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

No social security agreement links France to Fiji: the archipelago does not appear in the CLEISS list of agreements. Insurance periods cannot be aggregated and there is no cross-cover between schemes. According to the Assurance Maladie, an expatriate no longer falls under the French scheme and depends on the scheme of the country of work, whereas a seconded employee remains affiliated to France. Four players can therefore be involved: the Fijian scheme, the retained French scheme, the CFE and international health insurance.

The notions of reimbursement basis and out-of-pocket cost help compare offers. How the hospitals work is presented in the guide Fiji’s healthcare system.

An employee on a local contract is attached to the scheme of the country of work, to which their contributions are paid (Assurance Maladie). The arrangements for access to public care for a foreign employee and the financial contribution should be confirmed with the Ministry of Health and the employer; no official source read publishes these amounts. Private supplementary cover opens access to the private sector and to evacuation. See the glossary entry local contract.

A seconded employee of a French employer remains affiliated to French social security during their assignment, under the conditions of secondment outside an agreement: duration, conditions and contributions should be checked with the Urssaf (the French social security contributions collector) and the CLEISS before departure. Costs are reimbursed under French rules, on paid invoices, whatever price is charged on site. Employers often add an international group contract for evacuation and direct access to the private sector. See seconded or expatriate and the glossary entry seconded employee.

A self-employed person has no employer to affiliate them: they choose between local affiliation if it is open to them, the CFE or international insurance, the latter covering hospitalisation, outpatient care and repatriation. See digital nomad insurance.

A student, holding a study permit issued by the immigration service, can join the CFE youth offer before age 30 or take out student insurance; access to a Fijian public scheme depends on their status. See student insurance abroad.

The spouse and children, who obtain dependant status for children under 18 and the legal spouse, follow the policyholder’s cover when it provides for dependants; the CFE offers family contracts, for the main offer, with a quarterly contribution that depends on the ages of the household members (current amounts on cfe.fr). See expatriate family insurance.

The S1 form and the European Health Insurance Card are valid only in the European Union, the European Economic Area, Switzerland and the United Kingdom: they do not apply to Fiji. According to the Assurance Maladie, the retiree’s healthcare costs are no longer covered by France after departure; they choose the CFE, with the retiree offer (contribution published on cfe.fr) and with no medical questionnaire, or a private contract. During a stay in France, a pensioner of the general scheme with at least 15 years of contributions may be covered after registering with the Cnarefe; their spouse relies on the CFE and a private contract covering France. See the guide health insurance for retirees abroad and the page retiring in Fiji.

The CFE reimburses abroad according to a rate or flat amount specific to the country of care applied to the actual expense; the gap with the invoice remains payable by the member (CFE reimbursements). Cover is worldwide, including stays of less than three months in France. The waiting period is zero if joining takes place before departure or within three months of settling in; beyond that, it is 3 months before age 45 and 6 months from age 45. For maternity, conception must come after joining or after attachment as a dependant.

First-euro insurance reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions; with direct billing, it avoids the advance of costs and guarantees access to a suitable facility, which answers France Diplomatie’s warning about compromised access to care without cover. The tourist, who has a four-month visa, takes out insurance covering medical costs, surgery, hospitalisation and repatriation before departure; see long-stay travel insurance.

On return to France, the CFE applies no waiting period; the reopening of rights is requested from the CPAM (the primary health insurance fund) with form S1106 (Assurance Maladie). See return to France and reducing the waiting period.

• Consultation: in the public sector, depending on status and local regulations; free fees in private practices; reimbursed by the CFE on its country scale; actual costs within the ceilings of a first-euro contract.
• Hospitalisation: scheme of the country of work for a local employee, French scheme for a seconded employee, CFE or international contract for the others; evacuation abroad is provided for in the assistance contract, because local resources are limited.
• Medicines: a free medicines scheme exists in the public sector (Ministry of Health); elsewhere, reimbursed according to the CFE scale or within the ceilings of an international contract; prescription in international nonproprietary names.
• Dental: included at the CFE according to its scale and in most international contracts, with an annual ceiling.
• Optical: mostly covered by international contracts, with per-period ceilings to be read in the table of benefits.
• Maternity: covered by the CFE if conception follows joining; usual waiting period in international contracts; plan the delivery in an equipped facility, preferably close to a divisional hospital.

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