Social protection and health in Saint-Barthélemy

The applicable scheme is that of the Caisse de prévoyance sociale (CPS) of Saint-Barthélemy. Officially created on 1 April 2017 and run by the MSA Poitou according to its website, it took over the health insurance, family benefits and retirement previously provided by the CGSS and the CAF of Guadeloupe. Its booklet specifies that it protects all working people (employees, self-employed workers and micro-entrepreneurs) as well as non-working people on the basis of residence, and that the residence criterion is checked regularly. With universal health protection (PUMa), every adult is insured in their own right, provided they meet the conditions of entitlement.

The CPS reimburses all or part of care on the basis of the rates in force; the co-payment (ticket modérateur) and extra billing remain payable by the insured person, or their supplementary health insurance. Reimbursement is made via Carte Vitale, within five days according to the CPS, and direct billing (tiers payant) allows the fund to pay directly the share due to the professional or facility. The employer is required to offer supplementary health insurance and to contribute to its funding. For modest incomes, the CPS offers the Complémentaire santé solidaire (CSS), free or paid.

On site, public provision rests on the Irénée de Bruyn hospital centre, in Gustavia. According to the explanatory memorandum of an organic bill tabled in the Senate on 14 October 2022, it is an autonomous public establishment, a member of the Northern Islands territorial hospital group, with an emergency department, whose building is the only infrastructure on the island that has not been rebuilt five years after Hurricane Irma; the same text notes high turnover of doctors and regular closures of medical beds. Care requiring a technical platform is therefore provided off the island, in Saint-Martin or Guadeloupe.

• CPS affiliation: the employee is affiliated by their employer, as part of the pre-hire declaration (DPAE); the employer must hand over a copy of the declaration or of the CPS acknowledgement of receipt, for fixed-term and permanent contracts alike. Other insured persons (self-employed, resident non-working people) submit their application to the CPS.
• Notify the former body: the CPS asks that you inform your previous body (CPAM and CAF, or MSA) of the change of situation for an automatic transfer of data, and report any change (address, family or professional situation) as early as possible.
• Supplementary health insurance: no individual obligation is indicated in the CPS booklet, but the co-payment (ticket modérateur) and extra billing remain payable by the insured person; the employer must offer supplementary health insurance to its employees.
• Referring doctor: the coordinated care pathway rests on declaring a referring doctor (médecin traitant), who refers to specialists.
• Care off the island: coverage of transport for a medical appointment outside Saint-Barthélemy is not automatic; it requires a prior authorisation request serving as a medical prescription, drawn up by the doctor before departure.
• Student: in mainland France, they inform the CPAM of their place of residence; otherwise they remain affiliated to the CPS on presentation of a school certificate. For studies abroad, the CPS refers to the declaration of the country of study and to the question of student insurance.
• Micro-entrepreneur: the turnover declaration must be made on the CPS website, via the dedicated online service.

No individual fine for lacking insurance is mentioned in the sources consulted. The CPS does indicate that it carries out checks, under Article L114-10-3 of the Social Security Code, as part of its mission of covering health costs.

There is no international social security agreement between France and Saint-Barthélemy: the territory is part of the Republic. Organic Law no. 2007-223 of 21 February 2007, supplemented by Law no. 2007-224, created the overseas collectivity of Saint-Barthélemy "endowed with autonomy" within the meaning of Article 74 of the Constitution. Its status appears in the General Code of Local Authorities (Article LO 6211-1 et seq.), last amended by Organic Law no. 2021-1381 of 25 October 2021.

• National laws applicable by right: according to Article LO 6213-1 of the General Code of Local Authorities, laws and regulations apply by right, except in matters within the competence of the collectivity (taxes, duties and levies in particular). The rules on the entry and stay of foreigners only apply where expressly stated.
• European framework: unlike Saint-Martin, Saint-Barthélemy falls within the category of overseas countries and territories (OCT) with regard to the European Union (Guide de légistique, Légifrance).
• Management of social protection: the CPS, created by Law no. 2015-1268 of 14 October 2015, is described by the Senate explanatory memorandum as a local office attached to the MSA; an organic bill tabled on 14 October 2022 aimed to allow the collectivity to take part, under State control, in the exercise of State competences in social security and healthcare facility funding. The fate of that text has not been verified.
• Continuity of cover: the CPS states that social protection is ensured in France or Europe according to the regulations in force; for a permanent departure outside Europe, it refers to international agreements (CLEISS) and mentions the CFE or a private insurer.

The coordination arrangements between the CPS and the mainland funds for a temporary stay are not detailed in the CPS booklet: an insured person of a mainland fund travelling to the island is advised to ask their fund before departure.

1. Before departure: inform your previous body (CPAM and CAF, or MSA) of the change of residence, to allow automatic data transfer to the CPS.
2. People with a long-term condition (ALD): ask the medical control of the former fund to transfer the medical file to the CPS medical adviser; the CPS provides six months of cover while awaiting this file.
3. Employee: check that the employer has completed the DPAE, which includes affiliation to the CPS, and ask for the copy or acknowledgement of receipt.
4. Other situations with an existing social security number: submit form Cerfa 750 (transfer request), a bank details slip (RIB), an identity document or residence permit, proof of residence on the island, a copy of the Carte Vitale and, for working people, a copy of the employment contract.
5. Without a social security number: submit form Cerfa 15763*02 (entitlement opening), a bank details slip (RIB), an identity document or passport (French, EU, EEA, Swiss) or a residence permit (other nationalities), a birth certificate with apostille and sworn translation if the birth took place abroad, and proof of accommodation on the island.
6. Create your private account on the CPS website to track your reimbursements, obtain your certificates and exchange messages; the reception is located at 13 rue Lubin Brin in Gustavia (telephone 05 90 87 22 10, according to the CPS booklet).
7. Declare a referring doctor and update your Carte Vitale at least once a year or in case of a change of situation.
8. Find out about supplementary health insurance from your employer or, depending on income, apply for the Complémentaire santé solidaire (CSS) in the private account.
9. Before any medical appointment off the island: have the doctor draw up the prior transport authorisation request and submit it to the CPS before departure (about 15 days beforehand, except in an emergency); keep part 3 with the paid invoice and supporting documents for reimbursement.
10. For insurance covering evacuations and repatriation beyond the compulsory scheme, see the page on repatriation and assistance.
11. Permanent departure outside Europe: the CPS refers to international agreements (CLEISS) and mentions the Caisse des Français de l'Étranger (CFE) or a private insurer.