The Sint Maarten (Dutch Part of Saint-Martin) Healthcare System for a French National

Sint Maarten has been an autonomous country within the Kingdom of the Netherlands since 2010, and its health system is its own. The SZV (Social & Health Insurances), whose offices are in Philipsburg (Harbour View Building, 4 Sparrow Road), runs the social insurances and the health insurances: medical benefits, pensions, allowances for employers. Its telephone lines are open Monday to Friday from 7:30 a.m. to 2 p.m., and most procedures for insured persons go through an online account, MySZV, opened from age 17 on presentation of a digital copy of a Sint Maarten identity document or a passport, whatever the nationality.

This scheme does not resemble French health insurance: it does not give a right to every resident. It is aimed first at employees, and the SZV issues, on request, a letter certifying either ZV insurance or the absence of insurance. This letter of non-insurance is given to people who do not meet the conditions of the health insurance ordinance. The pages read describe no public affiliation for the other profiles: private or international insurance, or the CFE (Caisse des Français de l'Étranger), is then to be considered, as detailed in the page on healthcare reimbursement in Sint Maarten.

According to the SZV, all employees are insured under ZV health insurance, including those who perform work under contract, whose salary does not exceed the legal cap and who work at least five days a week. The SZV sets this cap at 10,000 florins a month, i.e. 120,000 florins a year, and the premium at 12.5% of salary (8.3% paid by the employer, 4.2% by the employee). The employer must register its company and its employees with the SZV, failing which it cannot open an online space.

The insured head of household may register their legally registered spouse, up to age 59, and their children up to age 24, or 25 if in full-time education. No other relative can be added: neither grandparents nor a partner. The file includes an identity document per person, the previous year's tax return for a spouse, proof of address from the civil registry less than three months old, the registration form and, for a child aged 18 to 24, a school attendance certificate. The head of household attends by appointment, with children aged 12 and over for the card photograph; the employer must have completed the change form correctly, failing which the dependants cannot be registered. Newborns are declared within ten working days.

The ZV insured person has an insurance card, whose issue, renewal and replacement in case of loss the SZV arranges, and may request a change of doctor. An emergency procedure exists: it allows a registration or renewal to be processed without an appointment when the card has expired and the insured person provides a prescription for chronic treatment, an urgent laboratory request, an urgent referral by their specialist with proof of an appointment, or a medical emergency recorded by the medical adviser.

In case of illness, the SZV describes a precise procedure. The employee informs their employer and consults their family doctor from the first day; if the doctor confirms the illness, they sign the “yellow card”. If the incapacity continues on the third day from the start of treatment, the employee must report, without an appointment, to the SZV's medical adviser with their insured card and signed yellow card, Monday to Friday from 7:30 a.m. to 10:00 a.m. The medical adviser checks the incapacity and decides on the follow-up; an insured person who disagrees about their fitness for work has rights of appeal.

For a specialist, the insured person goes through their family doctor, whose referral, valid for six months, is a condition of reimbursement. The SZV defines medical referral abroad: when the general practitioner finds a condition that requires a specialist who is absent from the care system of the Dutch part, the insured person is referred abroad. Referred insured persons receive compensation that includes transport to and from airports and appointments, as well as a daily allowance intended to supplement meals and accommodation; personal belongings and personal purchases are not covered. A companion may be designated under a specific SZV policy. The destinations and conditions are detailed in SZV policies, which the pages read do not reproduce.

The island's hospital is the Sint Maarten Medical Center (SMMC). As its pages could not be read live, neither its legal status, nor its rates, nor its services, nor the emergency number to dial are given here: this information should be checked with the establishment before any stay, and the list of public hospitals on the country page is deliberately left empty for lack of confirmation from an official source read.

The AVBZ (Algemene Verzekering Bijzondere Ziektekosten) is a national insurance introduced in 1997 to fund the care of people with a prolonged chronic illness who depend on others. It covers long-term care in designated establishments, including residence in a nursing home with permanent nursing care, medical aids and home adaptations (grab bars, shower seats, raised toilet seats, widened doors) and care for people with Alzheimer's disease by a local foundation. It does not cover conditions such as diabetes: medicines, consultations and certain aids come under basic insurance.

It cannot be bought: everyone who works contributes every month, with their employer and the government of Sint Maarten. You do not apply for it yourself: it is the treating doctor who submits the file. The contribution rate is not indicated on the page read; a resident retiree who receives the AOV has 1% of their pension deducted for the AVBZ.

The SZV reimburses treatments, medicines and medical aids to ZV, FZOG and OZR insured persons, depending on their insurance, their status and the other applicable conditions. The insured person pays the invoice and submits a form; each claim is reviewed by the medical adviser. Receipts must be itemised, paid, in the patient's name and less than six months old for a ZV insured person; a referral less than six months old is required, including for laboratory and imaging tests, together with a detailed medical report. Each adult and each child submits a separate form. Reimbursement, which can take up to six weeks, is paid by transfer with a decision letter, and a written appeal is possible within six weeks.

Dental care and glasses are not open to the ordinary ZV insured person: the SZV reserves them for former civil servants (FZOG), civil servants and holders of a PP card, and orthodontics for OZR insured persons only. Rates are set by law, and former civil servants and civil servants receive 90% or 100% of the approved rates. An employee in the private sector therefore has an interest in supplementing basic insurance with private cover for these items.

France Diplomatie recalls that the European Health Insurance Card covers neither Aruba, nor Bonaire, nor Curaçao, nor Saba, nor Sint Eustatius, nor Sint Maarten. It considers it essential to hold an assistance contract or insurance covering medical costs and medical repatriation, specifies that access to care may be refused without this cover, even in a life-threatening emergency, and that the French embassy cannot under any circumstances cover these costs. See assistance and repatriation and long-stay travel insurance.

On health, France Diplomatie recommends, depending on the conditions and length of the stay, vaccines against hepatitis A and typhoid fever, and the hepatitis B vaccine for frequent or prolonged stays, after medical advice well before departure. Dengue, whose symptoms resemble those of flu, has no curative treatment: consult immediately and avoid anti-inflammatory drugs, vaccination being indicated in certain cases. Chikungunya, spread by mosquitoes, calls for the same consultation; its prevention relies on vaccination and protection against bites. Zika affected Sint Maarten in 2015 and 2016: women who are pregnant or planning to be consult a doctor before leaving.

Medicines, pharmacies and emergency services in the Dutch part are not described by the official sources read. An expat health insurance policy makes it possible to compare cover that includes hospitalisation, dental care, optical care and evacuation; the country page details the procedures in Sint Maarten.