Expat insurance and health insurance in Bonaire, Sint Eustatius and Saba (Caribbean Netherlands)

The three islands have their own compulsory health insurance, the BES zorgverzekering, run by Zorg en Jeugd Caribisch Nederland (ZJCN), the Dutch Ministry of Health body for the islands (whose email address keeps the former name Zorgverzekeringskantoor). According to ZJCN, anyone who lives or works lawfully in Bonaire, Sint Eustatius or Saba is insured for care on those islands. Affiliation is requested at the ZJCN counter after registration in the island's population register (Burgerzaken), which issues the sédula, the local identity card; a tourist stay opens no right to this insurance.

The care package is set by the decree and regulation on BES health insurance: general practitioner and prescribed examinations, hospitalisation, prescribed medicines, maternity, medical transport and air ambulance in an emergency, full dental care for under-18s and limited care for adults (removable dentures, medically necessary treatments), physiotherapy under conditions, first-line psychological care up to nine sessions per indication. Certain care requires ZJCN's prior approval. When a necessary treatment does not exist on the island, ZJCN organises a medical evacuation to Curaçao, Sint Maarten, Aruba, Colombia or the Netherlands and covers the travel, accommodation and a daily allowance.

The insurance does not apply outside the three islands: ZJCN reimburses abroad, including in Curaçao, Aruba or Sint Maarten, only urgent treatment that cannot wait until return, at the usual rate of the home island, on invoices advanced by the insured. France Diplomatie indicates that the European Health Insurance Card does not cover these territories, that an assistance contract or insurance covering all medical costs and repatriation is essential and that the embassy cannot cover these costs. It also flags dengue (with no curative treatment), chikungunya and Zika in the Kingdom's Caribbean territories, and recommends vaccines against hepatitis A, typhoid fever and, for frequent or prolonged stays, hepatitis B.

• Status and passport: France Diplomatie describes Bonaire, Saba and Sint Eustatius as municipalities with special status, requires a passport for the Dutch overseas islands and specifies that they are not part of the Schengen area. The Dutch administration requires a passport valid throughout the stay and proof of return.
• Stay without a permit: the IND-CN immigration service grants foreigners, including French nationals, free access for 90 days in 180; the border may shorten this period depending on the purpose of travel and means of subsistence. Nationals of the European Union are among the nationalities that can enter directly, without a prior visa.
• Bonaire entry tax: US$75 per person, to be paid online up to seven days before travel, valid for one month (Openbaar Lichaam Bonaire). Registered residents are exempt; the arrangements for the other two islands are not detailed in the sources read and should be checked with their administrations.
• Residence permit: a permit is required to work or to stay more than three months. The temporary permit is generally valid for one year, then renewed; an indefinite-duration permit can be requested after five years of continuous stay in the Caribbean Netherlands. From 1 November 2026, certain applications require additional certificates from the local tax administration.
• Work permit: the employer must obtain an employment authorisation (tewerkstellingsvergunning) before employing a worker from abroad, after trying to recruit locally.
• Local affiliation: registration in the population register, sédula, then ZJCN; personal interim insurance is recommended before affiliation.
• Student: no EHIC on site; a student insurance or an international health insurance contract should be arranged before departure. The income required for a study permit is at least half the gross monthly minimum wage, excluding tuition fees.
• Seconded employee : with no agreement, continuation of the French scheme follows the rules of secondment outside an agreement; duration and conditions should be checked with Urssaf and CLEISS. Assurance Maladie (French health insurance) specifies that the seconded employee is then affiliated both to the French scheme and to that of the country of secondment.
• Retiree: French Assurance Maladie no longer reimburses care in a country outside the European Union, the European Economic Area and Switzerland without an agreement; the S1 form and the EHIC do not apply. They can join the Caisse des Français de l'Étranger (CFE) or take out private insurance.

No individual fine for lacking health insurance was found in the sources consulted. The risk is financial: a tourist is not insured by ZJCN, and care received outside the three islands is reimbursed by ZJCN only in an emergency, on invoices advanced.

No social security agreement exists between France and the Caribbean Netherlands in the official sources consulted. The CLEISS list of bilateral agreements in force covers 42 states and territories, without the Netherlands or any Dutch island. The CLEISS Netherlands page specifies that the Netherlands applies the European coordination regulations; however, the European Commission reminds us that overseas countries and territories, including Bonaire, Sint Eustatius and Saba, are not part of the territory of the Union and are not directly subject to Union law, and France Diplomatie indicates that the European Health Insurance Card does not cover these islands.

• No aggregation of insurance periods or cross-cover of care was identified between France and the Caribbean Netherlands.
• On taxation, the France-Netherlands treaty of 16 March 1973, amended by the amendment of 7 April 2004, defines the Netherlands as the part of the Kingdom located in Europe; its article 30 provides for extension to other territories only by exchange of diplomatic notes, and the list of tax treaties of the French administration mentions neither Bonaire, nor Saba, nor Sint Eustatius. No allocation of taxing rights is therefore published for these islands; each taxpayer's situation should be confirmed with the tax administration.
• Seconded employee: continuation of the French scheme follows the rules of secondment outside an agreement; care is reimbursed on paid invoices, according to French tariffs and within the limit of the expenses incurred (form S3125 or ameli account).
• Expatriate employee: they are compulsorily subject to the local scheme, here the BES zorgverzekering for care; CFE membership allows them 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) and hand back your carte Vitale and EHIC to your health insurance fund, as Assurance Maladie asks of expatriates.
2. For any stay: take out an assistance contract or insurance covering all medical costs and repatriation, essential according to France Diplomatie.
3. Before arrival: check the validity of your passport, arrange proof of return and, for Bonaire, pay the entry tax online (tourismtax.bonairegov.com) up to seven days before travel.
4. Stay of more than three months or work: apply for the residence permit from the IND-CN; for salaried employment, the employer first obtains the employment authorisation. From 1 November 2026, the certificates requested from the local tax administration (no debt, payroll summary, income certificate) are added to the file depending on the type of application.
5. After arrival: register with Burgerzaken, which issues the sédula, then with ZJCN with the sédula, the permit (or proof of the renewal application) and, where applicable, the employer's certificate.
6. Collect the ZJCN care card (zorgpas), which replaces the former paper insurance certificate and recalls ZJCN's contact details in case of an emergency abroad.
7. Declare your income to the local tax administration: a newcomer who knows or supposes they owe tax requests their form by 15 July of the calendar year following arrival at the latest.
8. Seconded employee: ask Urssaf and CLEISS for the conditions of secondment outside an agreement.
9. Retiree: notify your pension fund of the change of address, plan the annual certificate of life and choose between the CFE and private insurance.
10. Registration on the roll of French nationals living abroad, with the French Embassy in the Netherlands, in The Hague (consulate general in Amsterdam); the list of honorary consuls published by the embassy mentions no post for Bonaire, Saba or Sint Eustatius.