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

Guernsey is not part of the European Union: European coordination regulations do not apply there and the island's government states that it does not accept the European health insurance card. CLEISS (the French centre for European and international social security liaison) describes an exchange of letters of 19 November 1965, in force since 1 December 1965, which builds on the general Franco-British convention of 10 July 1956 and on an administrative arrangement of 8 September 1958. It targets employed workers of French nationality or originating from Guernsey, Alderney, Herm and Jethou, applies in principle the legislation of the place of work with exceptions for seconded employees, and coordinates the sickness-maternity, invalidity, old age, work accident and death branches. Self-employed workers are not mentioned in it and tourists are not addressed.

Four players may be involved: the Guernsey scheme, the French scheme maintained for a seconded employee, the CFE and international health insurance. The notions of reimbursement base and out-of-pocket cost help with comparison. Conversions use the ECB reference rate. How the care network works is detailed in the guide to the Guernsey healthcare system.

The employee on a local contract contributes to Guernsey social security (7.5% of gross pay for them, 7.1% for the employer) and gains access to the specialist benefits scheme, consultation subsidies and the pharmaceutical service. Sick leave gives entitlement, from 26 weeks of contributions, to a weekly allowance of up to £215.04 (about €255). See the glossary entry on the local contract.

The seconded employee of a French employer can, according to CLEISS, remain on the French scheme under conditions, with cover of care received on site at no additional contribution. They send their paid invoices to their affiliation fund with form S 3125c, family members who accompany them follow the same procedure, the sick note is sent to the fund within 48 hours and daily allowances are paid by it. Family benefits cannot be exported and the maximum duration of secondment is not specified. CLEISS invites you to check with your supplementary insurer whether the contract needs adapting, as costs on site may be higher than in France. See seconded or expatriate.

The self-employed person is not mentioned in the 1965 convention. According to CLEISS, the local scheme covers non-employees like employees, except for unemployment, with a Class 2 contribution of 12.4%; the convention does not guarantee them continuation on the French scheme. An insurance for the self-employed or nomads can complement this scheme.

The retiree receives no certificate before departure. CLEISS specifies that the 1956 convention does not allow reimbursement of care in Guernsey on the basis of the French pension: cover falls under Guernsey social security, by virtue of residence, and is to be checked with it. People who have reached the local pension age (currently 65 years and 10 months, gradually raised towards 70) are exempt from the prescription charge and contribute 3.8% of income when they pursue no activity. On a stay in France, a retiree who receives a French pension based on at least 15 years of French insurance, with no professional activity, can receive care; beyond one month of hospitalisation, prior authorisation after a medical check is required. Only the retiree and their minor children are concerned, and the spouse insures separately. These files are handled by the CPAM of Seine-et-Marne (pre-registration on ameli-rfe.fr). See the guide health insurance for retirees abroad and the page retiring in Guernsey.

The spouse and children of a seconded employee follow the same scheme as they do; if they stay in France, they continue to depend on their fund. For a local resident, a non-employed spouse falls under Class 3, exempt below an annual income threshold revised every year; children up to 18 benefit from reduced rates with the doctor (£25) and the nurse (£15). See expatriate family insurance.

No provision specific to French students appears in the official sources consulted: the 1965 convention targets employees and access to the local scheme follows residence and registration for contributions. The Government of Guernsey reminds that the island is independent of European card holders; a student insurance with repatriation is therefore the safest solution, or the CFE youth offer for those under 30. The individual situation is to be confirmed with the island's immigration service and social security.

The CFE is a voluntary social protection body for expatriates. Abroad, reimbursement depends on the country of care and the type of procedure: a rate or flat amount applies to the actual expense. In France, it applies the principles of the Assurance Maladie (the French national health insurance) with hospital direct billing. The guide to CFE reimbursements details the mechanism.

• Offers: main offer (over 30), youth offer (under 30) and retiree offer, each with a contribution that depends on age and the plan chosen; the exact price depends on the country, age and family situation, according to the simulator. The retiree offer covers only care abroad, care in France falling under the compulsory scheme via the CPAM of Seine-et-Marne.
• Waiting period: no waiting period if joining takes place before departure or within three months of settling; beyond that, three months for those under 44 and six months for those over 45.
• Maternity: conception must be after joining or after being attached as a dependant; employees' daily allowances require at least 10 consecutive months of membership of the option at the estimated date of delivery.
• No health questionnaire: membership is open to everyone and the member cannot be excluded.

On return to France, the CFE extends health entitlements for up to three months after the return, while the affiliation to the CPAM of the place of residence is finalised (forms 1106 for the holder, 3705 for attached children); a former employee without a job in France shows three months of stable residence, and a new contract opens entitlements from its start. See reducing the waiting period and return to France.

International health insurance on a first-euro basis reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. In Guernsey, the emergency department agrees to bill the insurer directly if the patient completes a form at reception with the insurer's name, member number and contract number; if the insurer refuses, partly reimburses or does not process the file within 90 days, the balance is owed by the patient. A contract is compared on its annual ceiling, zone, repatriation cover and handling of medical history.

The tourist stays six months at most with an electronic travel authorisation. They pay for their care on the spot, with receipts, since France is not among the eight countries bound by a health agreement. CLEISS publishes no page for holidaymakers in Guernsey; according to its page on Jersey, retroactive reimbursement of unplanned care can be requested from the French fund under general law, with no guarantee. France Diplomatie recommends, for the United Kingdom, insurance covering medical costs, hospitalisation and repatriation. See long-stay travel insurance.

• Consultation: the local scheme pays £12 for a doctor and £6 for a nurse (scale revised every year); the seconded employee submits invoices with form S 3125c; the CFE applies the country scale; a first-euro contract reimburses actual costs within its ceilings.
• Hospitalisation: at the public hospital, care and accommodation are in principle not billed to residents, and specialist consultations fall under the scheme funded by contributions; emergency visits carry a charge. The CFE offers direct billing only in France; in Guernsey, direct settlement goes through an international contract.
• Medicines: £5.40 charge per item for up to 28 days, the pharmaceutical service covering the rest; exemptions notably at retirement age.
• Dental: dentists are at the patient's expense outside the local scheme according to the Government of Guernsey; the CFE and international contracts reimburse according to their table of benefits.
• Optical: opticians are also at the patient's expense; ceilings are read in the contract's or the CFE's table of benefits.
• Maternity: CLEISS indicates that maternity care is free for local members, with a weekly maternity allowance for a maximum of 26 weeks and a flat-rate grant (amounts revised every year); the CFE requires conception after joining.

The reimbursement guide and the page expat health insurance provide benchmarks; Expavy helps compare these options against your situation.