Expat insurance and health insurance in Aruba

Aruba has a compulsory general health insurance, the AZV (Algemene Ziektekostenverzekering), under the responsibility of the Ministry of Tourism and Public Health. According to the Government of Aruba, anyone registered as a resident with the civil registry (Civil Registry Office) is insured by the AZV. The premium is 11.5% of annual income, of which 8.9% is paid by the employer and 2.6% by the employee, up to an annual income of 85,000 florins; the employer withholds it each month and pays it to the tax administration before the 15th of the following month. The AZV does not cover the higher hospitalisation class, glasses, adult dental care or care abroad during holidays: supplementary insurance is needed for these items.

The reference public facility is the Dr Horacio E. Oduber Hospital in Oranjestad. Its emergency department operates 24 hours a day and receives about 40,000 patients a year. The on-call general practitioners' post (HAP) is set up in the emergency department for non-life-threatening problems. For a life-threatening emergency, dial 911. The hospital asks for a deposit before admission, accepts most insurers on presentation of a letter of guarantee that it must validate, and applies so-called "passer-by" rates to patients who are uninsured or whose insurer has no agreement with it; ambulance fees of US$250 are added to the bill.

France Diplomatie states, in its Netherlands page, that the European Health Insurance Card does not cover the Dutch overseas territories, that an assistance policy or insurance covering all medical costs and repatriation is essential and that the embassy cannot cover these costs. It points to the presence of dengue (with no curative treatment), chikungunya and Zika in the Kingdom's Caribbean territories.

• Entry: a passport is compulsory for Aruba, which is not part of the Schengen area (France Diplomatie). The Aruba Tourism Authority states that European Union citizens do not need a visa for a tourist stay, that the passport must be valid for the whole length of stay and be no more than ten years old, and that admission remains decided by the immigration officer at the border.
• Online ED card: the Government of Aruba reminds travellers that the online embarkation and disembarkation card (edcardaruba.aw) is compulsory for all travellers arriving by air or by boat, and that it can be completed up to a week before departure. Air arrivals of non-residents are subject to a US$20 sustainability fee, paid online with the card (Aruba Tourism Authority).
• Insurance on entry: the Aruba Tourism Authority website lists valid medical insurance among the admission conditions, with minimum cover of US$15,000; France Diplomatie considers it essential in all cases.
• Length of tourist stay: the standard length of admission is 30 days, with the possibility of requesting an extension up to 180 days per calendar year (Aruba Tourism Authority).
• Long stay and work: the DIMAS immigration service issues residence permits. To work, a positive opinion from the labour department (DPL) must precede the permit application to DIMAS, and a tourist cannot take paid employment with an Aruban employer.
• Permit medical examination: the applicant who receives provisional admission (VTA) undergoes a compulsory medical examination, at 75 florins for the consultation, excluding further tests.
• Local affiliation: the AZV is acquired by registering as a resident with the civil registry. For an employee, the employer withholds the premium from salary.
• Student: no EHIC on site; a student insurance or an international health insurance contract is to be arranged before departure.
• Seconded employee : in the absence of an agreement, continuation on the French scheme falls under French law on secondment outside agreements; duration and conditions should be checked with the Urssaf and CLEISS. An assistance policy and, depending on the case, membership of the Caisse des Français de l'Étranger (CFE) remain useful.
• Retiree: the French Assurance Maladie no longer reimburses care in a country outside an agreement; the S1 form and the EHIC do not apply. They can join the CFE or take out private insurance.

No individual fine for lacking health insurance was found in the sources consulted. The risk is financial: deposit before hospital admission, "passer-by" rates for the uninsured patient and ambulance fees billed with the account.

No social security agreement exists between France and Aruba in the official sources consulted. CLEISS publishes no Aruba page, and its list of bilateral agreements in force mentions neither Aruba nor the Netherlands. CLEISS specifies that the Netherlands apply the European coordination regulations; yet the France Diplomatie Netherlands page states that the EHIC does not cover the Dutch overseas territories, including Aruba.

• No aggregation of insurance periods or cross-border care cover was identified between France and Aruba.
• On tax, the France-Netherlands treaty of 16 March 1973 defines the Netherlands as the part of the Kingdom located in Europe, and can be extended to other territories only by exchange of notes. Aruba does not appear in the French administration's list of tax treaties. Only a tax information exchange agreement, signed in The Hague on 14 November 2011 as regards Aruba, is published; it does not allocate taxing rights and does not eliminate double taxation.
• Seconded employee: continuation on the French scheme follows the law on secondment outside agreements; care is reimbursed on paid invoices, at French tariffs and within the expenses incurred (form S3125 or ameli account).
• Expatriate employee: they are attached to the local scheme, here the AZV for care; joining the CFE makes it possible to remain insured in France and avoid waiting periods on return.
• Retiree: no S1 form or EHIC; CFE membership or private insurance, and pension paid abroad subject to the annual certificate of life.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds), in particular through the declaration of transfer of residence outside France within the month.
2. For any stay: take out an assistance policy or insurance covering all medical costs and repatriation, essential according to France Diplomatie.
3. Before arrival: check the validity of your passport, complete the online ED card (edcardaruba.aw) up to a week before departure and pay the sustainability fee for an air arrival.
4. Long stay: contact DIMAS (Paardenbaaistraat 11, Oranjestad) for the suitable permit (employment, family, study, retiree) and gather the documents requested: passport, certificate of good conduct legalised or apostilled and less than six months old, photograph, supporting documents specific to the category.
5. Paid employment: the employer first obtains the DPL's positive opinion, then the permit is requested from DIMAS; the medical examination follows provisional admission.
6. After the permit is granted: registration with the civil registry (Censo) with a legalised birth certificate less than six months old, the step that opens AZV insurance.
7. Seconded employee: ask the Urssaf and CLEISS for the conditions of secondment outside agreements.
8. Retiree: tell your pension fund of the change of address, plan for the annual certificate of life and choose between the CFE and private insurance.
9. Registration with the roll of French nationals living abroad, with the competent French representation (French embassy in the Netherlands, in The Hague; the embassy's list mentions an honorary consul for Aruba).