Social security and health insurance in Guadeloupe

According to Légifrance's legislative drafting guide, Guadeloupe is one of the territories governed by Article 73 of the Constitution, together with French Guiana, Martinique, Réunion and Mayotte; like Réunion, it is both an overseas department and an overseas region. The principle is legislative identity: Title V of Book VII of the Social Security Code (Articles L. 751-1 et seq.) in fact makes general social security legislation applicable to Guadeloupe. CLEISS (the French centre for European and international social security liaison) adds that, in the overseas departments, it is the CGSS that pay benefits, in place of the CPAM.

According to the CGSS, the general social security funds carry out in the overseas departments the missions of the pension, health and collection branches of the general scheme and of the agricultural scheme; the health branch is steered nationally by the CNAM. The CGSS of Guadeloupe receives visitors by appointment (made on ameli.fr or on 36 46) at branches in Basse-Terre, Capesterre-Belle-Eau, Les Abymes, Le Moule, Marie-Galante, Port-Louis, Saint-François, Sainte-Rose and Saint-Martin.

Health organisation falls to the Regional Health Agency (ARS) for Guadeloupe, Saint-Martin and Saint-Barthélemy (rue des Archives, 97113 Gourbeyre). Public provision rests notably on the Guadeloupe University Hospital (CHU) (route de Chauvel, Pointe-à-Pitre) and on the Basse-Terre hospital, a public medicine, surgery and obstetrics facility serving a catchment area of more than 100,000 inhabitants. The CHU website presents a new facility on the Plaine aux Abymes: the location of services should be confirmed with the CHU.

The guide to the neighbouring island of Saint-Martin (French part) describes the overseas collectivity attached to the same CGSS and the same ARS.

• Entry and stay: a French citizen coming from mainland France needs neither a visa nor a residence permit; the formalities are those of a move within France (change of address, health insurance fund, taxes, school). For personal belongings and vehicles, customs states that Guadeloupe is part of the customs territory of the European Union but is a third territory for tax purposes: a shipment from mainland France follows the import regime, with a declaration and octroi de mer (a local levy on goods).
• Affiliation: according to the Assurance Maladie, anyone who works or lives in France on a stable and lawful basis can have their healthcare costs covered; an employee is covered as soon as they start working, a self-employed person from the start of their activity, and a person with no occupation on the basis of their residence.
• Opening of rights: CLEISS specifies that opening is not automatic where there is no occupation, cover based solely on residence, or arrival in France: you must fill in Cerfa form S1106 and send it to the body of your place of residence, here the CGSS. CLEISS cites stable and lawful residence of at least 3 months; the Assurance Maladie indicates that, in case of inspection, you must be able to show 6 months of residence in France over the last 12 months.
• Coordinated care pathway: declare a GP of record (médecin traitant); outside the pathway, reimbursement is much lower (see the "Consultation" line of the costs table).
• Employee sent by their mainland employer or transferred civil servant: they work in France, under the same scheme; the concept of secondment abroad has no meaning for Guadeloupe. A public official may depend on a specific cover body, to be notified together with their administration (service-public.gouv.fr).
• Student: according to the public service, they generally remain on their parents' scheme on first enrolment in higher education, become an independent insured person at 18 and can apply for the Complémentaire Santé Solidaire if their resources are low.
• Supplementary health cover: depending on the contract, it covers the co-payment (ticket modérateur), the hospital daily charge (forfait hospitalier) and extra-billing; the Complémentaire Santé Solidaire has income ceilings specific to the overseas departments.
• Travel outside France: the CGSS issues the European Health Insurance Card for travel in Europe; outside Europe, only urgent and unforeseen care can possibly be reimbursed on return, on the basis of flat-rate French tariffs.

No fine specific to Guadeloupe is mentioned in the sources consulted for lacking cover. The public service does, however, indicate for a student that deliberately refusing to join, or failing to start the process, is punishable by 6 months' imprisonment and a €15,000 fine. The Caisse des Français de l'Étranger only becomes useful if you leave Guadeloupe to live outside France.

There is neither a bilateral agreement nor a coordination regulation between France and Guadeloupe, which is part of the Republic. The framework is institutional:

• Status: overseas department and region, governed by Article 73 of the Constitution; laws and regulations apply there as of right, with possible adaptations reflecting their particular characteristics and constraints (Légifrance).
• Social security: general scheme, run locally by the CGSS (health, pensions, collection); family allowances fall to the family allowance fund (CAF).
• European Union: CLEISS ranks Guadeloupe among the outermost regions, to which the European social security coordination regulations apply. An insured person of the French scheme living there can obtain an EHIC from their CGSS to travel in Europe.
• Other French territories: the Assurance Maladie treats health-related travel from Guadeloupe, Martinique, French Guiana, Réunion, Mayotte, Saint-Barthélemy, Saint-Martin and Corsica separately.
• Departure abroad: a French citizen who leaves Guadeloupe to live abroad then falls under the rules described in the CFE guide and, depending on the country, under a social security agreement.

1. Before departure: file the change of address online and notify your health insurance fund, the family allowance fund, the tax office, France Travail, your mutual insurer and your pension fund (service-public.gouv.fr).
2. Once there, contact the CGSS of Guadeloupe (appointment via ameli.fr or on 36 46) to transfer your file; with no professional activity, submit Cerfa form S1106 with supporting documents.
3. Have your Vitale card updated, choose and declare a GP of record to stay within the care pathway.
4. Keep proof of residence or activity: 6 months of residence in the last 12 months may be requested in case of inspection.
5. Review your supplementary health cover: the co-payment, the hospital daily charge of €23 a day and extra-billing are not covered by the general scheme; check your eligibility for the Complémentaire Santé Solidaire.
6. Plan the shipment of goods and a vehicle from mainland France: customs declaration and octroi de mer (douane.gouv.fr).
7. If care is unavailable locally: ask your doctor for prior approval for medical transport and contact your referent at the CGSS; an assistance policy can supplement cover for travel outside France.
8. On returning to mainland France: inform the CGSS and request the opening of rights with the fund of your new place of residence (form S1106 if residence is the only criterion).