the country’s supply, but it also means the driving is almost entirely cross-border, and the domestic haulage sector is small. For a driver based here, the healthcare setup is actually favourable: CASS reimburses 75 to 90 per cent of costs, contributions are among the lowest in Europe, the single hospital in Andorra la Vella is modern and well regarded, and the cross-border agreements with France, Spain and Portugal mean your cover follows you into exactly the countries you are most likely to drive through. The practical priorities are to confirm the cross-border certificate procedure with CASS before each trip and to add a complementary private policy that covers the co-payment plus on-road emergencies and repatriation. As ever, remember that specialised treatment is often referred across the border, so cover that works smoothly in Spain and France is worth more here than almost anywhere else.

• Browse driver vacancies in Andorra.
• Register a driver profile.
• For employers — recruitment and compliance support

Health insurance by Andorran parish

The rules are the same across all seven parishes — public enrolment with CASS through your employer, private cover on top — but Andorra is small enough that the single national hospital in Andorra la Vella serves everyone, with primary care centres in each parish. Here is the picture parish by parish.

Andorra la Vella

The capital parish and home to the Hospital Nostra Senyora de Meritxell, the country’s only hospital, along with the widest range of specialists and private clinics. Driver jobs in Andorra la Vella.

Escaldes-Engordany

Adjoining the capital and effectively part of the same urban area, with easy access to the national hospital and the main clinics. Driver jobs in Escaldes-Engordany.

Encamp

A parish on the road toward the French border at the Envalira pass, with a primary care centre and quick access to the capital’s hospital. Driver jobs in Encamp.

Canillo

The highest and most easterly parish, on the route to the French frontier, with local primary care and hospital referrals to Andorra la Vella. Driver jobs in Canillo.

La Massana

A western parish in the ski-resort belt, served by a primary care centre with the national hospital a short drive away. Driver jobs in La Massana.

Ordino

A northern mountain parish with a small population and a primary care centre, referring serious cases to the capital. Driver jobs in Ordino.

Sant Julià de Lòria

The southernmost parish on the road to the Spanish border, with local primary care and referrals to Andorra la Vella or across into Spain. Driver jobs in Sant Julià de Lòria.

How health cover works in Andorra — the essentials

Andorra sits outside the EU and EEA, so the European Health Insurance Card does not apply and there is no automatic reciprocal cover for most visitors. Public healthcare may exist but is often limited for foreigners or charged, and standards can vary between the capital and rural areas, which makes private health insurance the practical route for visitors and new arrivals alike.

If you are moving to Andorra to live or work, expect to arrange private health cover or join any local scheme available to foreign residents, and to show proof of insurance for a visa or residence permit. For a short visit, comprehensive travel health insurance that covers private treatment and repatriation is strongly advised, since you will generally pay for care yourself.

Related guides

• Andorra work permit
• Andorra residence permit
• EU work visa — overview
• Driver vacancies across Europe

Official government sources

• CASS — the Caixa Andorrana de Seguretat Social, public health and social security.
• Ministry of Health — health policy and public services.
• Immigration Service — residence permits and insurance requirements.
• Hospital Nostra Senyora de Meritxell — the national hospital.

Information only — not legal, medical or insurance advice. Rates, covered services and rules can change. Always confirm current details with the official Andorran authorities above before you act.