The CASS: how the healthcare system works in Andorra is an important subject for employees, self-employed workers, families and anyone planning to move to the Principality. CASS, short for Caixa Andorrana de Seguretat Social, is Andorra’s social security institution. It manages healthcare cover as well as pensions and other social protection benefits.
What is CASS?
Andorra does not operate a completely free, state-funded healthcare system in the same way as some larger European countries. Instead, CASS generally works through contributions and reimbursement. People who are affiliated with CASS pay social security contributions, while CASS covers an approved percentage of the cost of eligible healthcare.
Healthcare is delivered through the public system, including the Servei Andorrà d’Atenció Sanitària (SAAS), and through private doctors and clinics that have an agreement with CASS. The main public hospital is Hospital Nostra Senyora de Meritxell, near Escaldes-Engordany. Primary healthcare is also available through local centres and medical professionals in the different parishes.
Who must register with CASS?
Employees working for an Andorran employer are normally registered with CASS by their employer. Self-employed residents, known locally as compte propi, generally register and pay their own contributions. The contribution is calculated according to the applicable rules and may include both the employee and employer portions in the case of salaried work.
People applying for active residency normally need to arrange their employment, company or self-employed position and social security registration as part of their settlement process. Passive residents should not assume that CASS membership is automatic. Their residency application usually depends on demonstrating suitable private health insurance and other requirements set by the Govern d’Andorra. Requirements can change, so applicants should confirm their position with the Govern and CASS before moving.
How payment and reimbursement work
When you visit a doctor or clinic, ask whether the professional works under a CASS convention. With a contracted provider, the patient usually pays the applicable personal share and the provider claims the covered amount from CASS. If you use a non-contracted professional, you may need to pay the full bill first and request reimbursement, subject to CASS rules and limits.
For many covered medical services, the standard reimbursement is commonly 75%, while hospital treatment can have a higher level of cover. Some circumstances, such as workplace accidents, maternity-related care or specific long-term conditions, may have different rates. The exact percentage depends on the treatment, provider, referral and applicable CASS regulations, so check before arranging expensive care.
Seeing a doctor or specialist
For routine problems, residents can normally begin with a general practitioner or a primary care centre. A doctor can assess the condition, prescribe treatment and refer the patient to a specialist or hospital where appropriate. A referral may be important if you want the treatment to qualify for the expected CASS reimbursement.
In an emergency, go to the emergency department at Hospital Nostra Senyora de Meritxell or call 112. For non-urgent appointments, keep your CASS details and identification available, and ask the clinic about appointment procedures, fees and whether electronic reimbursement is available.
Prescriptions, medicines and treatment abroad
CASS may contribute towards prescribed medicines and other treatments when the relevant conditions are met. Keep prescriptions, invoices and medical reports, particularly when using a provider outside Andorra. Treatment abroad can require prior authorisation or a referral, especially when the service is not available locally or is provided at a significant cost.
Andorra has agreements and practical healthcare links with neighbouring countries, but these do not mean that every visitor or resident receives automatic free treatment in France or Spain. Before travelling, contact CASS and check what documentation, authorisation or private travel cover you need.
Practical advice for new residents
- Confirm your CASS registration status as soon as you start employment or self-employed activity.
- Ask whether your chosen doctor, dentist or clinic has a CASS convention.
- Keep invoices, prescriptions and referral letters for reimbursement claims.
- Check dental, optical, medicines and treatment-abroad cover separately, since these services may have specific limits.
- Use the CASS and Govern d’Andorra websites or contact their offices for current contribution rates and eligibility rules.
Understanding CASS makes budgeting for healthcare in Andorra much easier, whether you live in Canillo, Encamp, Ordino, La Massana, Andorra la Vella, Sant Julià de Lòria or Escaldes-Engordany. For doctors, pharmacies, insurance advisers and other useful services, browse local businesses in the directory.
