Social protection and health in Saint-Martin (French side)

Saint-Martin has no health system or social security scheme distinct from those of France: Title V of Book VII of the Social Security Code (Articles L. 751-1 et seq.) specifies that its provisions apply, among other territories, to Saint-Martin, for all beneficiaries of general social security legislation. The competences that the collectivity sets itself (taxation, roads, urban planning, tourism, energy, etc.) do not include social protection: for social contributions, the collectivity exercises its tax competences without prejudice to the rules set by the State for Saint-Martin (Article LO 6314-4 of the General Code of Local Authorities).

On the organisation of health, the Regional Health Agency of Guadeloupe, Saint-Martin and Saint-Barthélemy covers the territory and has a territorial delegation whose head office is in Saint-Martin. Public hospital provision rests on the Louis-Constant Fleming hospital centre: general emergency department open 24 hours a day, obstetric emergencies and a level 2b maternity unit. For some treatments that cannot be provided on site, the patient is transferred to a more distant facility, by a medical transfer (from home to a place of care) or a medical evacuation (medically supervised movement from a hospital), two arrangements that the Assurance Maladie describes for Saint-Martin and the other overseas territories.

Not to be confused with the Dutch side. The island is shared between the French side, described here, and Sint Maarten, a territory of the Kingdom of the Netherlands covered by France Diplomatie in its "Netherlands" page (see the separate "Sint Maarten" entry in the list of countries). The French social security scheme only applies to the French side: France Diplomatie specifies that the European Health Insurance Card does not cover the Dutch overseas territories, including Sint Maarten.

• Entry and stay: the territory is part of the French Republic; a French national arriving from mainland France does not need to request a visa or residence permit to live there. The formalities to plan are those of a move within France: change of address, change of fund, tax and social declarations.
• Health insurance affiliation: according to the Assurance Maladie, anyone who works or resides in France on a stable and regular basis is entitled to coverage of their health costs. For an employee, only carrying out a professional activity counts, with no minimum duration; for a self-employed worker, entitlements open from the start of the activity; a person with no activity is covered on the basis of their residence, with a check of presence in France (proof of 6 months of residence over the last 12 months).
• Competent fund: the application is made to the fund of the place of residence, here the Guadeloupe CGSS, which is competent for Saint-Martin (form S1106 for a person with no professional activity, according to the Assurance Maladie).
• No EHIC or coordination forms for French territory alone: this is not a stay abroad. The rules on "care received abroad" (advance of costs, form S3125) only concern travel to other countries, including the Dutch side of the island.
• Crossing to the Dutch side: a stay in Sint Maarten is a stay outside France. France Diplomatie recommends having, before departure, an assistance policy or insurance covering medical costs and medical repatriation, failing which access to care may be refused, including in a life-threatening emergency.
• Student: no foreign scheme; the student insurance for abroad does not target this territory, which falls under the French scheme. The affiliation conditions specific to a student are to be confirmed with the Guadeloupe CGSS.
• Employee sent from mainland France: they fall under the general scheme as soon as they carry out their activity in Saint-Martin; the notion of secondment abroad has no meaning for this French territory.
• Supplementary health insurance: the public service page on the Complémentaire santé solidaire distinguishes mainland France, Alsace-Moselle, the overseas departments and Mayotte, but does not mention Saint-Martin; its conditions of application in the territory are to be confirmed with the Guadeloupe CGSS.

The sources consulted mention no fine specific to the territory for lacking cover. On the other hand, care received on the Dutch side, outside the French system, means advancing costs and, according to the Assurance Maladie, reimbursement limited to urgent and unforeseen care, on the basis of French flat-rate tariffs.

Here there is neither a bilateral agreement nor a coordination regulation to apply between France and Saint-Martin, since the French side of the island is itself French. The framework is institutional:

• Status: overseas collectivity created by Organic Law no. 2007-223 of 21 February 2007 and effective since 15 July 2007, which replaces the commune, department and region of Guadeloupe on the French side of the island (Book III of the sixth part of the General Code of Local Authorities).
• Social security: general social security legislation applies in Saint-Martin (Article L. 751-1 of the Social Security Code). The CGSS and the family allowance fund of Guadeloupe are competent, each in its own field, for applying this legislation in Saint-Martin (Article L. 752-1).
• Public health: the territory remains attached to Guadeloupe, within the Health Agency of Guadeloupe, Saint-Martin and Saint-Barthélemy.
• Moving from one French territory to another: the Assurance Maladie treats medical travel from Guadeloupe, Martinique, French Guiana, La Réunion, Mayotte, Saint-Barthélemy, Saint-Martin and Corsica separately; French Polynesia, New Caledonia, Saint-Pierre and Miquelon and Wallis and Futuna are not covered.
• Dutch side (Sint Maarten): it does not fall under the French scheme; refer to the "Sint Maarten" entry and to assistance and repatriation.

1. Before departure: report your change of address and situation to your home Assurance Maladie fund, and to the other bodies (family allowance fund, France Travail, pension fund).
2. Contact the Guadeloupe CGSS, the competent fund for Saint-Martin, for affiliation and file transfer; with no professional activity, send form S1106 with the requested supporting documents to the fund of the place of residence.
3. Have proof of residence or activity to hand: 6 months of residence over the last 12 months may be requested in case of a check of presence in France.
4. Ask the CGSS about the Complémentaire santé solidaire, as the public service page does not mention Saint-Martin.
5. If care is not available on site: ask your doctor for the prior authorisation for transport, contact your fund's referent (or the PASS during a hospital stay) and consult the Assurance Maladie's medical travel passport.
6. Before any stay in Sint Maarten: take out an assistance policy or insurance covering medical costs and medical repatriation; in case of urgent care, keep prescriptions and paid invoices for a possible reimbursement claim (form S3125).