Social protection and healthcare in French Guiana

French Guiana has no health system or social security separate from those of France. Title V of Book VII of the Social Security Code specifies that its provisions apply in Guadeloupe, French Guiana, Martinique, La Réunion, Saint-Barthélemy and Saint-Martin to all beneficiaries of the general social security legislation (article L751-1), and article L752-1 provides for a general social security fund and a family allowance fund in French Guiana. According to CLEISS, it is the general funds (CGSS) that pay benefits in the overseas departments, in place of the primary funds. The CGSS of French Guiana website presents its sections on health insurance (Vitale card, complémentaire santé solidaire, State medical aid, sick leave, medical evacuation), retirement, occupational risks and collection from employers.

Health organisation is led by the Regional Health Agency of French Guiana, which steers public health policy and regulates the healthcare offering (IEDOM). The public hospital offering is built around the French Guiana university hospital (CHU), whose website shows sites in Cayenne, Saint-Laurent-du-Maroni and Kourou, three local hospitals and 14 decentralised prevention and care centres (CDPS); the IEDOM specifies that the CDPS are set up in isolated communes and cover about 20% of the population. Several communes in the interior (Maripasoula, Saül, Papaïchton, Grand-Santi, Camopi) are not connected by road, which makes access to care dependent on air or river transport (IEDOM).

The indicators show the scale of needs: about 700 doctors, i.e. about 24 per 10,000 inhabitants against about 34 in France, and just over 1,000 beds installed in health establishments (DREES, via the IEDOM). About 275,000 people are covered by the Assurance Maladie in French Guiana, of whom about a third are beneficiaries of the complémentaire santé solidaire (CGSS activity report, reported by the IEDOM).

On health risks, the ARS of French Guiana reminds that yellow fever vaccination is compulsory. Santé publique France follows dengue, chikungunya and malaria in its bulletins, with cases that vary strongly from one period to the next.

• Entry and stay: French Guiana is part of the Republic; a French national arriving from the mainland has no visa or residence permit to apply for. The formalities are those of a move within France: address, health insurance fund, tax and social declarations. Identity documents, the driving licence and the vehicle registration certificate are requested online; the prefecture of the French Guiana region presents these procedures on its website, as well as those for foreign nationals.
• Yellow fever: according to the ARS of French Guiana, vaccination is compulsory for any resident or tourist aged 1 or over; an up-to-date vaccination certificate or a medical contraindication certificate must be presented on entry, and the vaccination must have been done more than ten days before arrival. Only an airport transit of less than 12 hours is exempt.
• Health insurance affiliation: according to the Assurance Maladie, anyone who works or lives in France on a stable and lawful basis is entitled to have their healthcare costs covered. An employee no longer has to prove a minimum activity, a self-employed person is covered from the start of their activity, and a person with no activity is covered on the basis of residence; during checks, proof of 6 months of residence in France over the last 12 months is required (ameli). CLEISS, for its part, mentions stable and lawful residence for at least 3 months: the CGSS specifies the rule applicable to each situation.
• Fund and Vitale card: the CGSS of French Guiana is the territory's fund. It states that the Vitale card is free, available once a definitive social security number has been obtained, and that it covers the spouse and children under 25 living under the same roof.
• Referring doctor: CLEISS reminds that it is compulsory from age 16 and that a consultation within the care pathway gives access to better reimbursement.
• Complémentaire santé solidaire: to be requested from the CGSS of French Guiana, one application per household. An annual income ceiling, revised every year, gives entitlement to free cover (service-public.fr).
• Student: no foreign scheme; the student insurance for abroad does not target French Guiana, which comes under the French scheme. How a student coming from the mainland is attached to a fund is to be confirmed with the CGSS.
• Employee assigned from the mainland: comes under the general scheme as soon as they work in French Guiana; the notion of secondment abroad has no meaning for this French territory.
• Borders: Suriname (Maroni river) and Brazil (Oyapock river) are foreign countries. A stay on the other side of the river is a stay outside France (see the country pages Suriname and Brazil).

The sources consulted mention no fine specific to the territory for lacking cover. The risk is financial: the non-reimbursed share (ticket modérateur, co-payments, excess fees) remains payable by the insured person or their supplementary insurance, and care received outside France is subject to other rules. The Caisse des Français de l'Étranger (CFE) is for French people who live and work abroad: it only concerns a resident of French Guiana if they leave France.

There is no bilateral agreement or coordination regulation to apply between France and French Guiana: the territory is French. The framework is institutional:

• Status: overseas department and region governed by article 73 of the Constitution, which means national texts apply by right with possible adaptations. Since December 2015, a single collectivity, the Territorial Collectivity of French Guiana, exercises the powers of the department and the region, while remaining governed by article 73 (IEDOM). It is therefore not an overseas collectivity under article 74.
• Social security: the general legislation applies in French Guiana (article L751-1 of the Social Security Code); article L752-1 provides for a general social security fund and a family allowance fund in French Guiana.
• European Union: French Guiana is an outermost region of the European Union (IEDOM). For a resident of France, this changes nothing for health insurance: no European card or coordination form for the French territory alone. CLEISS indicates that the European Health Insurance Card can be used in the overseas territories known as outermost regions of the states concerned; a visitor insured in another EU state confirms their case with their fund and the CGSS.
• Taxation: tax from the scale is reduced by an allowance of 40% for French Guiana, capped at €4,050 (impots.gouv.fr, income tax brochure). VAT does not provisionally apply in French Guiana (article 294 of the General Tax Code, according to the IEDOM), where the octroi de mer (a local import levy) applies.
• Leaving for the mainland, another territory or abroad: the return to the mainland is prepared with the CGSS; leaving France comes under, depending on the country, the Assurance Maladie rules on care abroad or private insurance (see assistance and repatriation).

1. Before departure: report your change of address and situation to your home Assurance Maladie fund (ameli account, or 3646), then to the other bodies (family allowance fund, France Travail, pension fund, tax authorities).
2. Get vaccinated against yellow fever more than ten days before arrival and keep the international vaccination certificate; the list of authorised centres and doctors is on the ARS French Guiana website.
3. See your doctor before departure about malaria prevention (chemoprophylaxis if stays in risk areas are planned), dengue and chikungunya (protection against mosquitoes).
4. On arrival: contact the CGSS of French Guiana (3646 for the Assurance Maladie), open or update your ameli account, update your Vitale card and declare your referring doctor.
5. With no professional activity: send form Cerfa S1106 to the fund of your place of residence with the requested supporting documents (ameli).
6. Modest income: apply for the complémentaire santé solidaire from the CGSS of French Guiana, one application per household.
7. Plan for supplementary health insurance for the ticket modérateur and excess fees, and for assistance for trips to Suriname, Brazil or elsewhere outside France.
8. For care not available locally: have your doctor complete form S3139g (prior transport approval), file the application at least 15 days before the appointment date and call 3646 for information (CGSS of French Guiana).
9. For a return to the mainland: inform the CGSS of French Guiana and the fund of the new place of residence, update the Vitale card and declare a new referring doctor (see also the return to France page).