Healthcare Reimbursement in Antigua and Barbuda: Who Pays What Depending on Your Situation

The CLEISS keeps the list of France’s bilateral social security agreements: Antigua and Barbuda appears neither among the agreements in force nor among those signed but not yet in force, and the CLEISS does not publish a page on the local scheme. As the country is not a member of the European Union, neither the European regulations nor the European card apply. There is therefore no totalisation of periods and no cross-cover between schemes.

Four players can step in depending on status: the local scheme (Medical Benefits Scheme and Social Security Board), the maintained French scheme (secondment), the CFE and international health insurance. The notions of reimbursement base and out-of-pocket cost help you compare offers. How the local network works is described in the Antigua and Barbuda healthcare system. Before leaving, the insured person declares their departure to their health insurance fund within the month and returns their carte Vitale and European card, including for their minor children (Assurance Maladie, the French public health insurance).

An employee on a local contract contributes to the Medical Benefits Scheme at 3.5% of their salary, the employer paying 3.5%, and to the Social Security Board. For a non-national, registration requires twelve consecutive months of legal residence; benefits then open after 26 weeks of contributions. The MBS then reimburses tests, imaging, surgery, hospitalisation and medicines, and consultations for eleven illnesses only. Claims are filed within three months of the service. See the glossary entry on the local contract. During the waiting period, private insurance or the CFE fills the gap.

A posted employee sent by a French employer remains affiliated to the compulsory French scheme and their contributions are paid in France. With no agreement with Antigua and Barbuda, the CLEISS describes secondment outside an agreement: three years, renewable once. Care is covered within what would have been paid in France; to be reimbursed, the employee sends their fund the paid invoices with form S 3125c, and supplementary health insurance is advised if care is expensive locally. The posted employee may also have to contribute in the host country. Sick leave is sent to the fund within 48 hours, an accident at work to the employer within 24 hours, and family benefits stop if the children accompany the employee. See secondee or expatriate and the posted worker glossary entry.

A self-employed person registers with the Medical Benefits Scheme and contributes 5% of their income (2.5% from 60 to 69), with the same twelve-month legal residence condition for a non-national. With no agreement, they choose between the CFE and international insurance for the waiting period and for care that is not covered. See digital nomad insurance for mobile profiles.

A student needs a student permit and health insurance, which the Immigration Department requires. According to the CLEISS, rights to French health insurance are not exportable, or hardly so, to a country with no agreement: for a stay of less than six months, only article R160-4 of the Social Security Code allows an optional flat-rate reimbursement of unforeseen care, after the costs have been advanced. Beyond six months, a student under 20 remains a dependant under this limited arrangement, whereas a student over 20 is no longer covered: the CFE or private insurance takes over. See insurance for students abroad.

The spouse and children each have their own MBS card: an insured person’s contribution does not cover their family. The CFE and international insurers offer family policies, with maternity and paediatrics depending on the policy. See expat family insurance.

A retiree does not come under form S1, valid in the European Union: according to the Assurance Maladie, French cover ends on settling in a country outside the European Union, where no agreement applies; they can join the CFE or take out private insurance. The MBS reduces the employee contribution to 2.5% from 60 to 69, then to 0% from age 70, but registration of a non-national requires twelve months of legal residence. During stays in France, a retiree with 15 years of contributions in France comes under the Cnarefe; a CFE member sends their claims to the CPAM (local health insurance fund) of Seine-et-Marne. See the guide to a retiree’s health insurance abroad.

A CFE member is reimbursed in France under the principles of the Assurance Maladie and, abroad, according to a rate or flat fee specific to the country, applied to the expense incurred: the gap with the price charged remains their responsibility. Cover is immediate if membership takes place before departure or within three months of settling; beyond that, the waiting period is three months for those under 44 and six months for those over 45. No health questionnaire is required. For maternity, conception must come after joining. The Assurance Maladie points out that a member pays both the compulsory local scheme, if any, and the CFE, which avoids waiting periods and lost quarters on return. See CFE reimbursements.

On returning to France, a CFE member keeps their rights for up to three months under conditions. Without immediate employment, the universal health protection requires three consecutive months of residence in France, with form S1106 filed at the CPAM; with employment, rights open from the first hour worked (service-public.fr). See reducing the waiting period and the page on returning to France.

International health insurance from the first euro reimburses actual costs within its limits, after any deductible, waiting periods and exclusions of the policy. It meets the requirement stressed by France Diplomatie: some hospitals ask for payment in advance, and an assistance contract or insurance covering treatment, hospitalisation and medical repatriation is considered essential. Policies are compared on annual limit, coverage zone, evacuation and handling of medical history; check diving cover if you dive, as the country has only one decompression chamber.

A tourist stays less than six months without a visa. According to the CLEISS, no cover on the spot is possible outside an agreement; on return, the CPAM may reimburse the costs of unforeseen care, that is, care that could not be planned, without being obliged to. Medical repatriation is not covered by the Assurance Maladie and no daily allowance is paid during the stay. Travel insurance matched to actual costs is prudent. See long-stay travel insurance.

• Consultation: reimbursed by the MBS for eleven illnesses only; reimbursed by the CFE on its country scale; actual costs in a first-euro policy; at the patient’s expense for a tourist, apart from optional flat-rate reimbursement on return. Private practice fees are unregulated.
• Hospital care: reimbursed by the MBS; French scheme for a posted worker, within French rates; CFE according to the country of care; direct payment possible with an international policy. Payment in advance may be required.
• Medicines: collected at MBS pharmacies for members; reimbursed under CFE scales; covered within the limits of an international policy. The amounts covered by the MBS are not published in the pages consulted.
• Dental: the Ministry of Health has a dental service; the MBS does not list dental care among the benefits described; the CFE includes dental care according to its scales; the annual limit is decisive in an international policy.
• Optical: glasses and contact lenses appear neither in the MBS benefits described nor in the CFE presentation; they come mainly under international policies, with limits per period.
• Maternity: the Social Security Board pays a maternity allowance equal to 60% of the average insurable weekly wage for up to 13 weeks, as well as a flat-rate allowance subject to 26 weekly contributions; the CFE requires conception after joining; international policies generally apply a waiting period to maternity.

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