Expat insurance and health insurance in Barbados

The Barbadian Ministry of Health and Wellness describes mixed financing: a public, tax-based financing, the ministry's budget resulting from annual appropriations voted by Parliament, and private financing (health insurance, fee-for-service payment and other out-of-pocket spending). National policy aims at care that is free at the point of service; the ministry specifies, however, that public services are, in many cases, free at the point of service for Barbadian citizens and permanent residents. This wording does not expressly cover the foreign visitor, nor the expat without permanent resident status, whose access and billing conditions are not detailed on the pages consulted.

Primary care is delivered by nine polyclinics and two satellite clinics, which offer preventive and curative care: maternal and child health, vaccination, family planning, general medicine, dental and eye care, pharmaceutical services. The Queen Elizabeth Hospital, in Bridgetown, is presented by the government as the country's reference acute-care facility and as a teaching hospital affiliated with the University of the West Indies (Cave Hill campus). The ministry has announced its intention to strengthen community care (renovation of polyclinics, new clinics, a mobile clinic) in order to relieve pressure on this hospital.

For the traveller, France Diplomatie states that "in several hospitals, health care has to be paid for in advance" and that it is essential to have an assistance policy or insurance covering surgery, hospitalisation and medical repatriation, "at the risk of not having access to care, even in a life-threatening emergency". These costs can under no circumstances be covered by the French embassy. On the health front, France Diplomatie notes in particular dengue, chikungunya, Zika and typhoid fever. It also points out that hurricanes can hit the island from June to the end of November and disrupt essential services.

• Stay of less than three months: according to France Diplomatie, French nationals are not subject to a visa requirement; for a longer stay, an entry visa must be applied for (information from the Barbadian embassy in Brussels, given by France Diplomatie).
• Passport: the Barbadian Ministry of Foreign Affairs states that the passport must be valid for the duration of the stay in Barbados.
• Yellow fever: a vaccination certificate is required of travellers over one year old arriving from infected areas, according to the Barbadian Ministry of Foreign Affairs; France Diplomatie mentions it as mandatory for travellers coming from endemic areas.
• Health insurance: no insurance requirement on entry was identified in the sources consulted, but France Diplomatie considers an assistance policy or insurance covering medical costs and medical repatriation essential, even for a trip by pleasure boat.
• Remote worker (dedicated 12-month visa): the official website of the Barbadian 12-month remote work visa programme asks you to declare an expected income of USD 50,000 or more over twelve months (or the means to support yourself and your family), with non-refundable fees of USD 2,000 (individual) or USD 3,000 (family) at the date of consultation, and prohibits working for or providing services to Barbadian clients or employers. This visa does not, in itself, give any entitlement to health care cover: personal insurance remains to be arranged.
• Stay of more than three months to work or study: the terms (work permit, student status, residence) fall under the Barbadian Immigration Department and are not detailed by France Diplomatie; to be checked before departure.
• Seconded employee : with no bilateral agreement identified, continuation on the French scheme rests on the ordinary rules of secondment, to be confirmed with the affiliation fund before departure.
• Student: no EHIC, as Barbados is not a member of the European Union; a student insurance or comprehensive travel insurance is to be planned.
• Retiree or expat with no bilateral agreement: ameli states, for a country with no agreement, that it is possible to join the Caisse des Français de l'Étranger (CFE) to remain covered by French health insurance, in addition to any mandatory local scheme, and an assistance policy remains recommended.

No individual fine for lacking health insurance is mentioned in the sources consulted. The documented risk is that of paying for care in advance and of access to care being refused in the absence of cover, with no help available from the French embassy.

No social security agreement between France and Barbados was identified in the official sources consulted (France Diplomatie, ameli). The reference list of bilateral agreements is kept by CLEISS, whose pages were not accessible at the time of consultation: you should check with that body before any departure whether a specific arrangement exists.

• As Barbados is not a member of the European Union, the EU coordination regulations 883/2004 and 987/2009 do not apply, and the EHIC cannot be used there.
• With no bilateral agreement, ameli recommends finding out about the local social security and health system before departure, and points out that a specific private health insurance contract can be useful for being able to receive care in France.
• The Barbadian National Insurance Scheme (NIS) is a social benefits scheme: the official page consulted lists in particular sickness, maternity, invalidity and unemployment benefits and old-age pensions, but does not specify that it reimburses the cost of care. It should therefore not be presumed equivalent to health insurance.

To keep cover recognised in France, voluntary membership of the CFE (which, according to ameli, avoids waiting periods and lost quarters on return) or international health insurance are the routes usually considered.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds).
2. For any stay: take out an assistance policy or insurance covering surgery, hospitalisation and medical repatriation, essential according to France Diplomatie.
3. Check that your passport is valid for the whole duration of the stay.
4. Check the yellow fever vaccination certificate requirement if you are arriving from an infected area, and see a doctor or an international vaccination centre before departure.
5. For more than three months: apply for the appropriate visa or permit with the Barbadian authorities (Barbadian embassy in Brussels for information, according to France Diplomatie).
6. Remote worker: submit the 12-month visa application on the programme's official website, outside any activity for Barbadian clients or employers.
7. With no bilateral agreement identified: confirm with CLEISS that no arrangement exists, then consider the CFE or international health insurance.
8. On site: emergency numbers given by France Diplomatie, 211 (police) and 511 (ambulance).
9. Register with the roll of French nationals living abroad: the French embassy in Saint Lucia is responsible for Barbados, which also has a consular agency (Chelsea Road, St. Michael).