Healthcare Reimbursement in Saint Vincent and the Grenadines: Who Pays What Depending on Your Situation

Saint Vincent and the Grenadines appears neither among the social security agreements in force nor among those signed but not in force in the CLEISS list; the country does not belong to the European Union. Insurance periods cannot be totalled and no cross-cover exists. According to the Assurance Maladie (the French public health insurance), an expatriate comes under the scheme of the country where they work, whereas a posted worker remains affiliated to France. Four players can therefore step in: the local scheme, the maintained French scheme, the CFE and international health insurance.

The notions of reimbursement base and out-of-pocket cost help you compare offers. How the hospitals are organised is presented in the guide to the Saint Vincent and the Grenadines healthcare system.

An employee on a local contract is declared by their employer to National Insurance Services. The benefits described are cash benefits: sickness benefit at 65% of average insurable wage for up to 26 weeks, maternity allowance at 65% for up to 13 weeks and 660 Eastern Caribbean dollars per live birth. Coverage of care itself in the public sector should be requested from the Ministry of Health, and private supplementary insurance opens access to the private sector and to evacuation. See the glossary entry on the local contract.

A posted employee sent by a French employer remains affiliated to the French scheme for three years, renewable once; their contributions are paid in France (CLEISS). Care is reimbursed within what France would pay, on paid invoices and form S 3125c, whatever the price charged locally. A supplementary policy covers the gap when local prices are high. Children who accompany the employee do not give entitlement to French family benefits. See secondee or expatriate and the posted worker glossary entry.

A self-employed person can contribute to National Insurance Services, but this membership describes no coverage of care: the CFE, which covers sickness and maternity for self-employed workers, or international insurance completes the arrangement. See digital nomad insurance.

A student under 30 can join the CFE youth offer (quarterly contribution that varies with age; current amounts on cfe.fr) or take out student insurance; the European health insurance card has no value in this country outside the European Union. See insurance for students abroad.

The spouse and children follow the social protection rules of the country of expatriation, according to the Assurance Maladie, with the same insurance recommendations. The CFE and international insurers both offer family policies, for the main offer, with a quarterly contribution that depends on the ages of the household members (current amounts on cfe.fr). See expat family insurance.

Form S1 and the European health insurance card are valid only in the European Union, the European Economic Area, Switzerland and the United Kingdom. For a retiree living in Saint Vincent and the Grenadines, the Assurance Maladie indicates that healthcare costs are no longer covered by France; they can join the CFE or take out private insurance. The CFE retirees’ offer has a quarterly contribution that depends on the household; current amounts are published by the CFE (cfe.fr); it requires a pension from the French basic scheme, is aimed at retirees with no activity, includes no medical questionnaire and excludes no one.

During a stay in France, a general scheme pensioner who can show at least 15 years of contributions to a French scheme may be covered after registering with the Cnarefe; their spouse is covered only if an agreement provides for it, otherwise they join the CFE and take out a private policy. See the guide to a retiree’s health insurance abroad and the page on retiring in Saint Vincent and the Grenadines.

The CFE reimburses abroad according to a rate or flat fee that depends on the country of care and the type of care, applied to the actual expense; the difference with the price charged remains the member’s responsibility (CFE reimbursements). Cover is worldwide, including stays of less than three months in France. The waiting period is nil if membership takes place before departure or within three months of settling; beyond that, it is three months for those under 44 and six months after 45 according to the CFE. For maternity, conception must follow membership or attachment as a dependant. Low annual resources may open the subsidised category, with a reduced contribution for basic sickness-maternity insurance, on application to the home consulate.

Insurance from the first euro reimburses actual costs within its limits, after any deductible, waiting periods and exclusions. With direct payment, it avoids the advance of costs that some hospitals require. A tourist, who stays less than six months, takes out before departure an assistance contract covering medical costs, surgery, hospitalisation and repatriation (France Diplomatie): on return, only urgent and unforeseen care may possibly be reimbursed by the CPAM (local health insurance fund), on the basis of French flat-rate tariffs, after assessment by the medical adviser, through the ameli account or form S 3125 (Assurance Maladie); see long-stay travel insurance.

On returning to France, the CFE applies no waiting period for the retirees’ offer; more broadly, membership avoids waiting periods and lost retirement quarters. The insured person reports their departure to the local body and sends form S1106 to their French fund to reopen their rights (Assurance Maladie). See returning to France and reducing the waiting period.

• Consultation: fee not published by the official sources read; reimbursed by the CFE on its country scale, at actual cost within the limits of a first-euro policy, under French rules for a posted worker.
• Hospital care: payment in advance may be requested (France Diplomatie); the CFE reimburses on its country scale and applies direct payment in French public and private hospitals; an international policy with direct payment avoids the advance. Evacuation comes under the assistance contract.
• Medicines: cited among the care covered by the CFE; at actual cost within the limits of an international policy.
• Dental: cited among the care covered by the CFE and included in most international policies up to an annual limit.
• Optical: does not appear in the list of care cited by the CFE on its main offer page; it comes mainly under international policies, with limits per period to be read in the benefits table.
• Maternity: National Insurance Services pays an allowance at 65% of average insurable wage for up to 13 weeks (30 weeks of contributions, 20 of them paid before the claim) and 660 dollars per live birth; the CFE covers maternity if conception follows membership; international policies generally apply a waiting period.

The reimbursement guide and the page on expat health insurance give benchmarks; Expavy helps you weigh these options against your situation.