Healthcare Reimbursement in Aruba: Who Reimburses What Depending on Your Situation

Aruba is an autonomous country of the Kingdom of the Netherlands. CLEISS (the French Centre for European and International Social Security Liaison) publishes no Aruba page, and its list of bilateral social security agreements in force mentions neither Aruba nor the Netherlands; it specifies that the Netherlands apply the European coordination regulations, but France Diplomatie (the French foreign ministry) states that the European Health Insurance Card does not cover the Dutch overseas territories. There is therefore no European card, no aggregation of periods and no cross-border care cover.

Four players may step in depending on status: the local scheme (AZV), the French scheme maintained (secondment), the CFE and international health insurance. The right cover is chosen before departure, according to the permit, the employer and the budget. The notions of reimbursement basis and out-of-pocket cost help to compare offers. How the local system works is presented in the guide healthcare system in Aruba.

An employee on a local contract contributes to the AZV: the employer withholds 2.6% of salary (up to 85,000 florins of annual income) and itself pays 8.9%. Anyone registered as a resident with the civil registry is insured, which assumes that the residence and work permit has been obtained. The AZV covers neither the higher hospitalisation class, nor glasses, nor adult dental care, nor care abroad during holidays; private supplementary insurance fills these items. The Assurance Maladie (French national health insurance) reminds readers that an expatriate outside an agreement falls under the scheme of the country of work and must declare their departure within the month. See the glossary entry on the local contract.

A seconded employee remains, according to the Assurance Maladie, affiliated to the French scheme during their assignment: their employer informs the Urssaf before departure, which issues a document certifying that French legislation applies. Care is reimbursed on paid invoices, sent through the ameli account or form S3125, at French tariffs and within the expenses incurred, whatever the price charged on site. The Assurance Maladie page specifies that secondment cannot exceed 24 months except in exceptional cases, without giving a specific duration for countries with no agreement; duration and conditions should be checked with the Urssaf and CLEISS. An international group contract often completes the arrangement. See seconded or expatriate and the glossary entry on seconded employees.

A freelancer or digital nomad has no employer to withhold the premium. If they obtain a residence permit and register with the civil registry, they are insured by the AZV like any resident; the pages consulted do not detail the calculation of a self-employed person’s premium, to be requested from the AZV. The Government states that the self-employed old-age insurance contribution is 13.5% with an annual maximum of 8,782 florins. For a stay without registration, international insurance covering hospitalisation, outpatient care and repatriation remains the most complete solution; see digital nomad insurance.

A student files their application with DIMAS (the immigration service), which publishes a page dedicated to students. As the European Health Insurance Card is not valid, student insurance or an international contract is to be taken out before departure; a student’s access to the AZV depends on their registration with the civil registry and should be checked with the AZV and the institution. Before age 30, the CFE offers a youth offer whose quarterly contribution varies with age; current amounts are published by the CFE (cfe.fr). See student insurance abroad.

A retiree is covered neither by the S1 form nor by the EHIC, which concern the European Union, the European Economic Area, Switzerland and the United Kingdom: the French Assurance Maladie no longer reimburses their care abroad. They can join the CFE or take out private insurance, and, if they register as a resident, fall under the AZV. The CFE offers a retiree offer, reserved for holders of a pension from the French basic scheme with no professional activity, with no medical questionnaire; it covers care received abroad, and care in France falls under the basic scheme. For stays in France, a retiree of the general scheme may be covered by the Cnarefe, provided they have contributed for at least 15 years since 1 July 2019; otherwise they contact their pension body or take out private insurance. See the guide health insurance for retirees abroad and the page retiring in Aruba.

The spouse and children follow a family reunification or life-as-a-couple permit, whose pages DIMAS publishes. Each person registered as a resident is insured by the AZV; premium arrangements for children and spouses without income should be confirmed with the AZV. According to the Assurance Maladie, the family members of a retiree are covered during stays in France only if a bilateral agreement provides for it: without an agreement, the spouse joins the CFE or takes out private insurance. See expat family insurance.

The CFE is a voluntary social protection body. Its reimbursements follow the principles of the Assurance Maladie; abroad, they depend on the country of care and the type of procedure, as a rate or flat amount applied to the actual expense, and in France direct payment (tiers payant) is used in public and private hospitals. When the local price exceeds the basis used, the gap remains the member’s responsibility: the guide CFE reimbursements details this mechanism.

• Contributions: the individual contribution is quarterly and varies with age and the plan chosen (youth offer, main offer from age 30). A subsidised category exists, subject to income conditions. Current amounts should be read on the CFE website before any membership. See CFE contributions.
• Waiting period: immediate cover if joining before departure or within three months of settling abroad; otherwise a three-month waiting period for those under 44 and six months for those over 45, the page not specifying the intermediate case. There is no health questionnaire.
• Stays in France: the main offer covers stays of under three months.
• Maternity: conception must come after joining or after becoming attached as a dependant.

On returning to France, according to service-public.gouv.fr, a former CFE member can receive its benefits during the three months following their return, under conditions. Without the CFE, health cover requires a residence period in France of three consecutive months, with form S1106 submitted to the CPAM; work in France opens affiliation, and an unemployment allowance also opens rights. See the guide reducing the waiting period and the page return to France.

International health insurance with first-euro cover reimburses actual costs up to its ceilings, after any deductible, waiting periods and exclusions in the contract. It fits the hospital’s procedure: the Dr Horacio E. Oduber Hospital accepts most insurers on presentation of a letter of guarantee that it must validate, asks for a deposit before admission and bills at the “passer-by” rate if the insurer has no agreement with it. Contracts are compared on the annual ceiling, the coverage area, evacuation and the handling of pre-existing medical conditions.

The tourist is not a resident and does not fall under the AZV. France Diplomatie considers an assistance policy or insurance covering all medical costs and repatriation essential, and the Aruba Tourism Authority website lists valid medical insurance among the admission conditions, with minimum cover of US$15,000. Ambulance fees of US$250 are added to the hospital bill. Bank card assistance can complement the arrangement, with ceilings to be checked. See long-stay travel insurance.

• Consultation: covered by the AZV for a registered resident according to its provider rules, to be confirmed with the AZV; reimbursed by the CFE on its country scale; on paid invoices and French tariffs for a seconded worker; actual costs for a first-euro contract; at the patient’s expense for an uninsured tourist.
• Hospitalisation: covered by the AZV, the higher hospitalisation class remaining excluded; deposit before admission, insurer’s letter of guarantee, “passer-by” rates for uninsured patients; ambulance at US$250.
• Medicines: the AZV reimburses medicines and medical supplies under its own decrees, the detail of which should be requested from the AZV; reimbursed on CFE scales; covered within the ceilings of an international contract.
• Dental: the AZV excludes adult dental care; the CFE reimburses it according to its scales; most international contracts cover it within an annual ceiling.
• Optical: glasses are excluded from the AZV; they mostly fall under international contracts, with per-period ceilings, to be read in the table of guarantees.
• Maternity: the hospital has a maternity and obstetrics service; the conditions of AZV cover should be checked with the AZV; the CFE requires conception after joining; international contracts generally apply a waiting period.

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