Social security and health insurance in Réunion

According to IEDOM, Réunion is an overseas department and region (DROM) governed by Article 73 of the Constitution and by the principle of legislative identity: national laws apply there, with possible adaptations where these are motivated by the territory's particular characteristics and constraints. In the social field, CLEISS (the French centre for European and international social security liaison) indicates that health insurance benefits are paid by the CPAM in mainland France and by the general social security funds (CGSS) in the overseas departments. The CGSS of Réunion presents on its website the services of the Assurance Maladie, the Assurance Retraite, the URSSAF (the social security contributions collection body) and the MSA (the agricultural social security body).

According to IEDOM, the island has 62 health facilities, of which 10 public and 52 private. Public hospital provision rests on the University Hospital (CHU), located on two sites (North and South), and on two other public hospital centres, the Groupe hospitalier Est Réunion (GHER) and the Centre hospitalier Ouest Réunion (CHOR). Capacities remain lower than in mainland France: 224 beds and places in medicine per 100,000 inhabitants against 234, and 78 in surgery against 113. Doctor density, on the other hand, is higher (379 per 100,000 inhabitants against 346), while that of nurses (817 per 100,000) remains lower than in mainland France (932).

On prevention, IEDOM notes that 1 death in 3 there is considered avoidable, that diabetes is twice as common as in mainland France and that nearly one Réunion resident in two is overweight. The ARS of Réunion also monitors mosquito-borne diseases (dengue and chikungunya) and leptospirosis; see the guide healthcare system in Réunion.

• Standard affiliation: according to ameli, universal health coverage (PUMa) applies to anyone who works or lives in France on a stable and lawful basis. An employee does not have to show a minimum period of activity, a self-employed person is covered from the start of their activity, and a person with no occupation comes under the residence condition alone.
• Arrival from mainland France with no occupation: CLEISS specifies that the opening of rights is not automatic when the person comes under the residence criterion alone; they send form S1106 to the Assurance Maladie body they depend on according to their place of residence, here the CGSS. CLEISS mentions stable and lawful residence for at least 3 months; ameli indicates that, during inspections, you must be able to show 6 months of residence in France over the last 12 months.
• No expatriation formality: the move takes place within the national territory. According to ameli, the declaration of transfer of residence outside France and the return of the Vitale card are for workers who move abroad.
• Subsidiary health contribution: CLEISS indicates that people with no professional activity may owe a subsidiary health contribution of 6.5%; the conditions of application should be confirmed with the fund.
• Children and young people: according to CLEISS, a child's dependant status ends at the latest on 30 September of the year they turn 18; minors over 16 can ask to be insured in their own right. According to ameli, a student becomes an insured person at 18.
• No entry formality: for a French citizen, neither a visa nor a residence permit; the prefecture of Réunion handles routine procedures (identity card, passport, driving licence, registration certificate) and reserves its "foreign nationals counters" for foreign nationals, by appointment only.

There is no compulsory health insurance separate from social security. The risk is mainly financial: the co-payment (ticket modérateur), the flat-rate contribution, the deductibles, the hospital daily charge and extra-billing remain the responsibility of the insured person or their supplementary health cover. The Caisse des Français de l'Étranger (CFE) offers generic offers (main offer, youth offer, retiree offer) intended, according to its website, for expatriates who live and work abroad: it is not justified as long as you live in Réunion.

This is not a social security agreement between two States: Réunion is part of the Republic and the framework is institutional. IEDOM recalls that the DROM are governed by Article 73 of the Constitution and that Réunion is one of the outermost regions of the European Union (Article 349 of the Treaty on the Functioning of the European Union). According to CLEISS, PUMa covers people who carry out an activity or live in France on a stable and lawful basis, including in Réunion; benefits are provided by the CGSS.

• No coordination to organise for a move between mainland France and Réunion: no secondment form, no international cover certificate.
• Change of fund: ameli attaches the insured person to the fund of their place of residence; form S1106 (application to open rights) is sent to that fund if needed.
• Departure to another country (Mauritius, Madagascar, Seychelles, Comoros, for example): the scheme changes. According to ameli, an expatriate worker no longer comes under the French system as soon as they arrive, declares their transfer of residence outside France within the month following departure and returns their Vitale card and European Health Insurance Card; they can join the CFE. See the sheets Madagascar, Seychelles and Comoros.
• Stay outside Europe from Réunion: ameli indicates that only urgent and unforeseen medical care can possibly be covered on return, after payment on the spot, on the basis of flat-rate French tariffs and with no daily allowances; an assistance policy is recommended in countries where care is expensive.

1. Before leaving mainland France: report your change of address to your Assurance Maladie fund, the family allowance fund and your pension funds.
2. On arrival, employee: the activity opens rights (ameli); check that the fund of the place of residence (CGSS) has recorded the new address and update your Vitale card.
3. On arrival, with no occupation: send form S1106 (application to open rights) to the CGSS with the documents requested, and plan to prove residence in case of inspection.
4. Declare or choose a GP of record (médecin traitant): without a declaration, reimbursement falls (outside the pathway, €12.60 reimbursed instead of €23.20 for a sector 1 general practitioner consultation).
5. Take out supplementary health cover for the co-payment, the hospital daily charge and extra-billing, or examine eligibility for the Complémentaire Santé Solidaire.
6. Find out about local risks: protection against mosquitoes (dengue, chikungunya), leptospirosis prevention, hurricane vigilance in the rainy season (November to April according to IEDOM).
7. For travel abroad, plan assistance covering medical costs and repatriation, see repatriation and assistance.
8. On a permanent departure to mainland France: notify the CGSS and, if necessary, send form S1106 to the fund of the new place of residence, see insurance on return to France.