Expat insurance and health insurance in Niue

The official sources consulted do not describe, in Niue, a contribution-based health insurance scheme open to foreigners and comparable to French Sécurité sociale: care is organised by the Department of Health, whose budget, published by Niue's Ministry of Finance, distinguishes administration, the medical service, nursing, public health and dental care. New Zealand's Ministry of Foreign Affairs states that New Zealand provides budgetary and sector support for the island's health, education and tourism.

Services are concentrated in Alofi: the Niue Foou hospital offers a general outpatient consultation, an operating theatre and emergency services, and is, according to Health New Zealand, the central establishment for primary and secondary care. For tertiary and specialist care, patients are transferred to New Zealand, with emergency evacuation services and annual visits by New Zealand specialists; most of Niueans' planned surgery takes place in New Zealand. The Department of Health tells visitors that, for non-residents, charges are invoiced and requested at the end of the service, and recommends bringing all of one's medication for the duration of the stay. See the page healthcare system in Niue.

• Stay of 30 days or less: France is on the list of countries whose nationals do not need a visa and receive a visitor permit on arrival. The passport must be valid for at least three months from arrival, with no exception for visitors; a return or onward ticket is required, failing which entry is refused; accommodation must be booked for the whole length of the stay (camping and couchsurfing are not allowed) and sufficient means of subsistence may be requested (Niue Tourism).
• Stay of more than 30 days: a visa must be requested before departure. The immigration law provides for visitor, work, study and transit visas, granted at the discretion of the Chief Immigration Officer, and requires for temporary permits character references, a criminal record and a health certificate from the country of origin (Niue's Ministry of Finance, Immigration Act).
• Work: a work permit is necessary; the law provides for a sponsor accepted by immigration where the guidelines require one, the payment of a bond in New Zealand dollars before the permit is issued and penalties for an employer who employs a person without a permit.
• Travel insurance: Niue Tourism strongly recommends insurance that includes medical evacuation, and the Health sheet of France Diplomatie for New Zealand, whose embassy is responsible for Niue, asks for insurance covering medical costs, hospitalisation and medical repatriation, as the embassy cannot cover these costs.
• Local affiliation: no compulsory health insurance contribution for a foreigner was found in the sources read; the conditions applying to a resident should be confirmed with the Department of Health.
• Student: no EHIC, as Niue is not a member of the European Union; compare student insurance abroad or the CFE before departure, as Assurance Maladie (French health insurance) limits 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.
• Biosecurity and customs: all foodstuffs must be declared on arrival; garden produce, honey and eggs from free-range hens are prohibited (Niue Tourism).

No individual fine for lacking insurance is mentioned in the sources consulted, but the payment of care by non-residents, the reliance on New Zealand for specialist care and the remoteness of the island make the financial risk high for an uninsured expat.

Niue is a state in free association with New Zealand since 19 October 1974: a constitutional monarchy whose head of state is the New Zealand sovereign, a Westminster-style parliamentary democracy with its own government and Parliament. Its inhabitants are New Zealand citizens and there is no Niuean citizenship; New Zealand, which belongs to the same Realm, assists Niue with foreign affairs, defence and security when the Government of Niue asks it to (France Diplomatie; New Zealand's Ministry of Foreign Affairs). It is neither a French territory nor a New Zealand province: the rules on entry, work, health and tax are those of the Government of Niue. For France, it is the embassy in Wellington that is responsible.

• Social security: the list of agreements in force published by CLEISS includes neither Niue 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.
• Employee on a local contract: subject to the host country's scheme and no longer insured under French social security; the carte Vitale is handed back (CLEISS). They may 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 within the limit of French benefits, on paid invoices sent with form S 3125c, and any local contributions remain due (CLEISS).
• Retiree: no certificate; it is up to the retiree to check local cover or to join the CFE or private insurance. A health insurance contribution is withheld from the pension as long as they fall 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 Niue; as Niue has its own tax administration and its own laws (Income Tax Act, Niue Consumption Tax Act), the territorial scope of the New Zealand treaty should be read on impots.gouv.fr before reasoning by analogy. Employers in Niue withhold payroll tax at source, according to the Taxation Office. Without a treaty, the French pension of a non-resident is subject in France to the withholding tax of article 182 A of the CGI (French general tax code), and the taxpayer declares all their income of French source (BOFiP).

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 medical costs and medical repatriation, with air medical evacuation, strongly recommended by Niue Tourism.
3. Check your passport (valid for at least three months from arrival), your return or onward ticket and your accommodation booking for the whole stay; fill in the arrival declaration requested by the Government of Niue.
4. Stay of more than 30 days, work or study: request the appropriate visa before departure from Niue immigration (Immigration.Niue@gov.nu), allowing for references, a criminal record extract and a health certificate.
5. Bring your prescription and the quantity of medication needed for the whole stay, as the Department of Health asks visitors to come with their treatment.
6. Seconded employee: request the secondment certificate from the competent social security body before departure; send paid invoices with form S 3125c.
7. Long-term settlement: choose any local insurance, employer insurance or the CFE, and obtain a tax identification number from Niue's Taxation Office.
8. Taxation: have your situation validated with the French tax administration and Niue's Taxation Office, as no double taxation treaty specific to Niue appears in the BOFiP list.
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, responsible for Niue (France Diplomatie).