Healthcare Reimbursement in the Cocos (Keeling) Islands: Who Pays What Depending on Your Situation

France Diplomatie is explicit: there is no bilateral agreement between France and Australia in the field of social cover. The list of countries linked to France by an agreement on the CLEISS website does not include Australia (see the bilateral agreement). The Cocos (Keeling) Islands, an external territory of Australia, come under the same framework: no form S1, no European card, no cross-cover. The embassy bears no medical costs, and without cover access to care may be refused, even in a life-threatening emergency.

Several parties are therefore involved depending on status: the Australian scheme (Medicare) for those eligible, the maintained French scheme for a seconded employee, the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help you compare plans. The conditions for access to Medicare are detailed in the page healthcare system in the Cocos (Keeling) Islands.

A local-contract employee leaves the French scheme: CLEISS indicates that they are subject to the social security scheme of the country of work, are no longer covered by French social security and return their carte Vitale. Their care goes through Medicare if they are eligible (citizen, permanent resident or holder of a visa covered by a ministerial order), otherwise through the insurance offered by their employer or a private contract. The employee notifies their health insurance fund, their CAF and France Travail of their departure. See the glossary entry on the local contract.

A seconded employee sent by a French employer can remain a member of the French scheme: for a country with no agreement, CLEISS describes a duration of 3 years, renewable once. They send their fund the paid invoices with the “care received abroad” form (S 3125c). The sick-leave notice must reach the fund within 48 hours, with a copy to the employer, and a work accident is declared to the employer within 24 hours. Family members accompanying the employee do not receive French family benefits, and those who stay in France continue to deal with the fund of membership. Maintaining the French scheme does not exempt them from local contributions if the country requires them. See seconded or expatriate and the seconded employee glossary.

A self-employed person or digital nomad has no employer to enrol them in a local scheme. They choose between the CFE, international insurance and a private contract; cover for hospital, outpatient care, evacuation and medical repatriation suits a stay of several years. See digital nomad 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. Reimbursement is limited to French flat-rate tariffs. Beyond age 20 or six months, they must join the host country’s scheme, whose cover differs from French cover, and Assurance Maladie recommends an assistance or insurance contract, the CFE being a private option for French nationals. See student insurance abroad.

Spouse and children follow the holder’s status, but CLEISS reminds us that the non-working spouse of an expatriate can apply for voluntary insurance if they meet prior membership duration conditions, with an application within six months of the end of compulsory insurance. For a seconded employee, the situation of accompanying dependants should be confirmed with the fund of membership. See expat family insurance.

For a retiree living in a country with no agreement, Assurance Maladie specifies that their healthcare costs are no longer covered by the French scheme. Two routes are offered: voluntary CFE membership, open to French nationals, or private insurance. The CFE retirees’ plan is for people who receive a pension from the French basic scheme and have no professional activity; it has no health questionnaire and covers care received abroad. A health insurance contribution may be withheld from pensions as long as the retiree remains attached to a French scheme, and they pay neither CSG, nor CRDS, nor Casa if their tax residence is no longer in France (CLEISS). See the guide retiree health insurance abroad and the page retirement in the Cocos (Keeling) Islands.

During a temporary stay in France, a pensioner of the general scheme registers with the Cnarefe and must show at least 15 years of contributions to French compulsory schemes; without a pension from the general scheme or with fewer than 15 years, they apply to the body that pays their pension or take out private insurance. An accompanying spouse is not covered and joins the CFE or takes out private insurance (ameli).

The CFE is a voluntary social protection body, which offers plans according to age and profile: youth, main and retirees; the price is given on quotation. 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. For the retirees’ plan, cfe.fr indicates immediate cover if membership takes place before departure or within three months of settling, and a waiting period afterwards; the other plans have their own conditions, to be read on the CFE website. The guide CFE reimbursement details this mechanism.

An international health insurance at the first euro in principle reimburses actual costs, within the contract ceilings. For an island with no hospital, the contract must above all include medical evacuation to Perth and repatriation, cover that France Diplomatie deems essential. See expat health insurance and CFE or private insurance.

A tourist has no EHIC outside the European Union. Assurance Maladie indicates that only urgent and unforeseen medical care can possibly be reimbursed on their return: they pay on site, keep prescriptions, paid invoices and proof of payment, and reimbursement, if the medical service grants it, is based on French flat-rate tariffs. In the event of refusal, no appeal is possible, and daily allowances are not paid. Assurance Maladie recommends an assistance or insurance contract that guarantees reimbursement of medical costs and medical repatriation. See long-stay travel insurance.

Return to France: service-public.gouv.fr indicates that membership is acquired from the first hour worked for a person who resumes an activity; otherwise, you must wait for 3 consecutive months of residence. A former CFE member may keep their benefits for the 3 months following their return, under conditions. For a retiree who is a member of the retirees’ plan, cfe.fr indicates that there is no waiting period on return and that they rejoin the general scheme; the fund of the place of residence (36 46) confirms the rights. See insurance for returning to France.

• Consultation: on the island, the health centre sees patients by appointment; consultations covered by Medicare are free of charge for Australian citizens and permanent residents (Department of Infrastructure). A patient without a Medicare card asks about billing arrangements before consulting and keeps their invoice for their insurance.
• Hospitalisation: there is no hospital on the island, serious cases are evacuated to Perth. A patient eligible for Medicare is treated free of charge as a public patient; others rely on private or international insurance, which must include evacuation.
• Medicines: the subsidised medicines scheme is for Medicare holders; without a card, the medicine is paid for at its price, then declared to the insurer (see Australian healthcare system).
• Dental and optical: a dentist, a dental therapist and an optometrist travel to the island according to the Shire; this care is not among the routine Medicare care described in the Australian healthcare system page. The insurance contract notice specifies ceilings and waiting periods for these items.
• Maternity: no maternity unit is described on the island in the sources read, which mention no hospital there. An insurance contract or the CFE generally imposes conditions on length of membership for cover; to be checked before conception.