Healthcare Reimbursement on Christmas Island: Who Pays What Depending on Your Situation

France Diplomatie writes that there is no bilateral agreement between France and Australia in the field of social cover: no form S1, no European card, no cross-cover (see the bilateral agreement). Christmas Island, an external territory of Australia, comes under Australian law. The embassy bears no medical costs.

Medicare, the Australian public scheme, is open to citizens, permanent residents, holders of certain temporary visas covered by a ministerial order and citizens or permanent residents of Christmas Island (Home Affairs; Services Australia). A visitor who is not eligible is a private patient and pays the costs not covered by their insurance at the time of treatment, in public hospitals as in private ones (Home Affairs). Several parties are therefore involved depending on status: visa insurance, the CFE, the French scheme maintained for a seconded employee, or international health insurance. The notions of reimbursement basis and out-of-pocket cost help you compare plans. See the page healthcare system on Christmas Island.

A local-contract employee leaves the French scheme and comes under the host country’s scheme (CLEISS). They notify the CPAM, the CAF and France Travail of their departure and return their carte Vitale. On the island, they benefit from Medicare if they are a permanent resident or covered by a ministerial order; otherwise they rely on private insurance, often required by the visa. See the glossary entry on the local contract.

A seconded employee sent by a French employer remains in the French compulsory scheme for three years, renewable once; they are covered up to the benefits they would have received in France, by sending their fund the paid invoices with form S 3125c. Accompanying dependants follow the same procedure; those who stay in France continue to deal with the fund of membership. The sick-leave notice is sent to the fund within 48 hours, and no French family benefit is due for children who follow abroad. CLEISS advises checking the top-up health insurance, as the gap with local prices can be large. See seconded or expatriate and the seconded employee glossary.

A self-employed person or digital nomad has no employer to enrol them: they choose between visa insurance, the CFE (voluntary sickness-maternity insurance) and international insurance. See digital nomad insurance. A working holiday visa holder must maintain adequate health insurance throughout the stay (condition 8501, Home Affairs): see the page working holiday insurance.

A student: according to Assurance Maladie, if they are under 20 or stay less than six months in a country with no agreement, their parents’ fund can reimburse their urgent medical costs, on three conditions: attending an institution preparing for an official qualification, providing a school certificate and returning at least once to France during the academic year, up to French flat-rate tariffs. Beyond age 20 or six months, they enrol in the host country’s student scheme or, failing that, the local scheme. Home Affairs specifies that insurance products for overseas students (OSHC) are the minimum reference cover. See student insurance abroad.

A retiree: in a country with no agreement, Assurance Maladie specifies that healthcare costs incurred abroad are no longer covered by the French scheme. For cover on site, two routes exist: voluntary CFE membership for a French national, or private insurance. The CFE retirees’ plan is for retirees of a French Sécurité sociale scheme who receive a pension from that scheme, with no professional activity, no health questionnaire, and covers only care received abroad; care in France comes under the French compulsory scheme. For temporary stays in France, the retiree registers with the Cnarefe, with a minimum contribution period of fifteen years (ameli). See the guide retiree health insurance abroad and the page retirement on Christmas Island.

Spouse and children follow the holder’s status. For a seconded employee, they are reimbursed like them on paid invoices. For a local employee, their cover depends on Medicare if they are eligible or on the holder’s insurance. For a retiree, ameli specifies that the spouse must join the CFE and take out private insurance for stays in France, unless an agreement provides otherwise. The CFE offers contracts including dependants. See expat family insurance.

The CFE is a voluntary social protection body. Its plans are referred to generically here: the main plan, open to people over 30 who are not retired, the youth plan and the retirees’ plan. The price is calculated on quotation, according to country of residence, age and family composition. Abroad, reimbursement depends on the country where care is received and the type of treatment: the CFE applies a rate or flat amount to the actual expense, and the difference from the price charged remains the member’s responsibility. The guide CFE reimbursement details this mechanism.

• Cover: care worldwide, including in France for stays of under three months with the main plan; the retirees’ plan covers only abroad.
• Waiting period: immediate cover if membership takes place before departure or within three months of settling; otherwise three months before age 44 and six months from age 45. No waiting period on return to France.
• Maternity: conception must follow membership or attachment as a dependant; daily allowances require at least ten consecutive months of membership of the relevant option at the presumed date of delivery.
• Health questionnaire: none, whatever the age.

See also the guide CFE or private insurance and the page CFE supplement.

International health insurance at the first euro reimburses actual costs up to its ceiling, after any deductible, waiting periods and exclusions in the contract. For the island, check that the coverage zone includes Australia and its territories, the annual ceiling, medical evacuation to Perth, medical repatriation and the handling of pre-existing conditions (see coverage zone).

A tourist stays three months at most with the eVisitor. Assurance Maladie specifies that, outside the European Union, care is paid for on site and that only urgent and unforeseen care can possibly be covered on return: the medical adviser decides, reimbursement is based on French flat-rate tariffs, no appeal is possible in the event of refusal and daily allowances are not paid. The claim is made from the ameli account or with form S3125. An assistance or insurance contract is recommended. See long-stay travel insurance.

Return to France. According to service-public.fr, with salaried employment in France, membership is acquired from the first hour worked: the contract or a payslip accompanies form S1106 sent to the CPAM (local health insurance office). With no activity, three consecutive months of residence in France must be shown. A CFE member may, under conditions, keep their benefits for the three months following their return. See returning to France and the guide reducing the waiting period.

• Consultation: free at the island health centre for consultations covered by Medicare for a citizen or permanent resident; billed according to the Australian Medical Association scale for a person not eligible (Department of Infrastructure); French rules on paid invoices for a seconded employee; rate or flat amount of the country of care at the CFE; actual costs for a first-euro contract.
• Hospitalisation: someone not eligible for Medicare pays costs not covered by their insurance at the time of treatment (Home Affairs); hospital care in Western Australia is provided under an agreement between the Australian government and that state; direct payment by the insurer avoids advancing funds; the prior authorisation is sometimes required by the contract. Rates are not published for someone not eligible: ask for a quote.
• Medicines: the Australian Pharmaceutical Benefits Scheme is applied on the island as on the mainland; the rate for someone not eligible is not published in the pages read. Reimbursement according to the insurer’s list, the CFE country scale or the ceilings of an international contract.
• Dental and optical: on the island, dental care is billed according to the Department of Veterans’ Affairs dental scale (Department of Infrastructure); ophthalmology is provided by visiting specialists. Cover is often separate and capped in international contracts: to be read in the table of benefits before subscribing.
• Maternity: at the CFE, conception must follow membership; the IOTHS offers antenatal care services and visiting obstetric specialists; international contracts generally apply a waiting period; a seconded employee is reimbursed under French rules on invoices.

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