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

Curaçao is an autonomous country of the Kingdom of the Netherlands outside the European Union. France Diplomatie (the French foreign ministry) specifies that the European Health Insurance Card does not cover the island, and CLEISS (the French Centre for European and International Social Security Liaison) lists no page and no social security agreement for Curaçao. No coordination therefore exists between the schemes: no Carte Vitale abroad, no aggregation of insurance periods, no cross-border cover. Four players may step in depending on status: the local scheme (BVZ), the French scheme maintained (secondment), the CFE and international health insurance.

The notions of reimbursement basis and out-of-pocket cost help to compare offers. Amounts are in Caribbean guilders (Cg) or, when the SVB expresses them that way, in Netherlands Antillean guilders (NAf); how care is organised is described in the guide Curaçao’s healthcare system.

An employee on a local contract is insured by the BVZ like any resident. The SVB table sets the premium at 13.6% of income, of which 4.3% is paid by the employee, withheld by the employer which also pays its share of 9.3%. The employee also falls under sickness-wage insurance (ZV), funded by the employer (1.9%), which pays 80% of the daily wage for two years at most, and under accident insurance (OV), paid by the employer. According to CLEISS, an employee who expatriates “then necessarily falls under the scheme of the State of activity” and is no longer insured in France. See the glossary entry on the local contract.

A seconded employee remains affiliated to the French scheme for three years renewable once, that is six years at most, under French legislation alone; this continuation “does not exempt from paying contributions” in the host country, hence a possible double burden. Care is reimbursed within the limit of the benefits the same care would have given in France, on sending the paid invoices to the fund with form S 3125c; CLEISS advises supplementary insurance when care is expensive on site. Dependants who accompany the employee follow the same procedure, and those who stay in France continue to deal with the fund. See seconded or expatriate and the glossary entry on seconded employees.

A resident freelancer contributes to the BVZ at the rate of 13.6% of income, up to Cg 150,000. For the self-employed, the CFE provides voluntary sickness-maternity insurance. A short-stay remote worker, holding a residence permit of six months at most, remains a visitor rather than a resident: the BVZ is for residents, and international insurance or the CFE then covers costs; see digital nomad insurance.

A student depends on French rules for a country without an agreement. For a stay of under six months, CLEISS mentions only the possibility of a flat-rate reimbursement of unforeseen care, after paying costs up front, capped at French tariffs, which the fund is under no obligation to grant. Beyond six months, a student over 20 is no longer covered by French health insurance and checks the local scheme or takes out private insurance or joins the CFE; before 20, they keep the status of their parents’ dependant, with limited protection. Before age 30, the CFE offers a youth offer. See student insurance abroad.

A retiree is not covered by the S1 form, which is valid in the European Union. As a resident in Curaçao, they contribute to the BVZ at 6.5% of income, up to Cg 150,000 (SVB table). The CFE offer for retirees is reserved for holders of a French basic scheme pension; it asks for no health questionnaire, covers care received abroad, and its waiting periods are three months before age 44 and six months from age 45 in case of late membership. See the guide health insurance for retirees abroad and the page retiring in Curaçao.

The spouse and children follow the holder’s permit or hold a family permit; each falls under the BVZ once resident. The seconded employee has their accompanying dependants benefit from the same reimbursement procedure as theirs. The CFE and international insurers offer family plans, with maternity and paediatrics depending on the contract. See expat family insurance.

The CFE is a voluntary social protection body. In France, it reimburses according to Sécurité sociale principles, with direct payment (tiers payant) in public and private hospitals; abroad, reimbursement depends on the country of care and the type of procedure, applied as a rate or flat amount to the actual expense. The offers cover consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines; monthly rates can be consulted on cfe.fr. The guide CFE reimbursements details this mechanism.

• Waiting period: immediate cover if joining takes place before departure or within three months of settling; otherwise a three-month wait before age 44 and six months from age 45.
• Maternity: conception must come after joining or after becoming attached as a dependant.
• No medical questionnaire for the adult, youth and retiree offers consulted.

On returning to France, a CFE contributor can, under conditions, receive the benefits of the expatriate scheme for three months. For a non-contributor without a job, three consecutive months of residence in France are needed before requesting universal health protection; with a job, affiliation resumes from the first hour worked (service-public.gouv.fr). 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 complements the BVZ, which provides for third-class hospitalisation, and covers evacuation and repatriation. Contracts are compared on the annual ceiling, the coverage area, evacuation and the handling of pre-existing medical conditions.

The tourist has no cover on site under an agreement. CLEISS states that the French fund can, on return, reimburse unforeseen care, after costs are paid up front, on paid invoices and a statement of costs, on the basis of French tariffs; this is a possibility and not an obligation. Medical repatriation is not covered by the Assurance Maladie (French national health insurance), and CLEISS recommends travel insurance suited to the country’s costs or checking the bank card guarantee. See long-stay travel insurance.

• Consultation: covered by the BVZ with the general practitioner to whom the insured person is attached; reimbursed by the CFE on its country scale; actual costs within the ceilings of a first-euro contract; at the French scale for a seconded worker.
• Hospitalisation: BVZ in third class, on a referral letter valid for six months; French scheme within the limit of French benefits for a seconded worker; CFE according to the country; direct payment possible with an international contract.
• Medicines: covered by the BVZ outside the negative list, with 1 florin per prescription line and maximum dispensing periods (one month in general, 15 days for antibiotics, three months for chronic diseases); reimbursed according to CFE scales or within the ceilings of an international contract.
• Dental: BVZ subject to income (less than NAf 12,000 a year for those over 18, no condition for minors, low-income people and retirees); included at the CFE according to its scales and in most international contracts within an annual ceiling.
• Optical: BVZ with a frame up to NAf 90 and lenses on prescription, one reimbursement every two years, under income conditions similar to dental; beyond that, mostly a matter for international contracts.
• Maternity: BVZ with follow-up by a midwife or the general practitioner, third-class delivery, three days of hospitalisation and home care for up to eight days after delivery; 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.