French expats: CFE alone, CFE top-up or first-euro insurance?
A decision guide for French expats in Asia: what the CFE pays by zone in 2026, what it costs, and when a top-up or first-euro insurance is the better choice.
Reviewed by a licensed advisor
In Hong Kong, Singapore and China, the CFE alone pays only a small share of a hospital bill: 19% of the real cost in Hong Kong and Singapore, 31% in China. For most French expats there, the real choice is between the CFE plus a top-up, which keeps the CFE's guarantees (no medical questionnaire, no age limit, continuity with French Social Security), and first-euro international insurance, which pays from the first euro under one private contract but accepts you on its own medical terms. This guide sets the three options side by side with the CFE's official 2026 figures and shows which one fits which profile.
What are your three options as a French expat?
1. The CFE alone
The Caisse des Français de l'Étranger (CFE) is a French social security body with a public-service mission, which expatriates join voluntarily. For care abroad it does not use French tariffs. It pays a percentage of the real cost, or a fixed amount, according to the zone of the country where you are treated. There are five zones: Hong Kong and Singapore are in zone 5, China in zone 4 and Thailand in zone 3.
2. The CFE plus a top-up
A CFE top-up is a private contract that pays part or all of what the CFE leaves unpaid, up to its own limits. Some CFE partners offer one contract and a single reimbursement for both layers.
3. First-euro international insurance
First-euro insurance is a private international health policy that pays from the first euro you spend, under its own table of benefits and limits, with no link to the CFE. You can hold it on its own, or keep the CFE alongside it, for example for continuity when you return to France or to keep contributing to the CFE's old-age insurance.
CFE, top-up or first-euro: how do they compare?
The table sums up the points that usually decide the matter. The CFE figures are official. The top-up and first-euro columns describe how these contracts generally work, because each insurer sets its own terms: always check the policy wording.
Point | CFE alone | CFE plus top-up | First-euro insurance |
|---|---|---|---|
How the price is set | Quarterly contribution by age band, solo or family; the same in every country | CFE contribution plus the top-up premium set by the insurer | One premium set by the insurer, usually by age, area of cover, deductible and health |
Medical questionnaire | None, and a member cannot be excluded | None for the CFE part; the top-up insurer sets its own rules | Usually yes; an existing condition can be excluded, surcharged or refused |
Age limit | None; the contribution stops rising from age 70 | None for the CFE part; each top-up insurer sets its own entry ages | Set by each insurer, often with a maximum age to join |
Hospital stay, without direct billing | 19% of the real cost in Hong Kong and Singapore, 31% in China, 42% in Thailand | The CFE share plus the top-up's share, up to the top-up's limits | Paid by the insurer up to the policy's limits |
GP or specialist visit | Fixed €21 in every zone | €21 plus the top-up's share | Paid up to the policy's limits |
Direct billing in hospital | Only in 33 countries (Thailand at 70%); none in Hong Kong, Singapore or China | Depends on the top-up insurer's network | Depends on the insurer's network |
Childbirth | Fixed €3,164.11 (vaginal) or €3,573.64 (caesarean), uncomplicated birth | The CFE amount plus the top-up's maternity cover | Under the policy's maternity cover and its own waiting period, if included |
Waiting periods | None if you join within 3 months of becoming eligible; otherwise 3 months under 45, 6 months from 45, 12 months after a cancellation not due to a return to France | The CFE rules plus any top-up waiting period | Set by each insurer, often with specific rules for maternity |
Return to France | Rights kept for up to 3 months after you return; no waiting period to rejoin French Social Security | Same as the CFE | No link with French Social Security; depends on the policy |
Pension rights | Through the CFE old-age insurance, a separate contract with its own contribution | Same as the CFE | None from the health policy |
Claims | You pay first abroad, then claim online; 4.9 days average processing of online claims in 2025 | A single reimbursement with all-in-one packs and management agreements | Set by the insurer |
Source: CFE, guarantees 2026 (arrêté of 17 December 2025), country list with hospital direct-billing rates, individual contribution scale April 2026, membership guide 2026 and annual report 2025; Code de la sécurité sociale art. R762-8. Read 4 Nov 2026.
What does the CFE pay in Hong Kong, Singapore, China and Thailand?
Since 1 January 2026, the CFE has paid care abroad under the arrêté of 17 December 2025. Most rates are a percentage of the real cost of the bill. Consultations and childbirth are fixed amounts, identical in every zone.
Care | Hong Kong, Singapore (zone 5) | China (zone 4) | Thailand (zone 3) |
|---|---|---|---|
Hospital stay (medicine, surgery, intensive care), without direct billing | 19% | 31% | 42% |
Hospital stay with CFE direct billing | Not available | Not available | 70% (you pay 30% plus extras) |
Chemotherapy | 20% | 35% | 40% |
Radiotherapy | 32% | 44% | 52% |
Imaging (X-ray, scanner, MRI) | 15% | 20% | 30% |
Medicines | 45% | 45% | 55% |
GP or specialist visit | €21 | €21 | €21 |
Vaginal birth / caesarean | €3,164.11 / €3,573.64 | €3,164.11 / €3,573.64 | €3,164.11 / €3,573.64 |
Source: CFE, guarantees 2026 (arrêté of 17 December 2025) and CFE country list by zone, read 4 Nov 2026.
What this means in Hong Kong and Singapore (zone 5)
For a hospital stay, the CFE pays 19% of the bill. The other 81% is yours unless a top-up or a first-euro policy pays it. For an MRI or a scanner the CFE pays 15%, for medicines 45%, and for a GP or specialist visit a fixed €21 (70% of a €30 flat rate), however high the fee. There is no CFE direct billing in either city, so you pay the hospital first and claim afterwards. In zone 5, the CFE is a base to build on, not a full cover. See our guides for Hong Kong and Singapore.
What this means in China (zone 4)
For a hospital stay, the CFE pays 31% of the bill and leaves 69% to you or your insurer. Imaging is paid at 20%, medicines at 45% and chemotherapy at 35%. The CFE has no direct billing in China, so you pay first and claim. More detail in our China guide.
What this means in Thailand (zone 3)
Thailand is one of only two countries, with Lebanon, where the CFE's hospital direct billing pays 70%. In a hospital of the CFE's partner network you do not advance the costs: the CFE pays 70% of the invoice and you pay 30%, plus items the CFE never pays, such as a private room or a companion's costs. Outside the network, the CFE pays 42% after you have paid the bill.
Direct billing is open to individual members on MondExpat, JeunExpat or RetraitExpat Santé whose rights are open. It is not available if you already hold a top-up from a CFE partner that offers its own direct billing with a network abroad. Check that point before you choose a top-up in Thailand. More in our Thailand guide.
Source: CFE, hospital direct billing guarantees 2026, country list by zone and membership guide 2026 (pages 14 and 15), read 4 Nov 2026.
How much does the CFE cost in 2026?
CFE contributions are quarterly. They depend only on your age band and on whether you join alone or as a family; the country where you live does not change the price, only what the CFE pays back. The scale below has applied since 1 April 2026, when the CFE raised individual and collective contributions by 11%. The monthly "from" prices still shown on the cfe.fr home page on 4 November 2026 match the older January 2026 scale.
Age | Solo, per quarter | Family, per quarter |
|---|---|---|
25 to 29 (JeunExpat Santé) | €189 | €564 |
30 to 34 | €291 | €600 |
40 to 44 | €411 | €843 |
50 to 54 | €546 | €1,068 |
60 to 64 | €828 | €1,476 |
70 and over | €909 | €1,623 |
MondExpat Santé, worldwide cover including stays in France. RetraitExpat Santé, for retirees of the French system who meet its conditions, costs €492 per quarter solo and €894 for a family. A French national living outside Europe, registered with the consulate, whose household resources are below €24,030 a year (2026 threshold) can ask for the reduced "catégorie aidée" rate of €228 per quarter.
Top-up and first-euro premiums are not on a public scale. Each insurer prices by age, cover, deductible and, for first-euro, your health, so we give no figure for them here: a quote for your age and country is the only reliable number.
Source: CFE, individual contribution scale April 2026; CFE newsletter January 2026; cfe.fr/categorie-aidee. Read 4 Nov 2026.
Which option fits you?
Your situation | What usually fits | Why |
|---|---|---|
Under 30, healthy, in Hong Kong, Singapore or China | CFE (JeunExpat Santé) plus top-up, or first-euro | The CFE costs €180 to €189 per quarter solo at this age; joining within 3 months of leaving avoids a waiting period if you need the CFE later |
30 to 44, healthy, no plan to return | First-euro, or CFE plus top-up | Compare the total cost; a first-euro insurer is more likely to accept you without exclusions while you are healthy |
45 or over | CFE plus top-up | No questionnaire, no age limit, contribution capped from 70; joining late from 45 means a 6-month wait |
Existing condition or chronic illness | CFE plus top-up | The CFE cannot refuse or exclude you; a first-euro insurer may exclude the condition |
Planning a child | CFE plus top-up, or first-euro with maternity cover | The CFE pays a fixed amount per birth; check the maternity waiting period of any private contract |
Planning to return to France | CFE, with or without top-up | Rights kept for up to 3 months after you return, and no waiting period to rejoin French Social Security |
Retired from the French system | RetraitExpat Santé plus top-up | €492 per quarter solo if you meet the conditions |
Living in Thailand | CFE plus a top-up that does not block CFE direct billing, or first-euro | CFE direct billing pays 70% in network hospitals |
Low household resources | CFE "catégorie aidée", plus a top-up if affordable | €228 per quarter under the 2026 resources threshold |
If you are 45 or over, or have a health history
This is where the CFE earns its place. It asks no health questions, accepts every French expat whatever the age, and cannot exclude a member. A first-euro insurer prices and accepts you on your health, and may exclude a condition you already have. If your top-up has its own questionnaire and excludes that condition, the CFE share is still paid. For outpatient care, members with a recognised long-term condition (exonération du ticket modérateur) get the CFE's higher "with exemption" rates; for hospital stays abroad the rate is the same for everyone.
If you plan to have a child
The CFE's fixed birth amounts cover the mother, the baby and the practitioners' fees for an uncomplicated birth. If you joined more than three months after leaving France, the conception date must be after your membership date. Private contracts usually set their own maternity waiting period, so arrange cover early whichever route you choose.
If you plan to return to France
A CFE member who tells the CFE about the return keeps rights for up to three months from the first day of residence in France. French health insurance opens at once if you take a job and can open after three months of stable residence if you do not, so the CFE bridges the gap. A first-euro policy has no link with French Social Security: if you return without a job, check whether it covers you in France for those first three months.
Source: CFE membership guide 2026 (pages 3, 15, 25, 38 to 39), guarantees 2026, contribution scale April 2026; Code de la sécurité sociale art. R762-8. Read 4 Nov 2026.
Who should skip the CFE?
The CFE is not the right base for everyone. You can reasonably go without it if all of the following are true:
you are young and healthy, and a first-euro insurer accepts you without exclusions;
you can afford a comprehensive first-euro formula with high hospital limits for the country where you live;
you do not plan to return to France in the coming years, or you accept the three-month gap if you return without a job;
you do not need the CFE's old-age insurance, or you take it separately;
your employer does not already pay your CFE contribution.
Be clear about what you give up. Your acceptance by the CFE does not depend on your health, so it stays open if you fall ill later; a first-euro contract does not give you that. Changing your mind also costs time: if you join the CFE more than three months after becoming eligible, you wait 3 months before reimbursement under 45 and 6 months from 45, and 12 months if you rejoin after a cancellation not due to a return to France. You pay contributions during that wait. A government inspection mission (IGAS-IGF) has also suggested a surcharge for late joining, for example after 45; the CFE says this is under study at ministry level and nothing is decided. See how to stay covered during the CFE waiting periods.
Source: Code de la sécurité sociale art. R762-8; CFE membership guide 2026 (page 9); CFE annual report 2025 (page 25). Read 4 Nov 2026.
Can you keep the CFE and take first-euro insurance as well?
Yes. Some expats hold both: first-euro insurance for the bills, and the CFE for what a private contract cannot give, such as continuity on return to France and guaranteed cover if the private insurer later refuses to renew or excludes a new condition. You then pay both, and the private insurer will not reimburse more than the bill, so tell it about your CFE cover.
Pension rights work separately. Health cover at the CFE gives no pension rights; those come from the CFE old-age insurance, a separate contract open to people who were covered by a French health insurance scheme for at least 5 years in total, or who paid at least 6 months of French old-age contributions before leaving. Since May 2026, self-employed expats can join it too. The CFE's three insurances (health, work accidents, old age) are separate: you can join one, two or all three, so you can keep the CFE old-age insurance alongside a first-euro health policy.
Source: CFE membership guide 2026 (page 19), individual contribution scale April 2026 (page 2), CFE newsletter July 2026. Read 4 Nov 2026.
How Alea helps
Alea is the official CFE representative for Hong Kong, China and Singapore. We help you join the CFE at the right time to avoid waiting periods, then compare top-ups and first-euro formulas from more than 50 insurers for your age, country and health history, including the option of keeping the CFE alongside private cover. If you are still weighing the CFE itself, read our CFE pros and cons or see our CFE page.
Talk to an advisor for a free comparison, with no obligation.
Is the CFE enough on its own in Hong Kong or Singapore?
For most people, no. Hong Kong and Singapore are in CFE zone 5, where the CFE pays 19% of the real cost of a hospital stay, 15% of imaging and a fixed €21 for a GP or specialist visit. There is no CFE direct billing in either city, so you pay first and claim. The CFE alone works as a base to complete with a top-up, or as a minimum safety net if nothing more is affordable.
What is first-euro insurance?
First-euro insurance is a private international health policy that pays your medical costs from the first euro spent, under its own table of benefits and limits. It works independently of the CFE and of French Social Security. The insurer usually asks medical questions, may exclude existing conditions, sets its own waiting periods and often has a maximum age to join. Premiums depend on age, area of cover, deductible and health.
Can I have both the CFE and first-euro insurance?
Yes. You pay both contributions. People do this to keep continuity with French Social Security on return, to keep cover the CFE cannot withdraw if their health changes, or alongside the CFE old-age insurance. The private insurer will not pay more than the bill, so declare your CFE membership when you claim. A CFE top-up is usually the cheaper way to combine the two layers.
Does first-euro insurance give me French pension rights?
No. A private health policy gives no French pension rights. Pension rights abroad come from the CFE old-age insurance, a separate contract from CFE health cover. It is open to people previously covered by a French health scheme for at least 5 years, or with at least 6 months of French old-age contributions, and since May 2026 also to self-employed expats. You can hold it on its own: the CFE lets you join one, two or all three of its insurances.
What happens if I join the CFE more than three months after leaving France?
You pay contributions from the start but wait before reimbursement: 3 months if you are under 45, 6 months from 45 (Code de la sécurité sociale art. R762-8). After a cancellation not due to a return to France, the wait is 12 months. For maternity, the conception date must be after your membership date. Joining within three months of becoming eligible avoids any waiting period.
Does the CFE pay hospitals directly in Thailand?
Yes, in the CFE's partner hospital network. The CFE pays 70% of the invoice and you pay 30%, plus extras such as a private room. Outside the network, it reimburses 42% after you pay. Direct billing is for individual MondExpat, JeunExpat or RetraitExpat Santé members with open rights, and it is not available if your top-up is from a CFE partner that already offers direct billing abroad.
Does the CFE contribution depend on the country where I live?
No. The contribution depends only on your age band and on whether you join solo or as a family. A 40 to 44 year old pays €411 per quarter solo under the April 2026 scale, whether in Hong Kong or Thailand. What changes with the country is what the CFE pays back: 19% of a hospital bill in Hong Kong, 42% in Thailand outside direct billing.
Written by
François Bossé
Insurance Advisor
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