Healthcare Reimbursement in Saint Lucia: Who Reimburses What Depending on Your Situation

No social security agreement links France to Saint Lucia: the country does not appear in the list of agreements published by the CLEISS. Insurance periods cannot be aggregated and there is no cross-cover between schemes. The Assurance Maladie points out that an expatriate no longer falls under the French scheme and that their scheme is that of the country of work, whereas a seconded employee remains affiliated to France. Four players can be involved: the Saint Lucian scheme, the retained French scheme, the CFE and international health insurance.

The notions of reimbursement basis and out-of-pocket cost help compare offers. How the hospitals work is presented in the guide Saint Lucia’s healthcare system.

An employee on a local contract falls under the scheme of the country of work, to which their contributions are paid (Assurance Maladie). The benefits of the National Insurance Corporation, the conditions for access to public care and the employee’s share are read from its official scales, which the employer can present. No official source read publishes these amounts at the date of this check. Private supplementary cover opens access to the private sector and to evacuation. See the glossary entry local contract.

A seconded employee of a French employer remains affiliated to French social security during their assignment, under secondment law outside an agreement: duration, conditions and contributions should be checked with the Urssaf (the French social security contributions collector) and the CLEISS before departure. Care is reimbursed under French rules, on paid invoices, whatever price is charged on site. Many employers add a group contract to cover the gap with private sector rates. See seconded or expatriate and the glossary entry seconded employee.

A self-employed person has no employer to affiliate them: they choose between affiliation to the local scheme if it is open to them, the CFE or international insurance, the latter covering hospitalisation, outpatient care and repatriation. See digital nomad insurance.

A student under 30 can join the CFE youth offer or take out student insurance; access to a Saint Lucian public scheme depends on their immigration status. See student insurance abroad.

The spouse and children follow the policyholder’s cover when it provides for dependants; the CFE and international insurers both offer family contracts, for the main offer, with a quarterly contribution that depends on the ages of the household members (current amounts on cfe.fr). See expatriate family insurance.

The S1 form and the European Health Insurance Card are valid only in the European Union, the European Economic Area, Switzerland and the United Kingdom: they do not apply to Saint Lucia. According to the Assurance Maladie, the retiree’s healthcare costs are no longer covered by France after departure; they choose the CFE, with the retiree offer (contribution published on cfe.fr) and with no medical questionnaire, or a private contract. During a stay in France, a pensioner of the general scheme who can show at least 15 years of contributions to a French scheme may be covered after registering with the Cnarefe; the spouse must rely on the CFE and on a private contract covering France. See the guide health insurance for retirees abroad and the page retiring in Saint Lucia.

The CFE reimburses abroad according to a rate or flat amount specific to the country of care applied to the actual expense; the difference with the price charged remains payable by the member (CFE reimbursements). Cover is worldwide, including stays of less than three months in France. The waiting period is zero if joining takes place before departure or within three months of settling in; beyond that, it is 3 months before age 45 and 6 months from age 45. For maternity, conception must come after joining or after attachment as a dependant.

First-euro insurance reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. With direct billing, it avoids the advance of costs that several hospitals require, according to France Diplomatie. The tourist, staying up to 42 days, takes out before departure insurance covering medical costs, surgery, hospitalisation and repatriation (France Diplomatie); see long-stay travel insurance.

On return to France, the CFE applies no waiting period: the return comes with a request to reopen rights at the CPAM (the primary health insurance fund) using form S1106 (Assurance Maladie). See return to France and reducing the waiting period.

• Consultation: Saint Lucian scheme or user fees depending on status in the public sector; free fees in the private sector; reimbursed by the CFE on its country scale; actual costs within the ceilings of a first-euro contract.
• Hospitalisation: Saint Lucian scheme for an affiliated employee, French scheme for a seconded employee, CFE or international contract for the others; payment in advance may be requested, and evacuation to Martinique is provided for in the assistance contract.
• Medicines: reimbursed according to the CFE scale or within the ceilings of an international contract; carry prescriptions in international nonproprietary names (France Diplomatie).
• Dental: included at the CFE according to its scale and in most international contracts within an annual ceiling.
• Optical: mostly covered by international contracts, with per-period ceilings to be read in the table of benefits.
• Maternity: covered by the CFE if conception follows joining; usual waiting period in international contracts; plan the delivery close to an equipped facility.

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