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

CLEISS publishes the list of countries linked to France by a bilateral social security agreement: Niue is not on it, nor is New Zealand. There is therefore no coordination of schemes, no S1 form, no EHIC and no cross-border cover (see the bilateral agreement). The Health sheet of France Diplomatie (the French foreign ministry) 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.

On the local side, the Department of Health states that non-residents are invoiced and pay at the end of the service. The notions of reimbursement basis and out-of-pocket cost help to compare offers. How the system is organised is described on the page healthcare system in Niue.

The employee on a local contract falls under the host country’s social security scheme and is no longer insured under French social security; they hand back their carte Vitale, no longer receive French family benefits and do not have their local periods of activity taken into account for the rate of their French pension (CLEISS). They may contribute voluntarily to the CFE for sickness, maternity and disability. No compulsory health insurance contribution for a foreigner was found in the local sources read: access to care for a resident holding a work permit should be confirmed in writing with the Department of Health.

The seconded employee remains affiliated to the French scheme, with contributions paid in France as if they were working there, for 3 years renewable once; they are covered within the limit of the benefits they would have received in France and send their paid invoices with form S 3125c. Any local contributions remain due, their dependants who accompany them fall under the same procedure and those who stayed in France continue to deal with the fund. If care is expensive, top-up health insurance can be taken out (CLEISS; see seconded employee).

The self-employed worker benefits from no coordination: they choose between the CFE, whose voluntary insurance for a self-employed worker covers only sickness and maternity (CLEISS), a private contract and international insurance.

The retiree receives no certificate before departure. CLEISS indicates that it is up to them to check with the host country’s institutions to what extent the local scheme covers their care, and that they may join the CFE voluntarily or take out private insurance. Retirees of the general scheme outside the European Union, the European Economic Area and Switzerland fall under the CNAREFE, the CPAM of Seine-et-Marne, for their affiliation and payments. See the guide retiree health insurance abroad.

The student under 20 or on a stay of less than six months may have urgent care reimbursed by their parents’ fund on the basis of French flat-rate tariffs, if they attend an establishment preparing for an official qualification and return to France at least once in the academic year; beyond 20 years or six months, they must in principle join the host country’s student scheme, or failing that the local scheme, and Assurance Maladie (French health insurance) suggests a private contract or the CFE (ameli). See student insurance abroad.

The spouse follows the status of the holder: secondment, local contract or CFE membership. The immigration law makes it possible to include the spouse and children in the permit application, and the health and police documents requested also apply to them. See expat family insurance.

The CFE offers plans suited to age and profile, notably for young expatriates, expatriates who live and work abroad and retired expatriates, with a price on quotation depending on country, age and family situation. Membership conditions, deadlines and any waiting periods should be checked on cfe.fr before departure. Members send their reimbursement claims for care received in France to the Seine-et-Marne primary fund (CLEISS). In Niue, the member advances the charges invoiced to non-residents, then is reimbursed according to the terms of their contract.

First-euro insurance from an international insurer reimburses actual costs within the contract ceilings: compare it on the coverage zone, the ceilings, medical history and above all evacuation to New Zealand, as specialist care is carried out off the island. See the page health insurance in Niue.

Outside Europe, for a temporary stay, only urgent and unforeseen medical care may possibly be covered by French health insurance on return. The visitor pays on site and keeps prescriptions, paid invoices and proof of payment; they request reimbursement from their ameli account or with form S3125. A medical adviser judges whether it was an emergency: if approved, reimbursement is made at French flat-rate tariffs, not actual costs, and if refused, no appeal is possible. No daily allowance is paid for a stay outside Europe.

On site, the visitor is a non-resident: charges are invoiced and payment is requested at the end of the service, which the Department of Health asks people not to take amiss. Evacuation and specialist care take place in New Zealand; Niue Tourism strongly recommends insurance that includes medical evacuation, which France Diplomatie, for New Zealand, also asks for in the form of insurance covering medical repatriation.

According to service-public.gouv.fr, for a return from a country outside the European Union, a former CFE member may, under conditions, receive the benefits of the expatriate scheme for the 3 months following their return. An employee who immediately finds a job is affiliated from the first hour worked (form S1106 given to the primary fund); without immediate employment, they must reside in France for 3 consecutive months before rights open, and universal health protection remains open to anyone with no cover. See the page return to France.

Consultation. The general outpatient consultation at the Niue Foou hospital is invoiced to non-residents; the fee schedule was not read on the official sources, and the amount should be requested from the Department of Health (+683 4100). Hospital stay. The same rule applies to hospital care and the hospital’s operating theatre; a major hospital stay means, for tertiary and specialist care, a transfer to New Zealand (Health New Zealand), to be covered by the insurance contract.

Medication. The Department of Health asks visitors to bring all of their treatment for the duration of the stay; no public medication tariff was read. Dental. A dental service appears in the Department of Health’s budget, but no tariff was read; dental care is covered by contract (CFE or private insurance), as the French scheme only examines the urgent and unforeseen abroad. Optical. No public optical tariff was read on the official sources: the item is covered by contract and should be planned for before departure. Maternity. No tariff or cover rule for a foreign woman giving birth was read: pregnancy follow-up and delivery should be prepared with the Department of Health and the insurer before departure, surgery and specialist care being, as a rule, carried out in New Zealand.