Expat insurance and health insurance in the Cook Islands

The Cook Islands have no contributory health insurance scheme comparable to French Sécurité sociale: public care is organised and funded by the Ministry of Health, Te Marae Ora, which applies a fee schedule distinguishing two categories of users. Category I covers islanders, permanent and honorary residents, spouses of an islander or permanent resident after six consecutive months, and expatriate workers who have lived and paid tax for more than six months (their spouse and children then also come under category I). Category II covers all visitors, including tourists and consultants for less than six months, and anyone else who does not fall under category I. Category II users pay the full rate at the time of care and must show proof of health insurance.

Provision is concentrated in Rarotonga: the public hospital offers an emergency department open 24 hours a day with paramedics, two operating theatres, a three-bed intensive care unit, a maternity ward and an isolation unit; routine care goes through five neighbourhood clinics (Puna Clinics) and the Tupapa primary care centre. Cases that the country cannot treat are referred to New Zealand under a patient referral policy that excludes visitors from cover. France Diplomatie considers an assistance contract or insurance covering all medical costs, hospitalisation and medical repatriation essential, failing which access to care may be refused, even in a life-threatening emergency. See the page healthcare system in the Cook Islands.

• Stay of 31 days or less: no visa for a French national, with a passport still valid six months after the end of the stay, a return ticket or one to a third country and proof of accommodation. Beyond that, an extension is requested from the Minister of Foreign Affairs and Immigration in Rarotonga (France Diplomatie).
• Long-term stay: the long-stay visitor permit (470 New Zealand dollars, or about €238) requires health insurance for the whole duration of the permit; a visitor who is neither a New Zealander nor an Australian is limited to 8 months of stay (Ministry of Foreign Affairs and Immigration).
• Work: a work permit is necessary, for example the international worker permit at 320, 640 or 960 New Zealand dollars for one, two or three years, with a written job offer and a command of English.
• Travel insurance: an assistance contract or insurance covering all medical costs, hospitalisation and medical repatriation is essential according to France Diplomatie; the embassy does not cover these costs.
• Local affiliation: the immigration FAQ presents visitor health insurance as recommended and not compulsory, but the Ministry of Health's fee schedule asks category II users for proof of health insurance at registration; no compulsory health contribution was found in the sources read.
• Student: no EHIC, as the Cook Islands are not members of the European Union; student insurance abroad or the CFE should be compared before departure, Assurance Maladie (French health insurance) limiting cover to urgent and unforeseen short-stay care.
• Seconded employee: in the absence of an agreement, continuation of the French scheme on the basis of domestic law, for 3 years renewable once (CLEISS); the Caisse des Français de l'Étranger (CFE) and an assistance contract remain recommended in addition.
• Retiree: no S1 form; CLEISS invites retirees to check the cover of the local scheme, then to choose between the CFE and private insurance.
• Customs: certain products (meat, eggs, honey products, seeds, outdoor sports and fishing equipment) must be declared on arrival; fruit and vegetables are not admitted (France Diplomatie).

No individual fine for lacking insurance is mentioned in the sources consulted, but the requirement for proof of insurance in category II, the exclusion of visitors from the patient referral policy and the distance from New Zealand make the financial risk high for an uninsured expat.

The Cook Islands are a state in free association with New Zealand since 4 August 1965: a parliamentary monarchy whose head of state is Charles III, represented locally, with a government of its own; its inhabitants are New Zealand citizens and the country maintains diplomatic relations with some sixty states, including France (France Diplomatie). It is neither a French territory nor a New Zealand province: the rules on entry, work, health and tax are those of the Cook Islands government. For France, it is the embassy in Wellington that is responsible.

• Social security: the list of agreements in force published by CLEISS includes neither the Cook Islands nor New Zealand. There is therefore no coordination of schemes: no S1 form, no EHIC, no cross-border cover (see the bilateral agreement). Local insurance periods do not count towards the French pension.
• Local-contract employee: they are subject to the host country's scheme and are no longer socially insured in France; the carte Vitale is handed back (CLEISS). They can contribute voluntarily to the CFE for sickness, maternity and disability.
• Secondment: without an agreement, the employee remains affiliated to the French scheme for 3 years, renewable once, and their contributions are paid in France; they are covered up to French benefits, on paid invoices with form S 3125c, and any local contributions remain due (CLEISS).
• Retiree: no certificate; it is for the retiree to check local cover or to join the CFE or private insurance. A health insurance contribution of 3.2% (basic pension) and 4.2% (supplementary pension) continues to be withheld as long as they come under a French scheme; no CSG, CRDS or Casa if tax residence is no longer in France (CLEISS).

Taxation. The BOFiP list of tax treaties concluded by France includes New Zealand (treaty signed on 30 November 1979) but not the Cook Islands; the territorial scope of the New Zealand treaty is read in its article 3 on impots.gouv.fr before any reasoning by analogy. France and the Cook Islands concluded a tax information exchange agreement, signed by exchange of letters in Paris on 3 September 2010 and in Rarotonga on 15 December 2010, entered into force on 16 November 2011 (BOFiP list): it organises the transmission of information and does not replace a double taxation treaty.

1. Before departure: notify 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; plan for proof of insurance at registration in a healthcare facility.
3. Check your passport (valid six months after the end of the stay), your return ticket and your proof of accommodation; fill in the arrival card.
4. Stay of more than 31 days: apply for the extension or a suitable permit (long-stay visitor, work, study) from the Ministry of Foreign Affairs and Immigration, which processes applications online.
5. Applying to work from abroad: attach a medical report less than three months old drawn up by a doctor approved in New Zealand and form IMM8 (Te Marae Ora).
6. Seconded employee: request the secondment certificate from the competent social security body before departure; send the paid invoices with form S 3125c.
7. Long-term settlement: choose local insurance (employer, individual contract) or the CFE, before departure or within three months, and obtain a taxpayer number (form RM1 from the Revenue Management Division).
8. Taxation: have your situation validated with the French tax administration and the Revenue Management Division, as no double taxation treaty exists with the Cook Islands.
9. Retiree: contact CLEISS or your pension fund before departure, then compare the CFE (retirees' plan) and private insurance.
10. Register on the roll of French nationals living abroad with the French embassy in Wellington, on which the Cook Islands depend; an honorary consul can be reached in Rarotonga (France Diplomatie).