Social protection and health in New Caledonia

Organic Law no. 99-209 of 19 March 1999 on New Caledonia places, in its Article 22 (4°), social protection, public hygiene and health, and health control at the borders among the competences of New Caledonia (version in force since 17 November 2013 according to Légifrance). The DASS, the department of the New Caledonian government responsible for implementing health and social protection policy, states that the territory has its own social protection system, separate from the mainland French system.

According to the DASS, the compulsory schemes are entrusted to bodies with the status of mutual aid societies, which New Caledonia supervises. The CAFAT has managed since 1958 the basic cover of employees and similar workers (sickness, invalidity, maternity, old age, unemployment, family) and, since 2002, the compulsory health cover of civil servants and self-employed workers. The CAFAT presents the RUAMM (unified health and maternity insurance scheme) as the health insurance of New Caledonians, with medical-surgical benefits (hospitalisation, medical and dental care, pharmacy, tests), long-term illness, maternity, invalidity and death. Supplementary cover comes from mutual insurers and private insurance, and medical assistance is provided for people not covered by compulsory insurance and on low incomes (managed by the provinces for their residents).

Public hospital provision rests on three facilities, according to the DASS: the territorial hospital centre (CHT) Gaston-Bourret, the reference facility for medicine, surgery and obstetrics, the specialised hospital centre (CHS) Albert-Bousquet for mental health, and the Northern hospital centre (CHN) for the North province.

• Local affiliation: according to the CAFAT, people in salaried employment, civil servants, self-employed workers (with no residence condition as long as they carry out their activity in New Caledonia) and pupils and students fall under compulsory schemes. A self-employed worker in activity can be neither a dependant of an insured person nor a voluntary insured person of the health scheme.
• Employee: the employer sends a hiring declaration to the CAFAT, which assigns a social cover number. Reimbursement of medical costs is opened for 1, 3 or 6 months (or for a year under annualised entitlements) depending on a number of hours worked or a minimum salary justified at the date of care; no reimbursement is provided during the first month of activity, except for apprentices, vocational training trainees and civic service volunteers.
• Without employment, resident: the CAFAT states that voluntary health insurance is open to anyone aged at least 16 at admission who resides in New Caledonia and does not fall under a compulsory scheme. The contribution rate is 4.67% of the RUAMM contribution ceiling, payable quarterly.
• Mainland French entitlements: according to the CAFAT, a person who has worked in mainland France and does not take up work in New Caledonia does not keep their mainland French social security entitlements; they must affiliate to voluntary insurance, with no waiting period, with cover from the 1^st day of affiliation provided the required number of hours has been worked.
• Dependants: spouse, PACS partner, cohabiting partner (established cohabitation of at least 12 consecutive months, according to the CAFAT) and dependent children, provided they have no compulsory health-maternity cover in their own right.
• Student: health-maternity insurance for pupils and students studying in New Caledonia, aged under 28, comprises basic insurance (CAFAT) and a supplementary insurance to be taken out with a mutual insurer or an insurance company; the indicative basic contribution is of the order of CFP 49,000 for a study year.
• Entry into the territory: the State services in New Caledonia state that all entry is subject to a check carried out by the border police directorate, at the two official crossing points (La Tontouta international airport and the port of Nouméa), and that these rules differ from those of mainland France. The pages consulted do not detail the formalities applicable to a French national: to be confirmed with the State services before departure.
• Seconded employee by their employer for an assignment: the CAFAT refers to forms SE 988-07 and SE 988-01, issued by mainland French social security. The conditions and duration of continued cover are not specified on the page consulted: to be confirmed before departure.

No individual fine is mentioned in the sources consulted for lacking cover. The risk is mainly financial: the CAFAT sources indicate that some care is not reimbursed (other than hospitalisation abroad, for example) and that the scheme applies co-payments (tickets modérateurs). For French citizens living outside France, the Caisse des Français de l'Étranger (CFE) offers generic plans (main offer, youth offer, retiree offer); as their accessibility for residence in New Caledonia has not been established by an official source read, it is to be checked with the CFE.

This is not a social security agreement between two States: the framework is institutional. Social protection falls under New Caledonia by virtue of Article 22 of Organic Law no. 99-209 of 19 March 1999, and coordination with mainland France goes through a NC-mainland agreement presented on the CAFAT website, with forms from mainland French social security (SE 988 series). The text of this agreement does not appear in the pages consulted; the CAFAT specifies its exact conditions.

• Arrival from mainland France, employee who has worked in mainland France: copy of the last six payslips and form SE 988-02, issued by social security.
• Secondment for a professional assignment: form SE 988-07 accompanied by SE 988-01.
• Temporary stay of an insured person or dependant of mainland French social security (including a student on holiday or on an unpaid placement): form SE 988-03; return, transfer of residence or appropriate care with the fund's agreement: SE 988-04; dependant alone in New Caledonia, with the insured person residing in mainland France or an overseas department: SE 988-05.
• Retiree receiving a pension from the mainland French scheme: form SE 988-06, issued by the pension fund; State retirees transferring their residence report the change to their fund before leaving mainland France, their pension then being paid by the Nouméa Treasury (Trésorerie générale), which also issues the SE 988-06.
• For an insured person of mainland French social security settled in New Caledonia, the CAFAT specifies that the long-term condition (ALD) system does not apply: a request for long-term illness cover is made by a doctor on site to the CAFAT medical control.
• Reverse direction (leaving New Caledonia for mainland France): the CAFAT offers a coordination agreement (reimbursement by social security of costs incurred, during a temporary stay or permanent move) and the issue of a social security number, to be requested before departure as only the CAFAT can issue it; the number is assigned within four weeks of filing the application according to the CAFAT.

1. Before departure: report your change of residence to your primary health insurance fund, which provides the form suited to your situation (family settling permanently, secondment, retirement).
2. Employee who has worked in mainland France: obtain form SE 988-02 from social security and gather the last six payslips; seconded: SE 988-07 and SE 988-01.
3. On arrival: file the application at the CAFAT one-stop desk (4 rue du Général Mangin, Nouméa) with the form and an identity document, or send it by post (CAFAT, BP L5, 98849 Nouméa Cedex).
4. Without employment on site: apply for admission to CAFAT voluntary health insurance (admission request form), with the supporting documents it lists.
5. Family: send the CAFAT the beneficiary registration file with supporting documents (maladie@cafat.nc); entitlements take effect on the date the complete file is received.
6. Retiree of the mainland French scheme: request form SE 988-06 from your pension fund before departure.
7. Student: take out CAFAT basic insurance before the 28^th birthday and compulsory supplementary insurance with a mutual insurer or an insurance company.
8. Plan supplementary insurance (mutual insurer or private insurance) for the non-reimbursed share, and travel insurance for trips abroad, as the CAFAT does not cover care without hospitalisation abroad. An assistance policy can also be considered in addition to the medical evacuation organised by the CAFAT.
9. If returning to mainland France: request the social security number from the CAFAT before departure, then contact the primary fund of your place of residence to open entitlements.