Social protection and health in French Polynesia

Since Law no. 94-99 of 5 February 1994 and Decree no. 94-1146 of 26 December 1994, French Polynesia has had its own generalised social protection scheme (PSG), in force since 1 January 1995. According to IGAS/IGA/IGF report no. 2018-104R, it covers the risks of sickness, work accidents and occupational diseases, family and old age, and, more limitedly, disability and social action. It is organised in three schemes run by a single fund, the Caisse de Prévoyance Sociale (CPS): the general employees' scheme (RGS), the self-employed scheme (RNS) and the French Polynesia solidarity scheme (RSPF). Health and maternity cover is identical from one scheme to another. The PSG is funded 70% by contributions, according to that report.

The mainland French system remains separate: the High Commission specifies that universal health protection (PUMa) only recognises mainland France, Corsica and the overseas departments (as well as Saint-Barthélemy and Saint-Martin) as stable residence in France, and excludes the Pacific overseas collectivities. There is no Assurance Maladie branch office in French Polynesia. State civil servants posted there and their dependants, on the other hand, continue to fall under mainland French social security, while contract staff recruited locally fall under the CPS.

The CPS reimburses care according to its own rates and its own nomenclature: it only applies rates of 0%, 70% or 100%, according to the High Commission, and some services reimbursed in mainland France (dental care, optical) are not necessarily reimbursed the same way on site. Public hospital provision relies on the Centre hospitalier de la Polynésie française (CHPF) in Pirae, the reference and last-resort facility, and on local hospitals. Care that cannot be provided on site gives rise to a medical evacuation (évasan), decided on the advice of the CPS medical adviser.

• Entry and stay: as French Polynesia is part of the national territory, a French citizen has no particular entry or exit procedure and no visa to request; the High Commission nevertheless states that a valid passport is required, including when transiting through certain countries (United States, Japan, New Zealand, Fiji, Cook Islands). The page consulted mentions no health formality on entry.
• Locally hired employee: in principle, the worker is subject to the scheme of the territory where they work (Decree no. 94-1146, Article 3). They are therefore affiliated to the CPS employees' scheme; the employer withholds the contribution. For health insurance, the overall rate in force is 14.94% (9.96% paid by the employer, 4.98% paid by the employee) up to a monthly ceiling of CFP 5,000,000, according to the table published in the Journal officiel de la Polynésie française.
• Self-employed / freelancer: affiliation to the CPS self-employed scheme, through the fund's affiliation department. The contribution schedules of the self-employed scheme could not be read from a usable official source and are therefore not given here.
• Seconded employee : the seconded worker remains subject to the scheme of their usual territory for a maximum of three years, with a possible three-year extension subject to the agreement of the authorities of the place of secondment; for a self-employed person, the initial period is twelve months, renewable once (Decree no. 94-1146, Article 3). To benefit from CPS direct billing (tiers payant), the employer declares the situation to Urssaf (Cerfa 11559-03), then the employee requests form 980-01 (and 980-04 for their dependants) from their home fund before registering with the CPS on arrival.
• Spouse or partner with no activity: according to the High Commission, the CPS requires six months of residence and an income ceiling for the solidarity scheme; with no professional activity in French Polynesia, the spouse is therefore by default covered neither by mainland French social security nor by the CPS on arrival. An exception (attachment of an adult dependant) exists exceptionally for certain State staff attached to the Val-de-Marne primary health insurance fund; it is not automatic and is not available from other funds.
• Keeping mainland French cover: in case of career break (disponibilité) or unpaid leave, an insured person can keep their right to reimbursement of health costs for a maximum of one year on the basis of their previous activity; after that, they must affiliate to the CPS (self-employed scheme or solidarity scheme depending on income), according to the High Commission.
• Certificates of entitlement: for members of mainland French social security, the certificate of entitlement sent to the CPS is valid for a maximum of one year and must be renewed at least one month before it expires; failing that, the CPS suspends entitlements without notice, according to the High Commission.
• Student: the CPS offers a dedicated section for students within the employees' scheme, whose conditions could not be read live: to be confirmed with the fund. A student insurance contract is not required by the texts consulted. Adult children, whether students or not, must have their own cover with the CPS or with social security depending on their place of residence.
• Retiree: they register with their pension fund (for the private sector, the national centre for French retirees abroad and the national old-age insurance fund; for State pensioners, the State pensions department) to obtain form 980-06, then register with the CPS on site.
• Supplementary insurance and assistance: no obligation to take out private insurance is mentioned in the sources consulted, but neither the CPS nor social security reimburses everything; supplementary health insurance covers all or part of the remaining cost. Membership of the Caisse des Français de l'Étranger (CFE) (main offer, youth offer, retiree offer) is aimed at French citizens living outside France: whether it applies to a resident of French Polynesia, a national territory, is not established by the sources consulted and must be confirmed with the CFE before any step is taken. An assistance policy is, however, recommended by the High Commission for travel outside French Polynesia.

The sources consulted mention no individual fine for lacking health cover; the main risk is financial, as a failure to affiliate or to update entitlements can suspend cover and, for a medical evacuation, the CPS first checks that the patient's entitlements are open.

There is no social security agreement between France and French Polynesia, since the latter is part of the Republic. Coordination between the mainland French and French Polynesian schemes rests on Decree no. 94-1146 of 26 December 1994, "on the coordination of mainland French and French Polynesian social security schemes", which takes effect on 1 January 1995. It covers in particular old age, sickness, maternity, invalidity, death, work accidents and family benefits, and establishes equal treatment of insured persons regardless of nationality.

• Status: Article 74 of the Constitution and Organic Law no. 2004-192 of 27 February 2004 give French Polynesia broad autonomy; health and solidarity policy falls within the competence of the Pays, with the State contributing financially.
• Aggregation of periods: where the insured person does not have the required insurance duration in their new territory for their sickness, maternity or invalidity rights, the periods completed in the other territory are taken into account (Articles 9 and 17); periods of less than one year are counted (Article 10). The corresponding certificate is requested from one's fund before departure.
• Temporary stay: an insured person who needs care during a stay in the other territory, or who is authorised to go there for treatment, receives care from the institution of the place of stay on behalf of their scheme of affiliation (Article 18). The High Commission specifies that form 980-04 must be requested from one's fund before departure, then registered with the CPS on arrival; failing that, costs are advanced then reimbursed by the home fund.
• Secondment: seconded workers and their dependants residing with them receive sickness and maternity benefits for the whole duration of the stay (Article 19).
• Dependants: those of a worker employed in one territory and usually residing in the other are entitled to benefits in kind, provided under the legislation of the territory of residence and charged to the worker's scheme of affiliation (Article 20); this provision does not apply if the family members have their own entitlement.
• Pensioners: holders of pensions or annuities who reside or stay in the other territory receive care charged to the scheme paying the pension (Article 21).
• Care in mainland France for a CPS-insured person: according to the High Commission, they can only be reimbursed by social security and according to the Assurance Maladie scale. Conversely, a member of mainland French social security must remember to have "outside usual residence" ticked on the claim form for normal reimbursement in mainland France.

1. Before departure: report your change of situation to your health insurance fund, family allowance fund, France Travail and pension funds, and check that your entitlements are up to date.
2. Take stock of your status: local employee (CPS affiliation by the employer), seconded (form 980-01 and, for dependants, 980-04), self-employed (self-employed scheme), retiree (form 980-06).
3. Ask your fund for the certificate relating to the aggregation of insurance periods, useful for the CPS to take over mainland French periods; the exact form is to be confirmed with your fund.
4. Create or check your ameli account and your certificate of entitlement, valid for a maximum of one year, before sending it to the CPS.
5. Check the validity of your passport before travelling, including for stopovers (any authorisations to be requested by the traveller depending on the transit country).
6. On arrival: register with the CPS (Papeete head office or branch) with identity document, form 980 and certificate of entitlement; the CPS then assigns a file number.
7. Open an online account with the CPS once your entitlements are up to date, and track the expiry dates of the certificate of entitlement and form 980 to avoid a suspension.
8. Have a long-term condition recognised by the CPS as well as by mainland French social security if you want to be covered at 100% in both territories.
9. In case of évasan: the treating doctor sends the request to the CPS, which checks entitlements then has the file examined by a medical adviser; the CPS then organises transport through its assistance provider.
10. Take out supplementary health insurance and, for travel outside French Polynesia, travel insurance covering care and repatriation.