Expat insurance and health insurance in the British Virgin Islands

The territory's health system combines a contributory public health insurance scheme, the National Health Insurance (NHI), and a single public care provider, the BVI Health Services Authority (BVIHSA). The Ministry of Health and Social Development develops health and social protection policy, carries out public health functions (surveillance, disease control) and prepares the territory for disasters. Several statutory bodies are attached to it: the BVIHSA, which runs public care, the registration councils for doctors and dentists, nurses and midwives and paramedical professions, and the Social Security Board, which administers retirement, disability, sickness, maternity and survivor pensions.

The NHI is open to all legal residents and their dependants. According to its frequently asked questions, cover begins at birth and lasts for life as long as contributions are up to date; tourists and short-stay visitors are not eligible and pay for their care or rely on private insurance. Private insurance may be used to complement the NHI, in its place or for the services it does not cover. The catalogue of benefits (Benefit Package) and the list of non-prescription medicines are published by the office; their detailed content was not read on the pages consulted.

Care is provided by the BVIHSA, which operates the Dr. D. Orlando Smith Hospital in Road Town (Tortola), a 120-bed hospital that succeeded Peebles Hospital, and a network of community clinics in Tortola, Virgin Gorda, Jost Van Dyke and Anegada. The BVIHSA specifies that emergency services are open 24 hours a day at the Tortola hospital and at the Iris O'Neal Health Center in Virgin Gorda. The World Bank does not publish the share of health expenditure in GDP for this territory: this figure is therefore not given here. For medical evacuations abroad, no NHI cover for air ambulance transport was read on the pages consulted; an assistance contract with evacuation remains to be considered (see repatriation assistance).

• Tourist stay: all travellers entering or leaving by air or sea complete the entry and departure card (ED Card) online, compulsory since January 2025, free of charge, to be completed within the 72 hours before travel (the same page advises doing so at least 24 hours beforehand). The Department of Immigration requires a passport valid for the whole stay. The list of nationalities subject to a visa published by the territory's tourist board does not name France; it does not expressly say that other nationalities are exempt, and confirmation should be requested from the Department of Immigration before departure. The authorised length of stay was not read in the sources consulted.
• Work: the Department of Immigration offers an “entry into the territory for work” service, and the Department of Labour processes work permit applications and renewals through its Labour Management System. The entry permission form (Immigration Entry Permit Form) must be attached to any renewal application. The permit fee schedule could not be read on the pages consulted.
• Resident health insurance: anyone residing in the territory must register with the NHI within the month following their arrival, according to the office; the employer ensures the registration of its employees. The office states that failing to register or to declare a change of circumstances is an offence punishable by a fine of up to $1,000, plus $100 a day, and that failing to register delays the start of cover. The documents requested include the passport, the work permit or proof of immigration status.
• Student: the European Health Insurance Card does not exist for this territory, which is outside the European Union; a student insurance or the CFE youth offer should be compared, and the position regarding the NHI should be confirmed with the office.
• Seconded employee : stays on the French scheme, according to CLEISS, for three years renewable once, with reimbursement up to what the French scheme provides on paid invoices (form S 3125c). Membership of the Caisse des Français de l'Étranger (CFE) remains an optional top-up.
• Retiree: CLEISS points to local institutions, voluntary membership of the CFE or private insurance; no S1 form exists, as this territory is not in the European Union.
• Long-term residence: resident status requires ten consecutive years of stay in the territory, with limited absences, and Belonger status twenty years of stay for the long-term residence route, according to the government's pages.
• Hurricanes: the hurricane season runs from 1 June to 30 November; the Department of Disaster Management publishes the list of shelters and family plan templates, and recommends reviewing your insurance contracts.

No law requiring a resident to hold private insurance was read on the pages consulted: the obligation identified is registration with the NHI, funded by employer and employee contributions.

The territory is not in the European Union. CLEISS lists it neither among the States linked to France by a social security agreement nor among those covered by the European regulations: for a temporary stay, it falls under the category “other countries or situations not covered”. The CLEISS page on the United Kingdom scheme does not mention this territory either. Without an agreement, no cover is arranged between the funds.

• Temporary stay: CLEISS indicates that reimbursement on return to France of unforeseen care is a possibility and not an obligation, that medical repatriation is not covered by health insurance, and that it is prudent to take out travel insurance suited to the real cost of care.
• Secondment: the employee remains affiliated to the French scheme, three years renewable once; contributions are paid in France, but they may also have to pay those of the host country, here those of the NHI and the Social Security Board. Care is covered up to what they would have received in France (form S 3125c with paid invoices).
• Expatriation: the employee comes under the local scheme and leaves the French scheme; they can join the CFE voluntarily. Without an agreement, France does not take local periods into account when calculating the French pension.
• Retiree: CLEISS recommends checking local cover, choosing the CFE or private insurance, and points out that a retiree who is no longer tax resident in France pays neither CSG, nor CRDS, nor Casa.
• Taxation: the BOFiP list of tax treaties does not include the British Virgin Islands. The BOFiP list of tax information exchange agreements mentions an agreement signed on 17 June 2009, in force since 18 November 2010 and published by decree no. 2011-29 of 7 January 2011: it organises cooperation between administrations and does not allocate taxing rights. Tax residence remains defined by article 4 B of the French General Tax Code (home or main place of stay, professional activity, centre of economic interests); a single criterion is enough. The territory does not appear in the list of non-cooperative States and territories, revised regularly.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds) and choose your cover according to your status.
2. Check the entry rules with the Department of Immigration: valid passport, whether your nationality is subject to a visa, authorised length of stay.
3. Complete the ED Card online before each arrival and keep the confirmation email, to be shown at immigration.
4. Employee: have the employer start the procedures for entry permission for work and the work permit before beginning the activity.
5. Within the month of settling: register with the NHI (employee, self-employed, spouse or child forms) at the Road Town office, on 1 (284) 852-7860, and have dependants registered.
6. Seconded employee: request retention on the French scheme from your employer and your fund; keep paid invoices for form S 3125c.
7. Retiree: prepare health cover (NHI, CFE or private insurance) before departure and enquire about the right of residence with the Department of Immigration.
8. Register on the roll of French nationals living abroad via service-public, with the French embassy in Saint Lucia.
9. Hurricanes: consult the list of shelters and prepare a family plan and an emergency kit before 1 June.