Healthcare Reimbursement in the Pitcairn Islands: Who Reimburses What Depending on Your Situation

CLEISS does not list Pitcairn in the list of social security agreements in force with France or in its list of foreign schemes, and its page on the British scheme does not mention the territory either. For a temporary stay, it falls under “other countries or situations not covered”: on site, no cover is possible, unless an agreement applies. There is therefore no European card, no totalisation of periods and no cross-border cover. On the local side, no compulsory health insurance scheme was identified: the government applies a health care funding policy that benefits habitual residents. Four players come into play depending on status: the French scheme maintained (secondment), the CFE, international health insurance and, for residents, the funding of the Government of the Pitcairn Islands.

The notions of reimbursement basis and out-of-pocket cost help to compare offers. How care is organised is presented in the guide healthcare system in the Pitcairn Islands.

The employee on a local contract falls under the local scheme and is no longer insured under French social security, CLEISS recalls. No public healthcare reimbursement scheme is open to them during their settlement period: they pay full price at the clinic and, if referred off the island, 100% of the costs, travel included. The government’s health policy requires them to keep private insurance covering off-island care and medical evacuation throughout the two-year settlement period. Staff under contract with the British government are, for their part, covered at the clinic by their individual employment contract: health cover is therefore negotiated before signing. See the glossary entry on the local contract.

The seconded employee remains affiliated to the French scheme during the assignment, for three years renewable once according to CLEISS. Their contributions are paid in France, but they may also have to pay those of the host country. They are covered within the limit of what they would have received in France: they send their paid invoices to their fund with form S 3125c, and top-up health insurance is advised if care is expensive. The local requirement for insurance with evacuation applies in parallel, the French scheme not covering what the French scale does not provide. See seconded or expatriate and the seconded employee glossary.

The self-employed worker has no particular access to a local reimbursement scheme. CLEISS indicates that a self-employed expatriate can join the CFE voluntarily for sickness and maternity. International insurance completes the arrangement for medical evacuation. See digital nomad insurance.

The student has no European card. Before age 30, the CFE offers a youth plan; student insurance with evacuation remains the usual option, as insurance is required for any visa. See student insurance abroad.

The spouse and children: the health care funding policy exempts resident minors who attend school on the island or in New Zealand, or who are home-schooled, from charges, but this rule targets habitual residents; the texts read do not specify the situation of a new arrival’s child. For a child aged 15 or under staying more than 14 days, an application for permission to enter is filed before booking. Both the CFE and international insurers offer family contracts. See expat family insurance.

The retiree is not covered by the S1 form, valid in Europe. CLEISS indicates that it is up to them to check with local institutions to what extent the local scheme covers their care, and that they may join the CFE voluntarily or take out private insurance. The CFE retirees’ plan is aimed at holders of a French basic scheme pension, with no health questionnaire; it covers only care provided abroad, while care in France remains covered by the French compulsory scheme. The price is on quotation. See the guide retiree health insurance abroad and the page retirement in the Pitcairn Islands.

During a temporary stay in France, cover applies to holders of a French pension who show at least 15 years of insurance in France; the spouse who accompanies them is not covered, and a hospital stay of more than one month requires prior recognition. A retiree who is no longer a tax resident in France pays neither CSG, nor CRDS, nor Casa, according to CLEISS. The island’s local pensions are reserved for permanent residents.

The CFE is a voluntary social protection body. Abroad, reimbursement depends on the country of care and the type of care, with a rate or flat amount applied to actual expenses; the CFE applies the principles of Assurance Maladie (French health insurance), adapted to local costs. The gap with the price invoiced remains at the member’s expense, and the availability of the plan for this destination should be checked on the CFE simulator. The guide CFE reimbursements details this mechanism.

• Plans: the main plan is aimed at expatriates over 30 who live and work abroad and also covers stays of less than three months in France; the youth plan, at those under 30; the retirees’ plan, at retirees of a French basic scheme. The price is calculated according to country, age and family composition, on quotation, with no health questionnaire.
• Waiting period: cover starts immediately if membership takes place before departure or within three months of settling abroad; beyond that, the waiting period is three months for those under 44 and six months for those over 45.
• Maternity: conception must follow membership or attachment as a dependant.

On returning to France, service-public states that a CFE member may keep their expatriate benefits for three months under conditions; the CFE specifies that there is no waiting period on return. Without the CFE, someone who does not work immediately must show three consecutive months of residence in France before submitting their claim (form S1106); someone who takes up a job is covered from the first hour worked. See reducing the waiting period and the page return to France.

International health insurance at first euro reimburses actual costs within the limits of its contract, after any deductible, waiting periods and exclusions. It answers the territory’s strongest constraint: the immigration policy requires insurance valid for the whole stay, covering medical care, emergency medical evacuation and repatriation of remains, with no exclusions that unreasonably limit the planned activities of the visa, from a reputable insurer. Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of medical history; the Governor may waive the requirement for an individual case.

The tourist has no cover on site. CLEISS recommends taking out travel insurance suited to the real cost of care in the country, or checking existing cover such as that of a bank card. Official tourism reminds travellers that insurance must also cover losses linked to delays or cancellations of the ship’s calls, and recommends cancellation insurance for illness or injury. Reimbursement on return to France of unforeseen care is a possibility and not an obligation, and medical repatriation is not covered by health insurance. See long-stay travel insurance.

The clinic’s fees are displayed on site and insurers’ ceilings are not published: the amounts reimbursed item by item are therefore not given here and should be requested from the clinic, the insurer or the CFE. The benchmarks below restate the rules of the government’s health policy.

• Consultation: free for habitual residents; payable for visitors and new arrivals. The visitor settles their care before leaving the island (FCDO). A seconded employee presents their paid invoices to their fund.
• Hospital stay and off-island care: in Tahiti or New Zealand, on the recommendation of the island’s doctor and with the Administrator’s authorisation. An eligible resident pays one third of the cost of care, travel and accommodation being covered, with a daily allowance and the possibility of a repayment plan; visitors, non-resident holders of a right of abode and new arrivals pay 100% of costs, evacuation included. Check the insurer’s cover before any planned departure.
• Medication: half price as a general rule for a habitual resident, free for the island’s retirees and schoolchildren who are minors, one third of the price for chronic illnesses approved by the doctor; full price for visitors and new arrivals. Over-the-counter products are paid by everyone.
• Dental: free for minors and the island’s retirees, one third of the cost for habitual residents, full cost for visitors and new arrivals. The dental ceilings of a CFE contract or international insurance are read in the terms of each plan.
• Optical: same categories as dental; full cost for a person holding a settlement visa.
• Maternity: the official sources read describe no maternity service on the island. The FCDO stresses that insurance matters more for a pregnant woman, and the CFE requires conception after membership. The plan is discussed with the island’s doctor and the insurer before departure.
• Work accidents: the government publishes a health and safety at work policy with compensation claim forms; its conditions were not read and should be requested from the employer.

The reimbursement guide and the page expat health insurance give benchmarks; Expavy helps you compare these options with your situation.