Expat insurance and health insurance in Sint Maarten (the Dutch part of Saint-Martin)

Sint Maarten has no single fund open to all residents: the SZV (Social & Health Insurances), based in Philipsburg, runs the social and health insurances. The ZV health insurance (Ziekteverzekering) covers employees and people performing an employment contract, provided that their salary does not exceed the legal cap and that they work at least five days a week. The legally registered spouse (up to age 59) and children (up to age 24, or 25 if in full-time education) can be registered as dependants. An AVBZ insurance (exceptional medical expenses) finances long-term care for chronic illness, funded by a monthly contribution from people who work; it reimburses neither consultations nor medicines, which come under basic insurance (ZV and the civil servants' schemes).

According to the SZV, the ZV premium is 12.5% of salary (8.3% paid by the employer, 4.2% by the employee), with the salary cap set at 10,000 florins a month and 120,000 florins a year. Reimbursement is made on the basis of medical rates set by law: the insured person advances the invoice and submits a form, and the SZV's medical adviser accepts or refuses each claim; the delay can reach six weeks. Dental care and glasses are open to former civil servants, holders of a PP card and civil servants, not to the ordinary ZV insured person. When the specialist required does not exist in the care system of the Dutch part, the SZV arranges a medical referral abroad.

France Diplomatie points out that the European Health Insurance Card does not cover Sint Maarten, that an assistance contract or insurance covering medical costs and repatriation is essential, that access to care may be refused without cover, even in a life-threatening emergency, and that the French embassy cannot cover these costs. Depending on the conditions and length of the stay, it recommends vaccines against hepatitis A and typhoid fever (hepatitis B for frequent or prolonged stays) and flags dengue, chikungunya and Zika, the latter having affected Sint Maarten in 2015 and 2016. The page of the island's hospital, the Sint Maarten Medical Center, could not be read live: its legal status, its rates and its emergency number are therefore not given here.

• Entry: a passport is compulsory for the Dutch Caribbean islands, which are not part of the Schengen area (France Diplomatie). A national identity card alone is not recommended. France Diplomatie cites entry.sx for the entry formalities of Sint Maarten; the authorised length of stay and whether this website is compulsory are not specified there, and the page itself could not be read: these points should be confirmed with the immigration service (IBPS).
• Arrival by air in Saint-Martin: Princess Juliana international airport, which also serves the French collectivity, is on the Dutch side; France Diplomatie therefore asks French travellers arriving by air in Saint-Martin to hold a passport.
• Border with the French part: according to the Senate, the land border is characterised by an almost total absence of physical marking and of systematic checks, the free movement of people and goods going back to the Treaty of Concordia of 1648. A delimitation agreement signed on 26 May 2023 was authorised by Law no. 2026-645 of 22 July 2026.
• Long stay: a residence permit is applied for with the IBPS immigration service (Philipsburg). Its list of documents includes in particular the passport, a criminal record less than six months old, the detailed form from the census office less than six months old and, for an employee, the work permit and the contract. Application fees are non-refundable.
• Local affiliation: the employee under the cap is affiliated to the ZV; the employer must register their company and their employees with the SZV.
• Student: no European card; the study permit requires a school enrolment letter and proof of income. According to CLEISS, French cover ceases after six months from age 20: a student insurance or membership of the CFE (Caisse des Français de l'Étranger) should be arranged.
• Seconded employee : without an agreement, CLEISS indicates a secondment of three years renewable once, while the Assurance Maladie page (the French national health insurance) recalls a general limit of 24 months except in exceptional cases; the applicable duration should be checked with the Urssaf. Care is reimbursed at French rates, on paid invoices (form S3125 or S 3125c), without exempting from local contributions.
• Retiree: neither S1 nor European card, which are reserved for the European Union, the European Economic Area, Switzerland and the United Kingdom (Assurance Maladie). The retiree offer of the Caisse des Français de l'Étranger (CFE) is reserved for holders of a pension from the French basic scheme.

No individual fine for lacking health insurance was found in the sources read. The risk is financial and one of access to care: France Diplomatie states that care may be refused without cover, and local health insurance does not address all profiles.

No social security agreement exists between France and Sint Maarten in the official sources read. The CLEISS list of bilateral agreements mentions neither Sint Maarten, nor Saint-Martin, nor the Netherlands, nor the Netherlands Antilles, nor Aruba nor Curaçao; its list of country pages includes only the Netherlands page, which states that the Netherlands applies the European coordination regulations. France Diplomatie specifies that the European Health Insurance Card does not cover the Dutch overseas territories, including Sint Maarten.

• No aggregation of insurance periods: each country examines pension rights separately (CLEISS, expatriation outside an agreement).
• Expatriate: they are attached to the scheme of the country of work and are no longer insured in France; membership of the CFE does not exempt from compulsory local contributions (CLEISS).
• Tourist: no cover on the spot; an optional flat-rate reimbursement of unforeseen care can be requested from the French fund on return (CLEISS).
• Taxation: the Franco-Dutch convention of 16 March 1973 defines the Netherlands as the part of the Kingdom located in Europe, and its article 30 allows it to be extended only by an exchange of notes. The impots.gouv.fr list has no Sint Maarten entry. Only a tax information exchange agreement appears in the BOFiP for the Dutch part of the island: signed in The Hague on 10 September 2010, in force since 1 August 2012; it does not eliminate double taxation.
• The two parts of the island come under distinct regimes: the French part is subject to European Union rules, Sint Maarten is not, which creates gaps in social matters (Senate). See the page on Saint-Martin (French part).

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds), in particular through the declaration of transfer of residence outside France within the month.
2. For any stay: take out an assistance contract or insurance covering all medical costs and repatriation, which is essential according to France Diplomatie.
3. Check the validity of your passport, compulsory for the Dutch Caribbean islands, including for an arrival by air in Saint-Martin.
4. Consult entry.sx, the website cited by France Diplomatie for entry formalities, then confirm the authorised length of stay with the immigration service (IBPS).
5. Long stay: submit the permit application to the IBPS (8 A.Th. Illidge Road, Philipsburg) with the documents for the category: passport, criminal record less than six months old, census office form, supporting documents specific to the permit.
6. Employee: the employer registers itself and its employee with the SZV; the ZV insured person requests their insured card and, if needed, the registration of their spouse and children.
7. Seconded employee: ask the Urssaf for the document certifying that French legislation applies and keep paid invoices for reimbursement.
8. Retiree: notify your pension fund of the change of address, plan for the annual life certificate, choose between the CFE and private insurance.
9. Registration on the roll of French nationals living abroad: the French embassy in the Netherlands (The Hague) has a consular agency in Philipsburg, run by an honorary consul.