Short answer
The CASS (Caixa Andorrana de Seguretat Social) covers people who contribute by refunding a percentage of its own tariffs. Through your referring doctor you get back 75 % of consultations, 90 % of hospital stays and 100 % of maternity care. Going directly, consultations and hospital stays drop to 33 %. With a practitioner who has no agreement with the CASS, the calculation starts from 20 % of the tariff.
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Key facts
- A consultation is refunded at 75 % through the via preferent and 33 % outside it
- Source: CASS, via preferent
- Maternity care reaches 100 % if you follow the via preferent
- Source: CASS, via preferent
- With a practitioner outside the agreement, the CASS only uses 20 % of its tariff as the base
- Source: CASS, via preferent
- After your first registration, 25 days of contributions are needed before ordinary illness is paid
- Source: CASS, payment of medical costs
What the CASS is
The CASS is Andorra's social security fund. It is financed by contributions from work and covers healthcare, sick pay and pensions for people who work in the country and their dependants. It is not a national health service: you pay at the point of care and claim back.
An employee's contribution is 22 % of salary, of which 6.5 % comes from the payslip and 15.5 % from the employer. The self-employed pay their own contribution on a base set by the CASS.
How the refund is calculated
For each medical act the CASS sets a reference price, the tarifa de responsabilitat. You get back a percentage of that price, not of the bill. If the practitioner charges exactly the tariff, you get the full percentage back; if they charge more, the extra is not counted.
The rates, one by one
| Medical act | Through your referring doctor | Going directly |
|---|---|---|
| Hospital stay | 90 % | 33 % |
| Maternity | 100 % | 33 % |
| Consultations | 75 % | 33 % |
| Rehabilitation | 65 % | 60 % |
| Tests, acts and prescribed products | 75 % | 60 % |
| Practitioner outside the agreement | On 20 % of the tariff | On 20 % of the tariff |
Figures from the CASS via preferent page, updated on 11 August 2026.
The referring doctor route
The via preferent is the route that starts with the GP you choose as your referring doctor. Specialist referrals come from that doctor and are valid for 18 months, for up to 12 visits. Emergencies at the medical centres of the ski resorts, and emergencies outside Andorra, count as if you had followed the route.
Who is covered
- Employees, from registration. The employer must register you within the 7 days before your first working day and, at the latest, on that day.
- The self-employed, from the start of their activity.
- Indirect insured persons: a spouse who doesn't contribute and children up to and including age 24.
- CASS pensioners.
When refunds start
Registering doesn't mean you are refunded from day one. The first time, you need 25 days of contributions before the CASS pays for ordinary illness or an accident outside work. After that, until you reach 12 months, it asks for 15 days of contributions in the month before the care.
The 100 % refund
Some situations entitle you to a 100 % refund. To get it you must follow the via preferent and hold no reimbursement top-up, or present a certificate of exclusion if you do. The CASS lists the conditions on its page about refunds up to 100 %.
What stays outside the CASS
- People who don't contribute: passive residents, digital nomads and visitors need private cover.
- The gap between what the practitioner charges and the CASS tariff.
- A mountain rescue the Govern decides to bill. See ski insurance and mountain rescue.
If you want to cover the gap, read private health insurance and the CASS top-up.
Frequently asked questions
Is seeing a doctor free if I contribute to the CASS?
Not entirely. You pay and the CASS refunds a share of its tariff: 75 % through your referring doctor, 90 % for a hospital stay. The rest is paid by you or by your top-up insurer.
Who is covered by the CASS?
Employees, the self-employed and CASS pensioners, and their indirect insured persons (dependants), such as children up to and including age 24.
Do I get anything back from a doctor without a CASS agreement?
Very little: the calculation is made on 20 % of the official tariff, whatever you paid.
I've just started a job. When will the CASS refund me?
You need 25 days of contributions from your first registration before ordinary illness or a non-work accident is paid.
What if I get hurt skiing?
If you contribute, an emergency treated at the ski resort's medical centre counts as via preferent. A mountain rescue is a separate matter and can be billed.
Sources
How we checked this guide
We checked every figure against the official sources listed at the end and reviewed this page on 14 October 2026. Seguros Andorra is not an insurance intermediary: we explain how insurance works, we do not sell it. If something has changed, let us know. Our method is described on how we work (in Spanish).
Keep reading
- Health insuranceHow the CASS and private health insurance fit together in Andorra.
- Private health and top-upCASS top-up or full private health cover in Andorra, and how to choose between them.
- Moving checklistThe insurances a newcomer to Andorra needs, in the order they come up.
- Ski and rescueSki and mountain insurance in Andorra, official rescue prices and resort cover.
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