The “Via Preferent” (healthcare itinerary) and new changes to the healthcare system in Andorra

Andorra’s healthcare system is based on the co-payment of medical expenses between the CASS (the Andorran Social Security System) and the citizen. Changes have recently been implemented, known as the Via Preferent, which impact how citizens access their general practitioner (GP) and specialist doctors. Find out what this means and leave any doubts behind!

The Via Preferent

Via Preferent is the name given to the itinerary that can be taken by a user within the public healthcare system, in order to attain the most favourable reimbursement of medical expenses from the CASS. Through this itinerary, the general practitioner (GP) is the gateway to the healthcare system, promoting high-quality healthcare that is personalised, safe and efficient. The Via Preferent features two key figures throughout the process: the referring physician and the referring specialist.

The referring physician

This modification entered into force on 17 September 2018. It means that all those covered by social security must choose a general practitioner (GP) who will become their referring physician and will be in charge of sending them to a specialist when necessary. For children younger than 13 years of age, the referring physician must be a paediatrician.

The only specialisations that do not require referral from the referring physician are: gynaecology, obstetrics, ophthalmology, stomatology and dentistry.

The referring specialist

It is important to know that, in addition to referral by the referring physician, there are other ways of accessing a specialist, such as referral by emergency services or referral following hospitalisation. Users who have medical check-ups with specialists in Andorra will be able to access these specialists, exceptionally until the 30 June 2020, without prior referral from their referring physician.

People with a medical condition, requiring regular specialised monitoring, may have a referring specialist that they consult directly once the initial referral has been made by their referring physician. In this case, the chosen specialist can then make any referrals.

Visits to a doctor abroad require direct referral from a specialist doctor in Andorra, and must only be for cases in which the specialisation is not covered in Andorra or the intervention cannot be carried out by local doctors. It is possible to access healthcare abroad directly in the case of an emergency or if studying outside the principality, as long as the condition that the person is covered indirectly by social security is fulfilled.

The choice of a referring physician can be made directly at the GP’s office or paediatrician’s office, as well as through the CASS, at the Nostra Senyora de Meritxell Hospital and in National Health Service (SAAS) primary healthcare centres.

The referring physician can be changed as many times as desired. This procedure must be carried out on the CASS website. To do so, it is necessary to have previously acquired a username and password, which can be requested directly at CASS branches.

Advantages

As previously mentioned, healthcare expenses are paid jointly by the person covered by social security and the CASS. Once the referring physician has been chosen, a visit to the GP will require payment of 25% of the cost of the visit. It will no longer be necessary to advance the 75% covered by the CASS.

The choice of a referring physician will also mean that visiting a specialist directly will be penalised, as the CASS will only reimburse 33% for the visit instead of the usual 75%.

For further information, the legislation can be consulted in full on the website www.cass.ad

What if I have MoraBanc complementary health insurance?

If you have Premium health and life insurance, changes related to the new Via Preferent will affect you minimally. Social security approved medical intervention will continue to be paid automatically. Unapproved intervention will require medical bills to be sent for reimbursement as before. People covered by social security who decide not to follow the Via Preferent system will find that:

For those with a PREMIUM insurance policy who do not follow the Via Preferent system, their insurance will continue to cover 100% of the cost of social security approved medical intervention, and everything will continue as before.

For those who do not have a PREMIUM insurance policy and do not follow the Via Preferent system, their insurance will continue to pay the 25% and the CASS will pay 33%, instead of the usual 75%, meaning that the remaining 42% will need to be paid by the user.

These amounts may vary depending on the medical intervention in question. For further information on each type of coverage, please request information at one of our branches.

For all the details of this service, as well as the prices and features included in the different types of insurance coverage, please contact your personal manager.

What about you? Are you covered against unforeseen events?

If you do not yet have insurance, find out about the different options available on our website. You can also contact MoraBanc Assegurances, your branch, or send us any queries you may have by completing this form.

To stay informed of any further changes, keep an eye on our blog!