The Healthcare System in Bonaire, Sint Eustatius and Saba (Caribbean Netherlands): Insurance, Hospitals, Emergencies and Health Risks

Care on the three islands rests on the BES zorgverzekering, the health insurance specific to the Caribbean Netherlands, run by Zorg en Jeugd Caribisch Nederland (ZJCN), the health and youth service of the Dutch Ministry of Health for Bonaire, Sint Eustatius and Saba. ZJCN’s email address keeps the former name Zorgverzekeringskantoor. The content of the care package is set by a decree and a regulation: ZJCN reminds us that the minister can change it, and that certain care requires its prior approval. Providers (doctors, hospital, pharmacies) work on the islands; the insured checks their affiliation by presenting their sédula.

France Diplomatie classes Bonaire, Saba and Sint Eustatius among the Netherlands’ municipalities with special status and specifies that the European Health Insurance Card does not cover Dutch overseas territories. The European Commission indicates that these islands, overseas countries and territories, are not directly subject to Union law: the health system that applies there is therefore that of the islands, distinct from that of the European Netherlands.

According to ZJCN, anyone who resides or works lawfully on one of the three islands is insured for care on those islands. Affiliation is requested at the ZJCN counter and requires registration in the island’s population register, with Burgerzaken, which issues the sédula, the local identity card to carry at all times. The documents requested are the sédula, a residence permit (or proof of an extension application), the employer’s certificate for a local employee and, for anyone arriving from the European Netherlands, proof of the end date of Dutch insurance. A tourist stay opens no right to the insurance; nor does it for an employee of a Dutch public-law employer or for someone subject to an insurance obligation in the European Netherlands.

ZJCN recommends taking out personal interim insurance before affiliation, to avoid a period without cover. The pages consulted give neither the premium amount for an unemployed resident, nor the split of an employee’s premium beyond the 0.5% share of salary indicated by the tax administration; these points should be requested from ZJCN. Since 2024, a care card, the zorgpas, replaces the former paper insurance certificate: it is collected at the ZJCN office (Kaya Grandi 91) with the sédula and a form, on Monday, Wednesday and Friday from 8 am to 12 noon, on Tuesday and Thursday from 1 pm to 4 pm, or by appointment by email.

The general practitioner is the first point of contact: ZJCN covers general medicine care, as well as laboratory, radiology and pathology examinations prescribed by the general practitioner. It is the GP or the specialist who refers to a provider; an insured person who prefers a provider of their choice must request ZJCN’s authorisation before treatment, with a referral letter, a quote and a signed declaration of agreement. Requests made after the fact are refused, and ZJCN may reject a request when there are enough contracted providers. Once approval is obtained, the insured advances the costs and ZJCN reimburses at most the usual rate of the island, with no letter of guarantee or advance.

Among other outpatient care, the ZJCN page cites first-line psychological care (nine sessions per indication at most), physiotherapy (nine sessions a year for a child, extendable to eighteen), speech therapy with prior approval, occupational therapy (ten hours a year), dietary advice (three hours a year) and chiropody. Alternative medicine and medical examinations remain excluded.

In Bonaire, the Fundashon Mariadal foundation, located on Kaya Soeur Bartola in Kralendijk (telephone +599 715 8900), is the island’s hospital: hospitalisation, polyclinic, laboratory, radiology, dialysis and pharmacy, with an emergency department and an air ambulance presented on its website. It aims to provide 80% of care on site, which leaves room for evacuations for the rest. Visiting hours are displayed daily on its website. In Saba, the Saba Cares foundation (Paris Hill Road 12, The Bottom; telephone +599 416 3288) runs a clinic, an emergency department open 24 hours a day, an admissions service, a laboratory, home care and a dental practice; it indicates clinic reception from 8 am to 4 pm every day. For Sint Eustatius, the official pages consulted do not describe the island’s health facility; ZJCN (+599 318 3379) guides the insured.

The alarm number of the Caribbean Netherlands is 911 (Rijksdienst Caribisch Nederland), which answers medical emergencies, police and fire services; in Saba, the police can be reached on +599 416 3737 and the fire service on +599 416 7477. ZJCN can be reached for emergencies abroad on +599 715 8899 (Bonaire), +599 318 3379 (Sint Eustatius) and +599 416 3552 (Saba), or by email at info@zorgverzekeringskantoor.nl.

When a medically necessary treatment does not exist on the island, the insured is entitled to a medical evacuation, “as close as possible, further if necessary” according to ZJCN. The service assigns a case manager and organises the travel and stay. The destinations cited are, in Colombia, facilities in Cali, Medellín, Barranquilla and Bogotá; in Curaçao, the Curaçao Medical Center; in Sint Maarten, the Sint Maarten Medical Center; in the Netherlands, Amsterdam UMC and Erasmus MC; and in Aruba, the Horacio Oduber hospital. ZJCN covers the necessary examinations and treatments, the insured’s flights and, if needed, their companion’s, airport taxes, transfers, accommodation, as well as a daily allowance for the insured and their companion, excluding days of hospitalisation.

A companion may be accepted for a minor, a person with a mental, visual or hearing disability, a person using a mobility aid, a patient too ill to travel alone or a woman referred to give birth. A second medical opinion is possible with ZJCN’s prior approval. For care received on one’s own initiative outside the islands, including in Curaçao, Aruba or Sint Maarten, ZJCN reimburses only urgent treatment that cannot wait until return, at the usual rate of the home island, after advancing the costs, and it recommends travel insurance; follow-up treatment is not covered, and invoices more than 12 months old are not processed.

Medicines: ZJCN covers prescribed medicines, pharmacist advice, certain dietary products, the flu vaccine and female contraception (IUD, implant, pessary, emergency pill); over-the-counter medicines are excluded. Dental: full care for under-18s; for adults, removable and partial dentures, medically necessary treatments and dental surgery with X-rays, whereas gum surgery, simple extractions and implants are excluded. Optical and appliances: prostheses, dressings and aids for seeing, hearing, moving or breathing are covered according to the regulation, sometimes with a contribution from the insured; glasses are not named on the pages consulted, which refers back to the regulation or to ZJCN.

Maternity: ZJCN covers hospitalisation of the mother and child, the midwife and post-natal care. The hospital stay is capped at three days unless medically necessary, home care lasts 24 to 49 hours over six weeks, and ZJCN provides for a medical evacuation for a pregnancy that requires it. Long-term care, palliative care in a specialised facility and medical transport (ambulance, air ambulance in an emergency) are also covered, some with prior approval.

France Diplomatie recommends, for the Dutch overseas territories, vaccines against hepatitis A and typhoid fever depending on the conditions and length of stay, and against hepatitis B for frequent or prolonged stays. It flags dengue, which has no curative treatment and for which anti-inflammatory drugs must be avoided, chikungunya, which is prevented by vaccination and protection against bites, and Zika, which affected Aruba, Bonaire, Curaçao and Sint Maarten in 2015 and 2016; pregnant women or those planning a pregnancy consult a doctor before any travel.

The Dutch travel advice centre (LCR, attached to the RIVM) indicates that dengue is present in Bonaire and Saba and that protection against mosquitoes is needed during the day. It reports generally few or sporadic cases in Aruba, Bonaire and Curaçao. In Bonaire, the LCR specifies that yellow fever does not exist, but that vaccination, done at least ten days before arrival, is compulsory for travellers coming from a country where it exists, including after a stopover of more than twelve hours. No source consulted gives a routine vaccine recommendation for an ordinary stay.

On climate, the KNMI places the hurricane season from June to November; Saba and Sint Eustatius are frequently hit, Bonaire far less. Bonaire’s administration alerts the population and can open shelters, and the Disasterprep app is available. See the page living in the Caribbean Netherlands and, for choosing cover, healthcare reimbursement, the expat health insurance page and the CFE.