The CASS: Andorra's social security
The Caixa Andorrana de Seguretat Social (CASS) is the public body that has managed the Principality's social security since 1966. It centralises registration, contributions, healthcare, sick leave and retirement and invalidity pensions for workers and residents.
Every employed worker in Andorra is compulsorily registered with the CASS, and the company handles the registration with the first contract. The self-employed register themselves, and passive residents, who do not work in the country, can join voluntarily by paying a monthly fee.
How it works: you pay and the CASS reimburses
The Andorran system is a reimbursement one, similar to the French: when you go to the doctor you pay 100% at the time and then submit the invoice and the benefit form to the CASS, via the app, in person or by post, to recover the covered part.
GP and specialist consultations are reimbursed at 75% of the responsible tariff when you go through the preferential route with a contracted professional. A GP visit costs between 25 and 40 euros and the CASS refunds three quarters of it.
Hospitalisation at the Hospital Nostra Senyora de Meritxell has the highest coverage, 90%, including surgery, stay, tests and treatments during admission. Pharmacy, basic dental treatments (extractions, fillings, cleanings) and prescribed physiotherapy are also reimbursed at 75%.
What you contribute and how much coverage costs
The total CASS contribution is 22% of gross salary, split into two branches: the general branch (healthcare, sick leave and maternity) at 10% and the retirement branch at 12%. Of the total, the worker contributes 6.5% (3% + 3.5%) and the company 15.5% (7% + 8.5%).
These percentages are noticeably lower than Spain's, and the result is that the employment cost of an employee in Andorra is lower. With the minimum wage of 1,568.67 euros in 2026, the worker's contribution is about 102 euros and the company's about 243.
The difference with Spain is clear: there healthcare is free at the point of care and financed by taxes; in Andorra you pay and then recover. For a newly arrived employee it is a change of habit, but waiting times are short and the system is simple.
Agreements with hospitals in Spain and France
Andorra does not have everything in its public network, which is why the CASS maintains agreements with reference hospitals for treatments requiring technology that does not exist in the country: advanced oncology, transplants or complex cardiac surgery are referred to the Hospital Clínic, Vall d'Hebron and Sant Pau in Barcelona, or to the CHU in Toulouse and Montpellier, with coverage equivalent to what the patient would have in Andorra.
Emergencies abroad are covered if they are justified and the documentation is submitted. One thing to watch out for: Andorra is not part of the European Union, so the European Health Insurance Card does not give you coverage there. Your Andorran employees covered by the CASS can use it when they travel within Europe.
Complementary private insurance
The fixed 75% of the CASS leaves a 25% co-payment that most residents absorb without any problem. For what the CASS does not cover equally in all cases — orthodontics, prosthetics, optical care or treatment outside the contracted network — there is a market of private health insurance policies with moderate premiums.
For a company, the private top-up can be a retention benefit, but it is not necessary to comply with the law: CASS registration together with the employment contract already guarantees public coverage for the workforce.
