Expat insurance and health insurance in the Cocos (Keeling) Islands

The Cocos (Keeling) Islands have neither a hospital nor a health system distinct from that of Australia: care is provided by the Indian Ocean Territories Health Service, an Australian health service that also runs Christmas Island. The Shire of Cocos (Keeling) Islands describes two health centres, one on Home Island and the other on West Island, with a general practitioner, nursing care, tests, an emergency service open day and night and visiting specialists or allied health professionals. Consultations are by appointment, and an on-call nurse answers outside opening hours.

For access to Medicare, the Australian Department of Health sets as a condition that you ordinarily live in Australia and are a citizen, permanent resident, New Zealander, applicant for permanent residence (under conditions) or holder of a temporary visa covered by a ministerial order; other visitors and temporary residents are not eligible and must take out private insurance. France Diplomatie describes Australian hospital infrastructure as excellent, deems essential an assistance contract or insurance covering all medical costs and medical repatriation, and specifies that the embassy bears none of them. See the page healthcare system in the Cocos (Keeling) Islands.

• Stay of 3 months at most: eVisitor electronic authorisation, applied for online for each family member, children included, with the passport declared in the application. It covers tourism, business and family visits (France Diplomatie). The France Diplomatie page does not mention the Cocos Islands: confirm the applicable procedure with Home Affairs before booking.
• Tourist stay of more than 3 months: visitor visa (subclass 600) according to France Diplomatie. To work or study, a visa suited to the project is needed; its catalogue can be consulted on the Home Affairs website.
• Health insurance: France Diplomatie deems essential an assistance contract or insurance covering all medical costs and medical repatriation, and warns that without cover access to care may be refused, even in a life-threatening emergency. Depending on the type of visa, an adequate health insurance condition may apply: it is checked on the visa notification.
• Local membership: Medicare is reserved for citizens, permanent residents and a few temporary visa holders; CLEISS expressly lists citizens and permanent residents of the Cocos Islands, Christmas, Norfolk and Lord Howe among the people covered.
• Student: no EHIC outside the European Union. Assurance Maladie (French health insurance) reimburses under conditions the urgent care of a student under 20 or on a stay of under six months in a country with no agreement; beyond that, they come under the country’s scheme. See student insurance abroad.
• Seconded employee : for a country with no agreement, CLEISS describes secondment of 3 years renewable once with the French scheme maintained; the CFE and an assistance contract remain recommended in addition.
• Retiree: French Assurance Maladie no longer covers care in a country with no agreement; the CFE or private insurance takes over (ameli).

No individual fine for lacking insurance is mentioned in the sources consulted. The risk is financial: on an island with no hospital, a medical evacuation to Perth is not covered by the embassy, and no official evacuation rate was read.

Institutional framework. The Cocos (Keeling) Islands are an external territory of Australia. They have been Australian since 1955 and, in 1984, the Cocos Malay community voted for integration with Australia (Shire of Cocos (Keeling) Islands). Since 1 July 1992, the Australian federal government has applied the laws of Western Australia there, and the Shire performs the functions of a Western Australian local authority. Social protection, visas and taxation come under the Australian framework.

No social security agreement. France Diplomatie indicates that there is no bilateral agreement between France and Australia in the field of social cover, and Australia appears neither in the list of countries linked to France by an agreement on the CLEISS website nor in the list of its texts (see the bilateral social security agreement).

• No form S1, no EHIC, no aggregation of insurance periods: CLEISS specifies that, for a country with no agreement, pension rights are examined separately by each country and that contributions paid locally do not automatically give entitlement to a pension payable in France.
• Expatriation: the employee working on site comes under the local scheme, returns their carte Vitale and informs their fund, the CAF and France Travail; voluntary French insurance (CFE for health) is possible in addition to local membership.
• Secondment: CLEISS describes, for countries with no agreement, a duration of 3 years renewable once with the French scheme maintained and reimbursement on paid invoices (form S 3125c).
• Retiree: health contribution possible on the pension as long as they remain attached to a French scheme; no CSG, CRDS or Casa if tax residence is no longer in France (CLEISS).

Tax treaty. The France-Australia convention, signed in Paris on 20 June 2006 and in force since 1 June 2009 (BOFiP, the French tax administration’s official guidance), defines in its article 3 the term “Australia” in the geographical sense: it excludes external territories, with the exception of six, including the territory of the Cocos (Keeling) Islands (text published in the Journal officiel, Légifrance). Article 17 reserves taxation of pensions and annuities paid to a resident to the state of residence, subject to article 18 for civil service pensions. The convention therefore applies to the Cocos Islands, which does not exempt you from checking your situation with the French tax administration and the Australian tax administration (ATO).

1. Before departure: notify the French agencies of your departure (health insurance fund, CAF, France Travail, pension funds); hand back your carte Vitale if you are expatriating.
2. For any stay, including a short one: take out an assistance contract or insurance covering all medical costs and medical repatriation, essential according to France Diplomatie.
3. Apply for the eVisitor online for each family member, or for a visa for a stay of more than 3 months, to work or to study; confirm the procedure applicable to the Cocos Islands with Home Affairs.
4. Organise the journey: the air link goes through Perth, with limited frequency (Shire); check the flight schedule before buying a ticket.
5. Seconded employee: the employer requests maintenance of membership from the health insurance fund; self-employed: enquire with Urssaf and the CFE.
6. Long-term settlement: check the right to Medicare with Services Australia once the residence status is known, and join the CFE before departure or within three months of settling if the profile allows (cfe.fr).
7. Taxation: have your tax residence situation validated with the French administration and the ATO, the tax treaty including the Cocos Islands in the definition of Australia.
8. Retiree: arrange the CFE (retiree plan) or private insurance, bearing in mind the 15-year contribution condition for care in France during temporary stays (ameli).
9. Register on the roll of French nationals living abroad and on Ariane; France Diplomatie does not specify, in the pages read, the competent consular post for the Cocos Islands: confirm with the embassy in Canberra.