Healthcare Reimbursement in Bonaire, Sint Eustatius and Saba (Caribbean Netherlands): Who Reimburses What, Depending on Your Situation

Bonaire, Sint Eustatius and Saba are municipalities with special status of the Netherlands, but CLEISS, which notes that the Netherlands applies the European coordination regulations, publishes no bilateral agreement with them, and the list of agreements in force covers 42 states and territories without the Netherlands. The European Commission reminds us that these islands, overseas countries and territories, are not directly subject to Union law, and France Diplomatie indicates that the European Health Insurance Card does not cover Dutch overseas territories. There is therefore no European card, no aggregation of periods and no cross-cover of care.

Four players can step in depending on status: the local scheme (ZJCN), 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 page healthcare system in the Caribbean Netherlands.

The local-contract employee joins ZJCN once registered in the population register, with the sédula, their permit and their employer’s certificate. The local tax administration indicates an employee share of the health insurance premium of 0.5% of salary, on a base of US$38,390 a year at most; the employer’s share is not detailed in the pages consulted. Assurance Maladie (French health insurance) reminds us that the expatriate then falls compulsorily under the scheme of the country of work and hands back their carte Vitale and European card to their fund before departure. See the glossary entry on the local contract.

The seconded employee remains, according to Assurance Maladie, affiliated both to the French scheme and to that of the country of secondment. They keep the paid invoices and send them to their fund, through the ameli account or with form S3125; reimbursement follows French Sécurité sociale rates, within the limit of the expenses incurred, whatever the price asked on site. Secondment cannot exceed 24 months except in exceptional cases, and Assurance Maladie invites people to consider a specific health insurance contract, as care can be very expensive. Duration and conditions outside an agreement should be checked with Urssaf and CLEISS. See seconded or expatriate and the glossary entry on the seconded employee.

The self-employed person or digital nomad has no employer to withhold the premium. A self-employed person holding a permit for non-salaried activity, registered in the population register, comes within ZJCN’s scope like anyone who resides lawfully on the island; the pages consulted do not detail how a self-employed person’s premium is calculated, to be requested from ZJCN. For a stay without a permit, ZJCN does not insure: international insurance covering hospitalisation, outpatient care and repatriation is the most complete solution; see digital nomad insurance.

The student files their permit application with the IND-CN, with an income of at least half the gross monthly minimum wage, excluding tuition fees. As the European Health Insurance Card is not valid, a student insurance or an international contract should be taken out before departure; access to ZJCN follows the conditions of lawful residence and registration, to be confirmed with the institution and ZJCN. Before age 30, the CFE offers a youth plan covering care worldwide. See student insurance abroad.

The retiree falls under neither the S1 form nor the EHIC, which concern the European Union, the European Economic Area, Switzerland and the United Kingdom: according to Assurance Maladie, in a country outside the European Union with no agreement, their health costs are no longer covered by French Assurance Maladie. They can join the CFE or take out private insurance and, if they reside lawfully on the island, fall under ZJCN. The CFE plan intended for retirees requires a French basic scheme pension and no professional activity, requires no health questionnaire and covers only care received abroad; care in France falls under the basic scheme. See the guide retiree health insurance abroad and the page retiring in the Caribbean Netherlands.

The spouse and children follow a family reunification permit, which requires a sponsor with an income of at least 120% of the gross monthly minimum wage for one person, 140% for several. Once registered in the population register, they come within ZJCN’s scope as lawful residents; the premium arrangements for children and for a spouse with no income do not appear in the pages consulted. The retired spouse and minor children of a member of the CFE retirees’ plan are also covered abroad. See expat family insurance.

The CFE is a voluntary social protection body. For its plan for non-retired adults over 30, cover is worldwide, including during stays of less than three months in France. Its reimbursements follow Assurance Maladie principles; abroad, they depend on the country of care and the type of procedure, as a rate or flat amount applied to actual expenses, and in France third-party payment is practised in public and private hospitals. When the local price exceeds the basis used, the difference remains at the member’s expense: the guide CFE reimbursements details this mechanism. Contributions are read from the scale published by the CFE before any membership; see CFE contributions.

• Waiting period: immediate cover if membership takes place before departure or within three months of settling abroad; otherwise a three-month waiting period before age 44 and six months after 45, the page not specifying the intermediate case. There is no health questionnaire.
• Maternity: conception must be after membership or after joining as a dependant.
• Stays in France: the main plan covers stays of less than three months.

On returning to France, according to service-public.gouv.fr, a former CFE contributor can benefit from its benefits for 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; resuming work opens affiliation from the first hour worked, and unemployment benefit rights are transferable to France for three months, under conditions. See the guide reducing the waiting period and the page return to France.

International health insurance at the first euro reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions in the contract. Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of pre-existing medical conditions. The pages consulted describe no letter of guarantee or deposit procedure specific to the islands’ facilities: to be checked with the insurer before a planned procedure.

The tourist is not insured by ZJCN, which excludes tourist stays. France Diplomatie deems an assistance contract or insurance covering all medical costs and repatriation essential, and specifies that the embassy cannot cover these costs. Bank card assistance can complement the arrangement, with ceilings to check. See long-stay travel insurance.

• Consultation: covered by ZJCN for an insured person, with referral by the general practitioner for specialists; reimbursed by the CFE on its country scale; on paid invoices and French tariffs for a seconded employee; actual costs for a first-euro contract; at the patient’s expense for an uninsured tourist.
• Hospitalisation: covered by ZJCN, including the medical evacuation organised by ZJCN when the care does not exist on the island, with travel, accommodation and daily allowance; a tourist’s hospitalisation requires travel insurance with assistance.
• Medicines: ZJCN covers prescribed medicines and excludes over-the-counter ones; CFE scales; ceilings of an international contract.
• Dental: full care for under-18s; for adults, removable and partial dentures, medically necessary treatments and dental surgery with X-rays, excluding simple extractions, gum surgery and implants; the CFE reimburses according to its scales.
• Optical: glasses are not named on the ZJCN pages consulted, which cite aids for seeing, hearing, moving or breathing, with prior approval and a contribution from the insured for some; they mainly fall under international contracts, with ceilings to read in the table of benefits.
• Maternity: ZJCN covers hospitalisation of the mother and child (three days at most unless medically necessary), the midwife and post-natal home care; the CFE requires conception after membership; international contracts generally apply a waiting period.

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