Healthcare Reimbursement in Norfolk Island: Who Reimburses What Depending on Your Situation

France Diplomatie says in so many words that there is no bilateral agreement between France and Australia in the field of social cover, and CLEISS does not mention Australia in its list of bilateral agreements in force: no S1 form, no European card, no cross-border cover (see the bilateral agreement). Services Australia does not list France among the countries with a reciprocal health care agreement either. The embassy does not cover any medical costs.

Several players therefore come into play depending on status: Medicare for eligible people (citizens, permanent residents, applicants for permanent residence, certain temporary visa holders), the French scheme maintained for a seconded employee, the CFE, an international health insurance or the insurance required by a visa. The conditions of access to Medicare and how care is organised are detailed on the page healthcare system in Norfolk Island. The notions of reimbursement basis and out-of-pocket cost help to compare offers.

The employee on a local contract falls under the scheme of the country of employment. According to Assurance Maladie (French health insurance), they declare their transfer of residence to their fund within one month, hand back their carte Vitale and their European health insurance card, and their medical costs are reimbursed by the body of the country of expatriation; private insurance can top up the cover. On the island, this means Medicare when the visa or status opens rights, and private insurance in the meantime. See the glossary entry on the local contract.

The seconded employee sent by a French employer may, in the absence of an agreement, be maintained in the French scheme under domestic legislation: three years, renewable only once. CLEISS specifies that they are covered for care within the limit of the benefits they would have received for the same care in France, that the formalities are made with Urssaf and that a seconded employee has a dual status, the host country being able to require its own contributions. If care is expensive, the employer can take out additional private health insurance. See seconded or expatriate and the seconded employee glossary.

The self-employed worker or digital nomad has no employer to affiliate them to a local scheme. They choose between the CFE, an international contract and, as long as they are not eligible for Medicare, the insurance their visa requires; cover for hospital, outpatient care, evacuation and repatriation suits a stay of several years. See digital nomad insurance.

The student: according to Assurance Maladie, in a country without an agreement with France, if they are under 20 or stay less than six months, their parents’ fund may reimburse their urgent medical costs, under three conditions: attending an establishment preparing for an official qualification, providing a certificate of enrolment and returning to France at least once during the academic year, within the limit of French flat-rate tariffs. Beyond 20 years or six months, the student enrols in the country’s student scheme or, failing that, in the local scheme. Home Affairs recommends OSHC-type insurance for students, whose level of cover can meet visa condition 8501 (maintaining adequate health insurance). See student insurance abroad.

The retiree who settles in a country without an agreement is no longer covered by French Assurance Maladie for care on site. Assurance Maladie and CLEISS indicate three routes: checking with the country’s institutions to what extent the local scheme covers them, joining the CFE voluntarily, or taking out private insurance. For their temporary stays in France, they are covered if they receive a pension from a French basic scheme, carry on no professional activity and show at least 15 years of insurance in France; a hospital stay of more than one month requires prior recognition, and the spouse who accompanies them is not covered by this arrangement. See the guide retiree health insurance abroad and the page retirement in Norfolk Island.

The spouse and children follow the status of the holder: Assurance Maladie indicates that family members who accompany an expatriate are covered according to the rules of the country of expatriation. For a seconded employee, the cover of dependants who accompany them should be confirmed with the affiliation fund; for a local employee, they generally fall under the employer’s plan or Medicare if their status allows it. See expat family insurance.

The CFE is a voluntary-membership social protection body. Assurance Maladie reminds us that an expatriate who wishes to continue to benefit from the French scheme can join it and that they then contribute both to the compulsory scheme of the country of expatriation and to the CFE; on return to France, they thus avoid waiting periods or lost quarters for their pension. CFE plans vary by age and profile, with a price on quotation; membership conditions, any waiting periods before cover starts, maternity cover and cover depending on the country of care should be read on cfe.fr before subscribing. The guide CFE reimbursements details the reimbursement mechanism.

See also the guide CFE or private insurance and the page CFE top-up.

International health insurance at first euro reimburses actual costs up to its ceiling, after any deductible, waiting periods and exclusions of the contract. For the island, it should be checked that the coverage zone includes Australia, the annual ceiling, medical evacuation to the mainland and the handling of medical history (see coverage zone). Home Affairs recommends obtaining, before any care, an estimate of the costs, of the share covered by the insurance and of any gap payments, called informed financial consent.

The 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 medical care may possibly be covered on return: the medical adviser decides, reimbursement is based on French flat-rate tariffs, no appeal is possible if refused and daily allowances are not paid. The request is made from the ameli account or with form S3125. See long-stay travel insurance.

The return to France. According to service-public.gouv.fr, with salaried work in France, affiliation is acquired from the first hour worked: the contract or a payslip accompanies form S1106 sent to the CPAM. Without 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 return to France and the guide reducing the waiting period.

• Consultation: care on the island is covered by Medicare for cardholders (NIHRACS); for others, the fee is requested from the clinic and reimbursed according to the contract (actual costs within the ceiling of a first-euro contract, country scale at the CFE, French benefits for a seconded employee).
• Hospital stay and evacuation: Medicare covers care for eligible people and evacuation to the mainland is covered by the Australian government for cardholders; a visitor without a card is a private patient and pays the costs not covered by their insurance (Home Affairs). Prior authorisation is sometimes required by the contract (see prior authorisation).
• Medication: the Pharmaceutical Benefits Scheme applies to Medicare cardholders; others read their contract for the list and rate of reimbursement. The island’s pharmacy may not have every product: bring your treatments.
• Dental and optical: a dental clinic exists within the island’s health service, by appointment; dental and optical cover is often separate and capped in private contracts, to be read before subscribing.
• Maternity: covered by Medicare for eligible people; for others, the conditions of maternity cover (date of conception, waiting periods) are read in the contract or at the CFE; as the island has no operating theatre, follow-up should be prepared with the health service.

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