CFE plus top-up or first-euro insurance in China: which suits you?

In China, both routes can give you proper cover, and with both, a private insurer pays most of a bill at an international hospital: the CFE pays 31% of a hospital stay in China, 21 € per doctor visit, and it has no direct billing there. So the real question is whether you want what only the CFE gives: acceptance with no health questionnaire and no age limit, continuity with French Social Security when you return, and access to its pension and work-accident insurance. If you need these, the CFE plus a top-up is usually the safer choice. If you are healthy, do not plan to return soon, and a first-euro insurer accepts you without exclusions, first-euro insurance can be simpler.

This page applies the choice to China. For the general comparison, read CFE top-up or first-euro insurance. For what the CFE pays in China against real hospital prices, read our China guide, is the CFE enough in China.

How does the CFE plus a top-up work in China?

You join the Caisse des Français de l'Étranger (CFE) and pay a quarterly contribution in euros, set by your age and family, the same in every country. The CFE reimburses care in China at its zone 4 rates: 31% of a hospital stay, 20% of imaging, 45% of pharmacy, 21 € per GP or specialist visit, and fixed amounts for a birth. A CFE top-up pays what is left, up to its own limits, and can add direct billing with hospitals and an evacuation guarantee.

These are MondExpat Santé amounts per quarter, in force since 1 April 2026; the top-up premium, set by the insurer, comes on top. With the CFE you pay the hospital or doctor first, then claim online. With an all-in-one pack, or with an insurer that has a management agreement with the CFE, you get a single reimbursement; with other insurers you claim from the CFE, then from the top-up.

Source: CFE individual contribution table, April 2026; CFE guarantees 2026 (arrêté of 17 December 2025); CFE partner page, read 4 Nov 2026.

How does first-euro insurance work in China?

First-euro international insurance is a private contract that pays from the first euro under its own table of benefits and limits, with no CFE in the chain. You deal with one insurer and make one claim, and you get direct billing wherever that insurer has an agreement with the hospital. In return, the insurer chooses whom it covers. It usually asks health questions and can exclude, surcharge or refuse a condition you already have. It often sets a maximum age to join and its own waiting periods, in particular for maternity. Its price is set by the insurer, usually by age, area of cover and deductible. Always read the policy wording rather than a summary.

First-euro insurance has no link with French Social Security. That matters most when you go back to France, as the table below shows.

Which option fits your situation in China?

Source: CFE individual contribution table April 2026; CFE membership guide 2026 (pages 3, 6, 9, 21, 25, 38 to 40); Code de la sécurité sociale R762-8; CFE newsletter July 2026, read 4 Nov 2026. The first-euro column describes how these contracts generally work; each insurer sets its own terms.

If you plan a birth

Arrange cover before the pregnancy, whichever route you take: the CFE's conception rule and a private insurer's maternity waiting period both look backwards. Costs at Shanghai hospitals and how the CFE pays are in giving birth in China with the CFE.

If you are joining late

The waiting period is set by law: none if you join within three months of becoming eligible, otherwise 3 months under 45 and 6 months from 45, during which you pay contributions but get no reimbursement. See how to stay covered during the CFE waiting periods and joining the CFE from China.

What does the difference look like on a real bill?

Take one example. Jiahui International Hospital in Shanghai lists a laparoscopic gallbladder removal at 45,000 to 60,000 CNY in its fee schedule of 15 January 2024, about 6,033 to 8,044 € at the European Central Bank rate of 3 November 2026 (1 € = 7.4590 CNY). The CFE pays 31% of that, 1,870 to 2,494 €. For you to pay nothing, the top-up or the first-euro insurer must cover the other 4,163 to 5,550 €, and the hospital must accept its direct billing. Either way the private contract carries most of the bill, so its limits and its hospital network matter more than the label on the contract. More hospital prices, set against what the CFE pays, are in our China guide.

Source: Jiahui fee schedule for Shanghai, updated 15 January 2024, "for reference only", read 4 Nov 2026; ECB reference rate; CFE guarantees 2026. Euro amounts are our calculations.

What happens to your pension and work-accident cover?

The CFE runs three separate insurances: health (sickness, maternity, invalidity), work accidents and occupational diseases, and old-age insurance on behalf of the French basic pension scheme. Its contribution table states that you can join one, two or all three, according to your needs. Choosing first-euro insurance for your health therefore does not close the door to the other two.

• Old-age (pension) insurance. No nationality condition. You must have been covered by a French mandatory health scheme for at least 5 years in total, or have paid at least 6 months of French old-age contributions before leaving, and be an employee abroad or have no professional activity. Since May 2026, self-employed expats can join too. Contributions are passed in full to the French basic pension scheme; the amounts depend on your situation and are in the CFE table.

• Work-accident insurance. For an individual, 1.15% of an annual base you choose between 21,328 € and 170,624 €, which is 60 € to 492 € per quarter.

• Daily allowance option. Sick-leave allowance, death capital and invalidity, at 39 €, 51 € or 78 € per quarter depending on your resources. It is an option of the CFE health insurance, so it goes with it.

A first-euro health policy gives no French pension rights. If pension continuity matters to you, look at the CFE old-age insurance whichever health route you choose.

Source: CFE individual contribution table April 2026 (page 2); CFE membership guide 2026 (pages 19, 21, 23); CFE newsletter July 2026; CFE annual report 2025 (page 13), read 4 Nov 2026.

Can you switch later, or keep both?

From first-euro to the CFE. You can join the CFE at any time while you live abroad. Join within three months of settling in China and there is no waiting period. Later, the CFE pays nothing for 3 months under 45 and 6 months from 45. A government inspection mission (IGAS-IGF) has also suggested a surcharge for late joining, for example after 45; the CFE says the idea is under study at ministry level, and nothing is decided.

From the CFE to first-euro. You go through the private insurer's health questions at the age you are then. If you leave the CFE and rejoin later without having returned to France, the waiting period is 12 months.

Both at once. Some expats keep the CFE alongside a first-euro policy, for continuity on return and as a cover that cannot refuse them if their health changes. You then pay both, and the private insurer will not pay more than the bill. The general comparison covers this case in detail.

Source: Code de la sécurité sociale R762-8; CFE membership guide 2026 (page 9); CFE annual report 2025 (page 25), read 4 Nov 2026.

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How Alea helps

Alea is a Hong Kong-based broker and the official CFE representative for Hong Kong, China and Singapore. We help you join the CFE at the right time, then compare CFE top-ups and first-euro formulas from more than 50 insurers for your city, age and health, side by side and with their direct billing in China. If you are still weighing the CFE itself, read CFE pros and cons or what is the CFE. Start with our CFE page, or talk to an advisor for a free quote with no commitment.