Healthcare Reimbursement in Martinique: Who Reimburses What Depending on Your Situation

Title V of Book VII of the Social Security Code makes general legislation applicable to Martinique (Article L. 751-1) and Article L. 752-1 provides there for a general social security fund and a family allowance fund. CLEISS specifies that, in the overseas departments, benefits are paid by the CGSS and not by the CPAM. No international coordination formality is therefore needed for a stay within French territory alone.

Reimbursement rests on three tiers: the compulsory scheme reimburses on the basis of its rates; the co-payment (ticket modérateur), the daily hospital charge and extra-billing fall to supplementary health cover; the Complémentaire Santé Solidaire, free or paid depending on income, covers modest incomes. The out-of-pocket cost therefore depends as much on the supplementary cover as on the compulsory scheme. How the care offering is organised is described in the guide healthcare system in Martinique.

The employee does not have to show a minimum period of activity: carrying out a professional activity is enough to open their rights (Assurance Maladie). This rule applies to an employee recruited locally as to an employee from mainland France, since there is no social security agreement between two States to invoke: the concept of secondment abroad has no meaning for a move within French territory. In case of sick leave, sickness daily allowances represent 50% of the basic daily wage, capped at a daily amount revised each year (CLEISS).

The transferred civil servant continues their career in their administration. The sources consulted do not specify who manages their health insurance for a post in Martinique: this should be confirmed with their managing department and the CGSS before arrival, along with the formalities for transferring the file. The pay rules (supplement, bonified leave) are in the guide working in Martinique.

The self-employed person is covered from the start of their activity (Assurance Maladie). Contribution terms should be confirmed with the CGSS, which houses the Urssaf (the social security contributions collection body) for the self-employed; reimbursement follows the general scheme rates.

The retiree and the person with no occupation are covered on the basis of their stable and lawful residence in France. In case of inspection, the Assurance Maladie asks for proof of 6 months of residence in France over the last 12 months, with 30 days to reply, failing which rights may be closed; CLEISS for its part mentions residence of at least 3 months. When the opening of rights is not automatic, Cerfa form S1106 is submitted to the fund of the place of residence. A subsidiary health contribution of 6.5% may apply subject to income conditions (activity income threshold revised each year, according to CLEISS). Insured people on the minimum old-age benefit (ASPA) benefit from higher rates: 80% for a general practitioner consultation, dental, optical and tests, and 100% for transport (Assurance Maladie). The guide retiring in Martinique details the pension and procedures.

The student generally keeps their compulsory scheme, often their parents’, then becomes an independent insured person at 18; they can ask to be one from age 16 (service-public.gouv.fr). They can supplement their cover with a student mutual insurer, with their parents’ mutual insurer or with the C2S if they have low resources. Student insurance for abroad does not apply to Martinique.

The spouse with no occupation is covered on the basis of their residence. Minor children are dependants; this status ends at the latest on 30 September of the year the child turns 18, and minors over 16 can ask to be insured in their own right. An adult dependant can request affiliation on a residence criterion with form S1110 (Assurance Maladie, CLEISS).

The mainland resident on a short stay remains affiliated to their home fund: Martinique comes under the same social security legislation. The sources consulted do not describe the practical arrangements for passing through (use of the Vitale card, third-party payment): it is prudent to ask your fund before departure.

Medical evacuation: when care is not available on the island, the Assurance Maladie covers transport subject to prior approval equivalent to a medical prescription, reimburses medical costs in part or in full if the exemption conditions are met and can cover a companion’s travel costs under conditions. The sources do not detail coverage of accommodation.

Returning to mainland France means informing the CGSS and requesting the opening of rights with the fund of the new place of residence. CLEISS specifies that opening is not automatic on arrival or change of situation and that Cerfa form S1106 must then be filled in. See also the guide return to France.

The Caisse des Français de l’Étranger is for French people living and working abroad; it offers a main offer, a youth offer and a retiree offer. As long as a French citizen lives in Martinique, they come under the general scheme: membership only becomes useful if they leave France. The simulator on the CFE website lists Martinique among its places of residence, but the page consulted does not specify the conditions: for a specific project, the CFE confirms eligibility. The CFE guide details the scales and waiting periods.

The Complémentaire Santé Solidaire reimburses expenses in full within the limit of social security tariffs, removes extra-billing, the daily hospital charge, the medical deductible and the flat-rate contribution, and opens third-party payment (service-public.gouv.fr). For the overseas departments, the annual income ceiling for a single person, revised each year, distinguishes free C2S from C2S with a contribution. First-euro private insurance is not needed for basic reimbursement; it can fund extra-billing and assistance cover beyond the compulsory scheme.

• Consultation: 70% for a general practitioner (€30 base); a €2 flat-rate contribution is withheld from the reimbursed share. The rate for specialists varies by discipline and sector of practice.
• Hospitalisation: 80% (65% for a transfer between facilities); daily hospital charge of €23; emergency patient charge, reduced for some insured people, at an amount revised regularly (CLEISS).
• Medicines: 65% for major or important medical benefit, 30% for moderate benefit, 15% for low benefit, 100% for irreplaceable and particularly expensive medicines; €1 medical deductible per box (not reimbursed by supplementary cover).
• Dental and optical: 60% for a dental surgeon consultation and for optical; C2S beneficiaries benefit from packages for dental prostheses, glasses and hearing aids.
• Biology tests: 60% (70% in pathological anatomy and cytology).
• Transport: 55%; €4 deductible per medical transport (CLEISS).
• Maternity: the rates page consulted does not detail maternity; three facilities on the island have a maternity unit (ARS) and reimbursement follows national rules, to be confirmed with the CGSS.