Expat insurance and health insurance in the Pitcairn Islands

The health system of the Pitcairn Islands rests on a public health centre (Pitcairn Health Centre), funded and organised by the Government of the Pitcairn Islands. Its operational policy states that it provides general medicine, nursing, X-ray, pharmacy, urgent care and care from birth to old age, for residents and visitors alike. The FCDO describes a clinic with a general practitioner and a nurse, prescription medication in limited quantities, and a possible consultation outside opening hours by calling the island's doctor. The doctor is recruited under contract by the government; they can also arrange remote specialist consultations (telehealth) with the support of a medical assistance provider appointed by the government.

The island has neither a hospital nor specialist care. The health funding policy speaks of "off-island" treatment, in Tahiti or New Zealand, on the recommendation of the island's doctor and with the authorisation of the Administrator; referral to Tahiti is generally preferred. The FCDO states that the nearest hospitals are at least two days away by sea, that a seriously ill patient is evacuated by boat to Mangareva and then by plane to Tahiti, or by boat or plane to New Zealand, and that the speed of an evacuation depends on the supply ship or another passing boat.

No compulsory health insurance scheme was identified in the sources read. The government funds care for habitual residents (free consultations, medication at half price as a general rule, off-island care covered at two thirds with travel and accommodation), but the visitor, the long-stay visa holder and the new arrival in the settlement period pay for their own care, evacuation included. The World Bank publishes no health indicator for this territory: no spending statistic is therefore given here. For evacuation and assistance, see repatriation assistance.

• Stay of 14 days or less: no prior visa if you arrive and leave on the same ship (FCDO). The short-stay visitor visa is issued on arrival using the combined immigration and biosecurity declaration form; every traveller fills in a landing card. If any of the answers on criminal record, immigration history or health is "yes", the government asks to be contacted before the journey, as a waiver may be necessary.
• Stay of more than 14 days: the long-stay visitor visa (six months, extendable) is requested before the journey, with the official form, a medical examination with a general health certificate and a chest X-ray certificate, and police certificates from the country of nationality and from any country where one has lived for more than 12 months. For a child aged 15 or under, each child is the subject of an application for permission to enter, before the journey is booked. The decision lies with the Governor, after consulting the Island Council; the amount of fees is set by a government notice.
• Compulsory insurance: every visa holder must maintain travel and health insurance valid for the whole stay, covering medical care, emergency medical evacuation and repatriation of remains, with no exclusions unreasonably limiting the planned activities, issued by a reputable insurer (immigration policy). Proof is requested from the moment a berth is booked on the ship.
• Work: a visitor has no right to work without a work permit. The temporary work visa (six months, extendable) requires an activity of public interest, the required skills and a decision by the Governor after consulting the Island Council; paid or commercial activity requires the written agreement of the Council, except for holders of a settlement visa or permanent residents.
• Residence: the settlement visa (two years) follows two routes, family (spouse, child, parent or sibling lawfully resident on the island) or skills useful to the community; it requires in principle three months of lawful residence in the 12 months preceding the application. Permanent residence is possible after more than two years of lawful residence. The seasonal resident visa allows up to six months to be spent in each 12-month period, without the benefits of a permanent resident.
• Health and character: the applicant must show good health (no danger to public health, no significant burden on the island's health services), good character, and sufficient means or a guarantor.
• Student: the European health insurance card does not exist for this territory, which is outside the European Union; compare student insurance or the CFE youth plan.
• Seconded employee : continuation of the French scheme, according to CLEISS, for three years renewable once, with reimbursement within the limit of what the French scheme provides on paid invoices (form S 3125c). Membership of the Caisse des Français de l'Étranger (CFE) remains a top-up option.
• Retiree: CLEISS points to local institutions, voluntary CFE membership or private insurance; there is no S1 form, as the territory is not in the European Union.
• Imports: importing alcohol without a licence, honey or used beekeeping products is illegal, and plant and animal products are strictly controlled (FCDO).

The government publishes its immigration policy and forms on its official website; the conditions of each visa category are read in that policy, which the Governor may adapt by individual waiver.

The territory is British and is not in the European Union. CLEISS lists it neither in the list of social security agreements in force with France, nor in its list of foreign schemes; the page on the British scheme does not mention it either. For a temporary stay, it falls under the category "other countries or situations not covered": on site, CLEISS indicates that no cover is possible unless an agreement applies. Without an agreement, no cover is arranged between the funds.

• Temporary stay: reimbursement on return to France of unforeseen care only is a possibility and not an obligation, medical repatriation is not covered, and travel insurance suited to the real cost of care is advised by CLEISS.
• Secondment: the employee remains affiliated to the French scheme, three years renewable once; their contributions are paid in France, but they may also have to pay those of the host country. Care is covered within the limit of what they would have received in France (form S 3125c with paid invoices).
• Expatriation: the employee falls under the local scheme and is no longer insured under French social security; they may join the CFE voluntarily. Without an agreement, local insurance periods are not taken into account for the calculation of the French pension.
• Retiree: CLEISS recommends checking local cover, choosing the CFE or private insurance, and recalls that a retiree who is no longer a tax resident in France pays neither CSG, nor CRDS, nor Casa.
• Taxation: the BOFiP list of tax treaties concluded by France does not include Pitcairn, and the entry on the United Kingdom mentions no extension to a territory. The list of tax information exchange agreements names several British territories but not Pitcairn. Tax domicile remains defined by article 4 B of the CGI (French general tax code) (home or main place of stay, professional activity, centre of economic interests); a single criterion is enough. The list of ordinances published by the Pitcairn government includes no income tax ordinance: the local tax regime should be confirmed with the Pitcairn Island Office in Auckland.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds) and choose your cover according to your status.
2. Stay of more than 14 days: write to the immigration service of the Government of the Pitcairn Islands before any travel plan, then submit the visa form with a medical certificate, a chest X-ray certificate and police certificates. Allow plenty of time for these documents.
3. Take out travel and health insurance valid for the whole length of the stay, with medical care, emergency medical evacuation and repatriation of remains, and keep proof of it: it is requested at booking.
4. Book a berth on the supply ship from Mangareva; the official tourism website publishes the crossing schedule, the proposed length of stay and the conditions of the transport contract.
5. Enquire about medication before booking: the FCDO states that the clinic has only a limited stock, and the government's policy invites long-stay arrivals to bring their treatments or to contact the doctor in advance.
6. Seconded employee: request continuation of the French scheme from the employer and the fund; keep paid invoices for form S 3125c.
7. Retiree: arrange health cover (CFE or private insurance) before departure and ask the government about the intended residence route.
8. Register on the roll of French nationals living abroad on service-public, for a stay of more than six months; the consular post of registration should be confirmed with France Diplomatie.