Healthcare Reimbursement in Svalbard and Jan Mayen: Who Pays What Depending on Your Situation

Svalbard is part of the Kingdom of Norway but is governed by the Svalbard Treaty of 9 February 1920 and by rules of its own (Lovdata). NAV (the Norwegian labour and welfare administration) specifies that the social security rules of the European Economic Area do not apply to the archipelago, while the Nordic social security convention does apply to people who already had rights in a Nordic country. Longyearbyen hospital adds that Svalbard is outside Schengen and that the EHIC covers neither care nor the air ambulance. The list of bilateral social security agreements in force published by CLEISS (42 agreements) does not include Norway. See the bilateral social security agreement.

Four parties may be involved: Norwegian national insurance (folketrygden) for those who are members, the maintained French scheme (secondment), the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help you compare plans. The organisation of care is presented in the page healthcare system in Svalbard.

An employee of a Norwegian employer operating in Svalbard is a member of national insurance for the duration of their contract and up to one month after, as long as they live in the archipelago; membership continues during sick leave and leave linked to a birth (NAV). A resident already insured before settling keeps their membership. For the Norwegian scheme, CLEISS describes patient participation for consultations and medicines, capped annually, no participation for hospitalisation in a public facility, and daily allowances paid first by the employer and then by NAV. Amounts change each year and are not reproduced here; their application at Longyearbyen hospital should be confirmed with NAV Svalbard. See the local contract.

A seconded employee sent by a French employer comes, according to CLEISS, under secondment to a country with no social security agreement: they remain a member of the French scheme, contributions being paid in France, for three years, renewable once. Their healthcare costs are reimbursed up to what Sécurité sociale would have reimbursed in France, on submission of paid invoices with form S 3125c; accompanying dependants follow the same procedure. Daily allowances are paid by the fund of membership on submission of the sick-leave notice within 48 hours. CLEISS suggests top-up health insurance when care is expensive. As European rules do not apply in Svalbard, the application of this framework should be confirmed with Urssaf (the French social contributions collection body). See seconded or expatriate and the seconded employee glossary.

A self-employed person or digital nomad does not meet the condition for membership (employee of a Norwegian employer on site) according to NAV, which excludes voluntary enrolment. They must demonstrate means of subsistence to the Governor and choose between the CFE and international insurance. See digital nomad insurance.

A student or researcher cannot use the EHIC. Research and teaching activities outside the travel zone require authorisation from the Governor, insurance covering search, rescue and medical transport, and communication equipment. The CFE youth plan (under 30, price on quotation) or student insurance should be considered. See student insurance abroad.

Spouse and children: the official sources read do not describe automatic cover of dependants by Norwegian national insurance in Svalbard, and NAV should be asked on this point. The CFE and international insurers offer family contracts, and a seconded employee can have accompanying dependants reimbursed under the CLEISS procedure. See expat family insurance.

Form S1 comes under European law, which does not apply to Svalbard. CLEISS indicates that, in a country with no social security agreement with France, a retiree’s health cover goes through three routes: the local scheme (to be checked with the country’s institutions), the CFE, or private insurance. In Svalbard, the local scheme is open only through employment or prior membership (NAV): a retiree who was never a member cannot join voluntarily.

For temporary stays in France, care is covered if the retiree receives a pension from a French basic scheme, has at least 15 years of insurance in France and carries on no professional activity; the Cnarefe manages the files of retirees of the general scheme. An accompanying spouse is not covered by this procedure. A health insurance contribution may be withheld from the pension, and a non-resident for tax purposes pays neither CSG, nor CRDS, nor Casa (CLEISS). See the page retirement in Svalbard and the guide retiree health insurance abroad.

The CFE is a voluntary-membership health insurance body for French nationals abroad. According to its website, reimbursement abroad depends on the country where care is received and the type of treatment, as a rate or a flat amount applied to the actual bill; in France, it follows the principles of Assurance Maladie (the French national health insurance), with third-party payment in public and private hospitals. The cover is presented as worldwide; its application in Svalbard and the scale used for the archipelago should be confirmed with the CFE. The guide CFE reimbursement details the mechanism.

• Plans: a main plan for people over 30 who are not retired, a youth plan for people under 30 and a retirees’ plan, depending on age and profile; price on quotation. They also cover stays of under three months in France.
• Waiting period: none if membership takes place before departure or within three months of settling; beyond that, three months before age 44, six months from age 45. No waiting period on return to France. See the glossary entry on the waiting period.
• Maternity: conception must follow membership or attachment as a dependant; maternity daily allowances require at least ten consecutive months of membership of the daily allowances option at the presumed date of delivery.

On return to France after a stay in a country with no convention, resuming an activity reopens rights with no waiting period; a retiree is covered by the fund that pays their pension; with no activity or entitlement, Universal Health Protection (PUMa) opens with the CPAM (local health insurance office) with, in principle, a three-month waiting period, and a CFE member may under conditions receive its benefits during the three months following their return (CLEISS). See the guide reducing the waiting period and the page returning to France.

International health insurance at the first euro reimburses actual costs up to its ceilings, after any deductible, waiting periods and exclusions in the contract. Contracts are compared on the annual ceiling, the coverage zone, medical evacuation and repatriation, the handling of pre-existing conditions and direct payment: the arrangements for admitting a non-member patient to Longyearbyen hospital should be checked with the insurer. For field activities, the contract must also cover the search and rescue costs required by the Governor’s regulations.

A visitor needs no visa, but Longyearbyen hospital warns that patients may have to pay for care and the ambulance and recommends insurance covering emergencies. On return to France, ameli (the Assurance Maladie website) indicates that, outside the EU/EEA area, only urgent and unforeseen medical care can possibly be reimbursed: payment is made on site, the claim is made with paid invoices and form S3125, the medical adviser assesses the urgency, reimbursement is made on the basis of French flat-rate tariffs and not actual expenses, no appeal is possible in the event of refusal and no daily allowance is paid. See long-stay travel insurance.

• Consultation: at Longyearbyen hospital, which serves as the doctor’s surgery; under national insurance rules for a member, under French rules for a seconded employee, at the country scale for a CFE member, at actual costs within the ceilings of a first-euro contract. The rate applicable to a visitor is not published in the sources read.
• Hospitalisation: a single small hospital, focused on emergencies; complicated cases leave by air ambulance for Tromsø, a transport that the EHIC does not cover. The contract must explicitly include evacuation.
• Medicines: to be carried in sufficient quantity, as the hospital may not write a prescription or have the product; CLEISS describes patient participation depending on the type of prescription in the Norwegian scheme.
• Dental: a dentist works at the hospital; under the Norwegian scheme, CLEISS indicates that basic dental care is free up to age 18 and then partly covered up to age 20, and that adult care is generally entirely at the insured person’s expense.
• Optical: no cover is described in the official sources read; it falls mainly under international contracts.
• Maternity: the hospital has no delivery room; the midwife provides follow-up, and the delivery is prepared on the mainland. The conditions on conception and waiting periods apply to the CFE and to international contracts.
• Rescue: a permanent resident pays search and rescue costs only in the event of intentional misconduct or gross negligence; visitors outside the travel zone must be insured (Governor).

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