Expat insurance and health insurance in Anguilla

Anguilla's health system rests on public care delivered by a single body, the Health Authority of Anguilla (HAA), and on cover largely funded by private insurance. The HAA's annual report indicates that it was created in 2004 to manage primary and secondary care, delivered by district health centres and by the Princess Alexandra Hospital. The national social protection policy of August 2018, drafted by the Ministry of Health and Social Development, specifies that the HAA is funded mainly by the ministry on the basis of annual agreements. In the government organisation described in the budget speech, health policy falls under the Ministry of Health, Tourism and Sports (Department of Health Services, tel. 264 498 6630).

No compulsory public health insurance scheme was identified in the sources read. The 2018 social protection policy recalls that a National Health Fund, decided in 2008, had not yet been established and describes the lack of adequate health insurance as a critical gap in the social protection framework. No more recent text establishing such a scheme was read. The HAA, for its part, indicates that it processed more than 7,000 reimbursement claims sent to insurance companies, almost all medical: private insurance is therefore the usual way of funding care for residents who have it. The government's budget speech also presents a programme, the Junior Shield Medical Programme, offering free care to children under six, and the extension of the Medical Shield Programme to dialysis patients living in Anguilla.

The same speech provides for health investment (hospital, Western polyclinic, magnetic resonance imaging, operating theatre) and the recruitment of nurses, paramedics and anaesthetists. The World Bank does not publish the share of health spending in GDP for Anguilla: this figure is therefore not given here. For cases beyond the island's means, the HAA reported more than 400 patients transferred abroad over one year; the cost and organisation of an evacuation fall under an assistance contract (see repatriation assistance).

• Tourist stay: the Government of Anguilla's visa portal indicates, for France, "visa not required". The tourist board requires a passport valid beyond the departure date and return or onward tickets; immigration and customs control takes place at the Blowing Point ferry terminal or at Clayton J. Lloyd airport, and at the Sandy Ground post for private boats. The length of stay authorised for a visitor was not read; an extension is requested from the Immigration Department (form 1-1), the visitor having to leave the island when the extended period expires.
• Work: the Department of Labour processes work permits (employee, self-employed, renewal and temporary categories). The job must first have been advertised, and the file includes in particular a criminal record covering the last ten years, a recent medical certificate, four photos, proof of the employer's social security contributions, the business licence and the employer's tax certificate. A processing fee of EC$100 (about €33) is added to the permit fee, the scale of which was not read.
• Local social security: registration with the Social Security Board is compulsory for employees, employers and self-employed workers, according to the Board.
• Resident health insurance: no legal obligation to have health insurance was read on the pages consulted. Private insurance, with evacuation, remains for the resident to take out; the government publishes, in the pages read, no list of minimum cover.
• Student: the European Health Insurance Card does not exist for this territory, which lies outside the European Union; a student insurance or the CFE youth plan should be compared. The Immigration Department publishes a student permit form.
• Seconded employee : continuation of the French scheme, according to CLEISS, for three years renewable once, with reimbursement within the limit of what the French scheme provides on paid invoices (form S 3125c). Membership of the Caisse des Français de l'Étranger (CFE) remains an additional option.
• Retiree: CLEISS points to local institutions, voluntary CFE membership or private insurance; no S1 form exists, the territory not being in the European Union.
• Long-term residence: belonger status is obtained notably after fifteen years of residence (application fee of EC$200, i.e. about €66), after five years of marriage to a belonger or by descent, according to the Immigration Department; the residence by investment programme has its own conditions.
• Hurricanes: the Department of Disaster Management keeps an up-to-date list of six shelters and a preparedness guide; it recommends a family plan, supplies and documents kept safe from water.

No law requiring a resident to have private insurance was read on the pages consulted; the obligation identified is registration with the Social Security Board, which pays sickness, maternity and retirement benefits but does not reimburse care. The conversions in this page are based on the ECB reference rate and on the parity of EC$2.70 to US$1 that emerges from the minutes of the Executive Council of 21 June 2023 (EC$16.20 for US$6.00).

The territory is not in the European Union. CLEISS cites it neither in the list of social security agreements in force with France, nor in its list of foreign schemes: the page devoted to the British scheme does not mention Anguilla either. For a temporary stay, it falls under the category "other countries or situations not covered": on site, CLEISS indicates that no cover is possible unless an agreement applies. Without an agreement, no cover is organised between funds.

• Temporary stay: reimbursement on return to France of unforeseen care only is a possibility and not an obligation, medical repatriation is not covered, and travel insurance suited to the real cost of care is advised.
• Secondment: the employee remains affiliated to the French scheme, three years renewable once; their contributions are paid in France, but they may also have to pay those of the host country, i.e., here, those of the Social Security Board and the Universal Social Levy. Care is covered within the limit of what they would have received in France (form S 3125c with paid invoices).
• Expatriation: the employee falls under the local scheme and is no longer insured in France; they can join the CFE voluntarily. Without an agreement, local insurance periods are not taken into account in calculating the French pension.
• Retiree: CLEISS recommends checking local cover, choosing the CFE or private insurance, and reminds us that a retiree who is no longer tax resident in France pays neither CSG, CRDS nor Casa.
• Taxation: the BOFiP list of tax treaties in force does not include Anguilla; the entry devoted to the United Kingdom mentions no extension to a territory. The BOFiP list of tax information exchange agreements mentions an agreement of 30 December 2010 between the French and Anguillan governments, signed as an exchange of letters in Paris on 27 December 2010 and in The Valley on 30 December 2010, in force since 15 December 2011 (decree no. 2012-57 of 18 January 2012). This agreement concerns the exchange of information; it does not replace a double taxation treaty. Tax domicile remains defined by article 4 B of the CGI (French General Tax Code; home or main place of stay, professional activity, centre of economic interests); a single criterion is enough.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds) and choose your cover according to your status.
2. Prepare entry: passport valid beyond the departure date, return or onward ticket, and checking nationality on the government's visa portal.
3. Employee: have the employer start the work permit application with the Department of Labour before beginning work; the job must have been advertised.
4. Register with the Social Security Board (James Ronald Webster Building, The Valley; tel. 264 497 2201/2); the employer (or the self-employed person) then declares the Universal Social Levy to the Inland Revenue Department.
5. Take out health insurance with evacuation before arrival, as no public reimbursement scheme was identified; compare the CFE and private insurance.
6. Seconded employee: request continuation of the French scheme from your employer and your fund; keep paid invoices for form S 3125c.
7. Retiree: prepare health cover (CFE or private insurance) before departure and enquire about the right of residence with the Immigration Department (264 497 3994).
8. Registration on the roll of French nationals living abroad via service-public, with the French Embassy in Saint Lucia.
9. Hurricanes: identify your shelter on the Department of Disaster Management list, prepare a family plan and an emergency kit before the start of the hurricane season.