Expat insurance and health insurance on Christmas Island

There is no fund comparable to French Sécurité sociale. The Australian public scheme, Medicare, is open to citizens, permanent residents (including those of Christmas Island) and certain categories of temporary visa holders covered by a ministerial order; the Department of Home Affairs specifies that, in most cases, visitors are not eligible and bear all their healthcare costs. France is not among the countries linked to Australia by a reciprocal health agreement (Services Australia).

On site, care is delivered by the Indian Ocean Territories Health Service (IOTHS), which the Australian government funds and operates: primary care, emergencies, short-stay hospital care, pharmacy, radiology, dental care, emergency medical evacuation and patient travel assistance, supplemented by visiting specialists and by a service agreement with the Western Australian Department of Health for hospital care in Western Australia. The Department of Infrastructure reminds us that specialties are not always available and that residents and visitors may have to travel to Perth. See the page healthcare system on Christmas Island.

• Short tourist or business stay: France Diplomatie indicates that French nationals must hold an electronic travel authorisation (eVisitor, subclass 651) or a visa. According to Home Affairs, France is among the countries eligible for the eVisitor, which allows stays of three months at most on each entry over twelve months, does not allow work and is applied for from outside Australia.
• Reaching the island from mainland Australia: the Department of Infrastructure specifies that a passport and visa are not required for this journey, but that a photo identity document must be presented for each passenger, children included; the passport is the recommended document. The usual Australian immigration and customs formalities apply on entry from abroad.
• Longer stay, work or study: a suitable visa is needed (working holiday visa, sponsored skilled worker visa, student visa, etc.), applied for from Home Affairs. The eVisitor visa is not a work visa and can be cancelled in the event of paid activity.
• Health insurance: Home Affairs strongly recommends that visitors not eligible for Medicare take out private health insurance, and several temporary visas are subject to condition 8501, which requires maintaining adequate health insurance. France Diplomatie deems essential an assistance contract covering all medical costs and medical repatriation; the island’s national park website adds that visitors should have insurance covering emergency evacuation.
• Animals and quarantine: importing dogs and cats to the island is prohibited by a local ordinance, with a possible exemption for an assistance dog; the quarantine rules of the Australian Department of Agriculture apply to transported products.
• Student: no EHIC outside the European Union; Assurance Maladie (French health insurance) recommends an assistance or insurance contract, and CFE membership remains possible. See the student insurance abroad.
• Seconded employee : with no agreement, secondment “outside an agreement” keeps the French scheme for three years, renewable once (CLEISS); the CFE and an assistance contract remain recommended in addition.
• Retiree: Assurance Maladie no longer reimburses care received in a country with no agreement; the CFE (retiree plan) or private insurance takes over (ameli; CLEISS).

No individual fine for lacking insurance is mentioned in the sources consulted for a visitor; the risk is financial, as someone not eligible for Medicare is treated as a private patient and pays for their care (Home Affairs).

No social security agreement links France and Australia. France Diplomatie says so in so many words (“there is no bilateral agreement between France and Australia in the field of social cover”) and Australia does not appear in the CLEISS list of agreements in force. The rules that follow apply to Christmas Island, which comes under Australian law.

• Sickness and maternity: no coordination; no form S1, no EHIC. On a temporary stay, only urgent and unforeseen care can possibly be reimbursed on return, on the basis of French flat-rate tariffs (Assurance Maladie).
• Secondment: in the absence of an agreement, secondment “outside an agreement” lasts three years, renewable once; the employee remains in the French scheme, reimbursed up to French benefits on paid invoices with form S 3125c (CLEISS).
• Expatriation: the local employee leaves the French scheme and comes under the host country’s scheme; they notify their departure to the CPAM, the CAF and France Travail and return their carte Vitale (CLEISS). Voluntary CFE insurance can supplement local protection.
• Retirement: with no agreement, each country’s pension rights are examined separately; contributions paid locally do not automatically give entitlement to a French pension (CLEISS).

Status of the territory. According to the Australian Department of Infrastructure, Christmas Island is an external territory of Australia, with no state level of government: the Australian government provides state-type services, an Administrator appointed by the Governor-General represents the minister, and the local authority (Shire of Christmas Island) provides municipal services. Federal services such as social security, customs, quarantine and the Pharmaceutical Benefits Scheme are provided as on the mainland.

Tax treaty. The France-Australia convention of 20 June 2006 (decree of 18 June 2009, in force on 1 June 2009) defines in its article 3 the term “Australia” in the geographical sense, excluding external territories, with the exception notably of the territory of Christmas Island: the convention therefore applies to the island. Tax residence is determined under article 4 of the convention, after applying each state’s domestic law (service-public.fr recalls the French criteria for tax residence: home or main place of stay, main activity, centre of economic interests).

1. Before departure: notify the French agencies of your departure (health insurance fund, CAF, France Travail, pension funds); hand back your carte Vitale and EHIC if you are expatriating.
2. For any stay, including a short one: take out an assistance contract or insurance covering all medical costs, medical evacuation and medical repatriation, essential according to France Diplomatie.
3. Apply for the eVisitor from outside Australia for a stay of three months at most, or for the visa matching the planned length and activity; bring a photo identity document for the journey from the mainland.
4. Seconded employee: the employer completes the secondment formalities outside an agreement with the social security body (CLEISS); keep the paid invoices for form S 3125c.
5. Long-term settlement: check eligibility for Medicare with Services Australia (permanent residence or ministerial order); in the meantime, private insurance or the CFE.
6. Taxation: have your tax residence validated with the French tax administration and the Australian tax administration (ATO), relying on the convention of 20 June 2006.
7. Retiree: arrange the CFE (retiree plan) or private insurance; for stays in France, register with the Cnarefe (ameli).
8. Take personal medicines for the whole stay (the Department of Infrastructure notes that some products can take a week to arrive), and a personal locator beacon for any outing away from inhabited areas.
9. Register on the roll of French nationals living abroad: France Diplomatie does not name Christmas Island in the pages consulted; confirm the competent post with the French embassy in Canberra.