Healthcare Reimbursement in Saint-Barthélemy: Who Pays What Depending on Your Situation

No international social security agreement needs to be called on: Saint-Barthélemy is part of the Republic and Article L751-1 of the social security code makes the general social security legislation applicable on the island. Management is local: the CPS, which protects working people and, by virtue of residence, non-working people, provides health insurance, family benefits and pensions (CPS booklet). The CLEISS (the French centre for international social security links) specifies that the right to have healthcare costs covered opens to anyone who works or lives in France in a stable and regular way, citing Saint-Barthélemy and Saint-Martin.

Reimbursement follows three tiers: the CPS reimburses on the basis of the rates in force; the ticket modérateur (co-payment) and extra fees fall to supplementary health insurance; the solidarity supplementary health scheme, free or paying depending on resources, covers people on modest incomes. The out-of-pocket cost therefore depends as much on the supplementary policy as on the compulsory scheme. The organisation of care on the island is described in the guide to the healthcare system in Saint-Barthélemy.

An employee is affiliated by their employer at the pre-hiring declaration, which opens a social security number for them if they have none. They benefit from reimbursement of care, daily allowances in case of sick leave (calculated on the salary of the previous three months), 100% coverage of costs linked to an industrial accident or occupational disease within the liability tariffs, and the invalidity pension under conditions. The employer is obliged to offer a supplementary health policy and to help fund it.

A State civil servant comes under the compulsory civil servants’ scheme. In mainland France, the law of 9 April 1947 entrusted the management of benefits to delegated mutual insurers, notably local mutual sections (National Assembly information report on the management of the compulsory scheme by certain mutual insurers). The CPS documents do not detail the case of an agent assigned to the island: the competent manager (the CPS or the delegated body of their administration) should be confirmed with their managing department before arrival, as should the file transfer formalities.

The self-employed person and the micro-entrepreneur are protected by the CPS. Their contributions are calculated from the self-employed social declaration (managers) or the turnover declaration (micro-entrepreneurs), to be completed on the CPS website; without a declaration, contributions rest on increased flat-rate bases. Reimbursement of care follows the same rates as for an employee; daily allowances depend on the entitlements opened and should be checked with the CPS.

The retiree is affiliated to the CPS, which protects retirees like employees and non-working people. They benefit from universal health protection by virtue of their residence, which the CPS checks regularly. Their pension remains paid by the schemes they come under; the guide to retiring in Saint-Barthélemy details the steps. The older people’s solidarity allowance is aimed at low-income retirees who live in France.

A student who continues their studies in mainland France informs the CPAM of their place of residence; failing that, they remain affiliated to the CPS on presentation of a school certificate. They also choose between remaining a dependant of their parents for family benefits or becoming a claimant themselves, a choice separate from tax attachment. For studies in the European Union, the European Economic Area or Switzerland, the European health insurance card, to be requested before departure, covers unscheduled care; outside these areas, the CPS asks you to declare the country of study to check bilateral agreements, and for Quebec a specific form is needed. The page on insurance for students abroad complements these benchmarks.

The spouse is insured in their own right: with universal health protection, every adult is an insured person, and in case of marriage, separation or widowhood, the non-working insured person keeps their own entitlements (Assurance Maladie, French public health insurance). An adult dependant can request affiliation on the residence criterion. Minor children are attached to one of the insured parents by the attachment request form; without a request, benefits are paid to the parent who makes the first reimbursement claim, and the attachment can be changed at any time.

A visitor from mainland France on a short stay keeps their home fund. The CPS booklet does not detail the cover arrangements for an insured person of another fund passing through the island: it is prudent to ask your fund before departure, and to plan for assistance covering medical transport and extra fees, which are not systematically covered. See the page on repatriation and assistance.

A trip to Sint Maarten, the Dutch part of the island neighbouring Saint-Martin, is a stay abroad. France Diplomatie (the French foreign ministry’s travel advice) specifies that the European health insurance card does not cover the Dutch overseas territories, including Sint Maarten. For a stay outside Europe, the Assurance Maladie states that only urgent and unforeseen medical care may possibly be reimbursed, after advancing the costs and an application with form S3125, on the basis of French flat-rate tariffs, with no daily allowances. An assistance contract is advised.

Returning to mainland France means informing the CPS and requesting the opening of entitlements with the fund of the new place of residence: the CLEISS specifies that opening is not automatic on a change of situation and that form Cerfa S1106 must then be completed. For a long-term condition, it is useful to request the transfer of the medical file to the medical adviser of the new fund: this is the step the CPS recommends on arrival on the island, where it provides cover for six months pending the file from the former fund.

The Caisse des Français de l’Étranger covers expatriates who live and work abroad (a main offer, a youth offer and a retiree offer, each with a contribution that depends on age and the plan chosen, according to the CFE website). As long as a French citizen lives in Saint-Barthélemy, they come under the CPS: CFE membership only becomes useful if you leave France. The CPS indicates that, for a permanent departure outside Europe, you should refer to the international agreements (CLEISS) and mentions the CFE or a private insurer. The guide to the CFE details the scales and waiting periods.

Private insurance from the first euro is not needed to obtain basic reimbursement in Saint-Barthélemy, but it can fund the extra fees and evacuations that exceed the compulsory scheme. Expavy helps you compare these options when leaving France is being considered.

• Consultation: reimbursed at 70% for a GP on the general scheme basis (ameli); the flat-rate contribution is deducted from reimbursements and capped at €50 a year together with the deductibles.
• Hospital care: reimbursed at 80% on the same basis; the hospital charge, due after 24 hours, remains payable by the patient or their supplementary insurer. In case of hospitalisation, bring your carte Vitale and your supplementary insurance certificate.
• Medicines: 65%, 30% or 15% depending on the medical benefit; the medical deductible is deducted automatically.
• Dental and optical: 60% on the reimbursement base for dentists and optical; recipients of the solidarity supplementary health scheme access dental prosthetic care, optical and hearing aids with no out-of-pocket cost.
• Maternity: 100% of care and hospitalisation costs from the first day of the sixth month of pregnancy until twelve days after childbirth, after a pregnancy declaration before the 15th week; transport costs covered at 100% to the compulsory tests of the 8th and 9th months or to temporary accommodation; Engagement maternité with an allowance of €80 a night.
• Transport: prior agreement counting as a medical prescription, filed about fifteen days before departure, except in an emergency; without a complete file, no reimbursement.