Expat insurance and health insurance in the Åland Islands

The Act on the Autonomy of Åland (1991:71) lists health among the archipelago's legislative powers (section 18, point 12); the Government of Åland for its part specifies that social insurance, pensions and labour law remain State powers (sections 27 and 29). In practice, public care is organised by Ålands hälso- och sjukvård (ÅHS), responsible for all public health in the archipelago, from maternity to specialist care and end-of-life care. Patients' fees come under Åland legislation: the ÅHS publishes a fee manual and a document on rights to protection against high costs (“högkostnadsskydd”). The amounts in these documents could not be read in the sources consulted and are therefore not reproduced here.

First contact is the health centre (hälsocentral) in Mariehamn or Godby, or the municipality's health clinic for residents of the archipelago; no referral letter is required to go there. The emergency department is at Mariehamn hospital (Doktorsvägen 1 A), with a doctor on call at all times; in a life-threatening emergency, 112 connects to the regional alarm centre. The ÅHS nurse advice line (018-535 117) answers every day from 8 a.m. to 8 p.m. For specialist care, the ÅHS cooperates with hospitals in Helsinki, Turku and Uppsala.

Kela remains present in the archipelago, but the split is particular: Kela's site indicates that Åland is an autonomous region whose social legislation differs in part from that of the mainland. Kela handles, for example, housing allowance and family allowances, as well as reimbursement of travel costs to a care provider in Åland; the KST (the municipalities' social services) pays social assistance and the maternity allowance; the AMS handles the general social benefit; for treatment on mainland Finland or in Sweden, the journey is reimbursed only on a voucher issued by the ÅHS. The Kela pages consulted on the reimbursement of medicines and private care do not mention Åland: their application in the archipelago should be confirmed with Kela.

• EU citizen: France Diplomatie indicates that French nationals enter Finland freely with a valid passport or identity card; the France Diplomatie pages consulted do not treat Åland separately.
• Stay of more than three months: InfoFinland indicates that registration of an EU citizen's right of residence is to be requested no later than three months after arrival, on the basis of employment, a business, a place as a student, family ties or sufficient resources; job seeking alone is not enough. Immigration is a State power (section 27 of the Act on the Autonomy).
• Population register: in Åland, registration of a foreign national requires a visit in person to the Statens ämbetsverk på Åland (Torggatan 16 B, Mariehamn; open Monday to Friday from 9 a.m. to 4:15 p.m., appointment possible by telephone). A municipality of residence (hemkommun) is obtained for an intended stay of at least one year, according to InfoFinland.
• EU visitor: according to the ÅHS, urgent care is open to everyone; the normal rate is applied on presentation of the European Health Insurance Card (EHIC), valid identification and the home address; otherwise, the patient pays the full cost.
• Planned care of an insured person from another EU state: the ÅHS applies the Cross-Border Healthcare Act; without an S2 certificate, the patient bears the costs themselves.
• Employee: Kela indicates that a worker who earns at least €800.02 a month in Finland obtains certain benefits from the start of employment, such as sickness allowance and the Kela card, whatever their origin. How an employee with no municipality of residence gets access to ÅHS care should be confirmed with the ÅHS.
• Retiree: form S1 requested from the French pension fund before departure (CLEISS), then presented to the competent Finnish body; Kela and the ÅHS confirm the handling of the S1 in the archipelago.
• Without affiliation or EHIC: the risk is above all financial; France Diplomatie reminds readers that an assistance contract or insurance covering medical costs, hospitalisation and repatriation is essential, as the embassy cannot cover them.

Two rules specific to the archipelago concern lasting settlement: the “hembygdsrätt” (right of domicile), which requires Finnish citizenship, conditions the free acquisition of land and the right to carry on an activity without authorisation; a French national who has not been naturalised in Finland cannot obtain it. They then apply to the Government of Åland for a land acquisition permit or a right to carry on an activity (“näringsrätt”), under the conditions described by the latter.

As Åland is part of Finland, no bilateral social security agreement is to be consulted with France: coordination goes through the European regulations 883/2004 and 987/2009, as for the other member states. The CLEISS and France Diplomatie pages consulted provide no exception for Åland as regards coordination; the CLEISS page on the Finnish scheme only notes that Åland residents turn to their municipality for certain birth and adoption benefits, and that the family allowances table has a column specific to the Åland islands.

The institutional framework is that of an autonomy under Finnish sovereignty, guaranteed by Finland according to the Government of Åland. Protocol No. 2 to Finland's accession treaty to the EU places Åland outside the EU fiscal union and recognises the hembygdsrätt as a condition for buying real estate and obtaining the right to carry on an activity; the Finnish tax administration specifies that Åland does not belong to the EU VAT and excise territory. The EHIC, form A1 and the S1 come under the coordination regulations.

• Temporary stay: EHIC, with the ÅHS conditions (valid identification and address); the EHIC replaces neither assistance nor repatriation.
• Secondment: the seconded employee keeps the French scheme with form A1; for their care, CLEISS indicates requesting an S1 from their French fund and handing it to the local body, or being reimbursed by the French fund (form S3125).
• Lasting settlement: registration of the right of residence, then entry in the population register at the Statens ämbetsverk på Åland.
• Taxation: the France-Finland treaty of 4 April 2023, in force since 28 August 2026, applies from 1 January 2027 according to the Finnish tax administration, replacing that of 11 September 1970.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds).
2. Seconded employee: request form A1 from your French fund before departure.
3. Retiree: request form S1 from your pension fund before departure.
4. Before departure: request the EHIC from your health insurance fund to cover the transition period.
5. Within three months of arrival, for a stay of more than three months: apply for registration of the EU citizen's right of residence.
6. Go in person to the Statens ämbetsverk på Åland (Mariehamn), appointment by telephone, to enter the population register.
7. Find out from Kela and the ÅHS about access to care and the benefits that apply in the archipelago depending on your status.
8. To buy land or set up a business: find out from the Government of Åland about the acquisition permit (jordförvärvstillstånd) and the näringsrätt.
9. Register on the roll of French nationals living abroad (French embassy in Helsinki); an honorary consul sees people by appointment in Maarianhamina (Mariehamn).