Healthcare Reimbursement in Anguilla: Who Reimburses What, Depending on Your Situation

CLEISS does not cite Anguilla in the list of social security agreements in force with France nor in its list of foreign schemes, and its page on the British scheme does not mention the territory either. For a temporary stay, it falls under the “other countries or situations not covered”: on site, no possibility of cover, unless an agreement applies. There is therefore no European card, no aggregation of periods, no cross-cover. On the local side, the official sources read identify no compulsory public health insurance scheme: the 2018 national social protection policy describes the lack of adequate health insurance as a critical gap, and the Health Authority of Anguilla (HAA) processed more than 7,000 reimbursement claims from private insurers over one year. Four players step in depending on status: the French scheme maintained (secondment), the CFE, international or local health insurance and, in cash, the Social Security Board.

The notions of reimbursement basis and out-of-pocket cost help to compare offers. 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 minutes of the Executive Council of Anguilla. How care is organised is presented in the guide healthcare system in Anguilla.

The local-contract employee falls under the local scheme and is no longer insured in France, CLEISS reminds us. They contribute to the Social Security Board (5.5% from the employee and 5.5% from the employer since 1 January 2025) and pay the Universal Social Levy (3% above EC$2,000 a month), but these levies do not fund the reimbursement of care: the Board pays cash benefits. The Labour (Relations) Act does, however, require the employer to maintain basic salary during 14 weeks of maternity leave (minus the Board’s benefit) and to pay sick leave after 110 days of service. Care cover therefore rests on an insurance contract, whose existence and content should be checked with the employer before signing. See the glossary entry on the local contract.

The seconded employee remains affiliated to the French scheme during the assignment, for three years renewable once according to CLEISS. Their contributions are paid in France, but they may also have to pay those of the host country. They are covered within the limit of what they would have received in France: they send their fund the paid invoices with form S 3125c, and top-up health insurance is advised if care is expensive. A sick note is declared to the fund within 48 hours, and a work accident to the employer within 24 hours. Accompanying children give no entitlement to French family benefits, since they no longer live in France. See seconded or expatriate and the glossary entry on the seconded employee.

The self-employed person contributes as such to the Social Security Board and pays 6% Universal Social Levy above EC$2,000 a month, without these payments giving a right to reimbursement of care. CLEISS indicates that a self-employed expatriate can join the CFE voluntarily for sickness and maternity. International insurance completes the arrangement for medical evacuation and care abroad. See digital nomad insurance.

The student has no European card. Before age 30, the CFE offers a youth plan (with a contribution that depends on age and the plan chosen); a student insurance with evacuation remains the usual option. See student insurance abroad.

The spouse and children: no public scheme covers dependants. The Junior Shield Medical Programme, presented in the government's budget speech, offers free care to children under six; its access conditions for a foreign child were not read. For a seconded employee, the reimbursement procedure for dependants is the same as for the holder. The CFE and international insurers both offer family contracts. See expat family insurance.

The retiree does not fall under the S1 form, valid in Europe. CLEISS indicates that it is for the retiree to check with local institutions to what extent the local scheme covers their care, and that they can join the CFE voluntarily or take out private insurance. The CFE retirees’ plan has a contribution that depends on age and the plan chosen, with no health questionnaire, for members with no professional activity and retired on a French basic scheme pension; it covers care abroad, while care in France remains covered by the French compulsory scheme. See the guide retiree health insurance abroad and the page retiring in Anguilla.

During a temporary stay in France, cover is for holders of a French pension who show at least 15 years of insurance in France; the accompanying spouse is not covered, and a hospital stay of more than a month requires prior recognition. A retiree who is no longer tax resident in France pays neither CSG, CRDS nor Casa, according to CLEISS.

The CFE is a voluntary social protection body. In France, it reimburses according to Assurance Maladie principles; abroad, reimbursement depends on the country of care and the type of care, with a rate or a flat amount applied to actual expenses. As a generic example, the main plan page indicates that the CFE would reimburse €21 for a GP consultation abroad. The territory’s own scale can be read in the CFE table of benefits: the difference from the price billed remains at the member’s expense. The guide CFE reimbursements details this mechanism.

• Plans: main plan, youth plan (under 30) and retirees’ plan, each with a contribution that depends on age and the plan chosen; the final price depends on country, age and family composition. The main plan also covers stays of less than three months in France.
• Waiting period: cover starts immediately if membership takes place before departure or within three months of settling abroad; beyond that, the waiting period is three months before age 44 and six months from age 45.
• Maternity: conception must be after membership or after joining as a dependant.

On returning to France, service-public indicates that a CFE member can keep their expatriate benefits for three months under conditions. Without the CFE, anyone who does not work immediately must show three consecutive months of residence in France before applying for universal health protection (form S1106); anyone who resumes work is covered from the first hour worked. See reducing the waiting period and the page return to France.

International health insurance at the first euro reimburses actual costs within the limits of its contract, after any deductible, waiting periods and exclusions. It answers the weak point of a territory with no public reimbursement scheme: routine care is billed to the patient or their insurer, and serious cases may require a transfer abroad (more than 400 patients transferred over one year according to the HAA). Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of pre-existing medical conditions.

The tourist has no cover on site. CLEISS recommends taking out travel insurance suited to the real cost of care in the country, or checking existing cover such as that of a bank card. Reimbursement on return to France of unforeseen care is a possibility and not an obligation, and medical repatriation is not covered by health insurance. See long-stay travel insurance.

The HAA’s rates and insurers’ ceilings are not published on the official pages consulted: amounts reimbursed item by item are therefore not given here and should be requested from the institution, the insurer or the CFE. The benchmarks below reproduce what the HAA and the Social Security Board publish.

• Consultation: the HAA’s district health centres provide primary care; fees and the patient’s share are not published on the pages consulted. The method of payment (third-party payment or advancing costs) should be confirmed with the institution and the insurer; a seconded employee submits their paid invoices to their fund.
• Hospitalisation: the Princess Alexandra Hospital recorded nearly 900 admissions and about 300 procedures over one year. Hospitalisation fees are among the HAA’s top five sources of revenue, and it reports collection difficulties and offers payment plans. It is prudent to check the insurer’s guarantee before a planned admission.
• Medicines: the HAA dispenses prescriptions in outpatient consultation and pharmacy is among its main sources of revenue; the reimbursement rate depends on the insurer’s contract.
• Dental: the HAA processed several hundred dental reimbursement claims with insurers over one year and performed more than 1,100 extractions and oral surgery procedures. Dental ceilings are read in the terms of each contract (CFE or international insurance).
• Optical: no information on optical cover was read on the pages consulted; international insurance or the CFE should be compared on this point.
• Maternity: the public hospital performed about 140 deliveries over one year. The Social Security Board pays a maternity allowance of 60% of average insurable earnings over the previous 39 weeks (26 weeks of insurable employment, of which 20 in the 39 weeks before the birth) and a flat-rate grant of 1,350 dollars, granted on 26 weeks of insurable employment of the mother or her husband. For the CFE, conception must be after membership.
• Dialysis: more than 5,000 sessions take place over one year; the Medical Shield Programme is to be extended to dialysis patients living in Anguilla, according to the government's budget speech.

The reimbursement guide and the page expat health insurance give benchmarks; Expavy helps you weigh these options against your situation.