Expat insurance and health insurance in Tokelau

Tokelau has no contribution-based health insurance scheme comparable to French Sécurité sociale. Care is organised by the Tokelau Government's Department of Health, whose director is based in Apia, and relies on three public hospitals, one per atoll. The independent evaluation of health services published by New Zealand's MFAT specifies that they mainly deliver primary care: St Joseph's Hospital in Nukunonu was developed as the national referral hospital, run directly by the Department of Health, while the services of Fakaofo and Atafu are run by their village councils (Taupulega). Cases the atolls cannot treat are referred to the hospital in Apia, in Samoa, or to New Zealand under the Tokelau patient referral scheme.

This scheme is open to Tokelauans living on the atolls and, according to the policy cited by the MFAT evaluation, to people who have lived there for more than six months, medical locums and government contractors; a visitor is not cited among the beneficiaries. New Zealand citizens, including those of Tokelau, have access to New Zealand's publicly funded services (Health New Zealand); a French national is entitled to them only under the visa conditions set by that country. France Diplomatie deems an assistance contract or insurance covering all medical costs and medical repatriation imperative, and Tokelau's Department of Health advises travellers to take out travel insurance, as cyclones, medical evacuations and changes to the boat schedule can disrupt a stay. See the page healthcare system in Tokelau.

• Entry permit: the official brochure of Tokelau's Department of Transport and Support Services states that non-Tokelauans must apply for a permit to enter; applications go through the immigration officer at the Savalalo office, in Apia. France Diplomatie publishes no entry rule specific to Tokelau: whether a permit can be obtained, its duration and its cost should be confirmed with the Government of Tokelau before any booking.
• Transit through Apia: the only access is through Samoa, where a French national needs no visa for up to 90 days in 180, with a passport valid for at least 6 months after the planned end of stay and proof of onward departure from the territory (France Diplomatie, Samoa sheet).
• Travel insurance: an assistance contract covering medical costs and medical repatriation is deemed imperative by France Diplomatie; the French embassy never covers these costs. Tokelau's Department of Health and the boat brochure also recommend personal insurance.
• Health before departure: bring your medication for the whole stay and a clinical summary, as well as repellent, plasters and hygiene products, which travellers are responsible for (Tokelau Department of Health); in Apia, drink bottled or boiled water, as typhoid is reported in drinking water in Samoa.
• Local affiliation: no health insurance obligation for a visitor was found in the sources consulted, and no contribution-based health insurance fund is described there.
• Student: no EHIC, as Tokelau is not a member of the European Union; no local student scheme is described, so student insurance abroad or the CFE should be compared before departure.
• Seconded employee : without an agreement, continuation of the French scheme on the basis of domestic law, for 3 years renewable once (CLEISS); the CFE and an assistance contract remain recommended in addition.
• Retiree: no S1 form; CLEISS invites retirees to check the existing cover with local institutions, then to choose between the CFE and private insurance.

No individual fine for lacking insurance is mentioned in the sources consulted, but the fact that visitors are not covered by the patient referral scheme, the distance from Apia and the cost of an evacuation make the financial risk high for an uninsured expat.

According to the New Zealand Ministry of Foreign Affairs and Trade, Tokelau is a non-self-governing territory within the Realm of New Zealand, with its own political institutions, judicial system and public services. An Administrator, a New Zealand government official, heads the executive under the authority of the New Zealand Minister of Foreign Affairs; powers are delegated to the village councils (Taupulega) of the three atolls, and the General Fono (national assembly) deals with national matters. New Zealand retains responsibility for international obligations, defence and security. The inhabitants of Tokelau are New Zealand citizens. It is neither a French territory nor an ordinary New Zealand province: the rules on entry, health and employment are those of the Government of Tokelau, and it is the embassy in Wellington that is responsible for the territory for France.

• Social security: CLEISS indicates that France has signed no bilateral social security agreement with New Zealand, and the list of agreements in force includes neither New Zealand nor Tokelau. There is therefore no coordination of schemes: no S1 form, no EHIC, no cross-border cover (see the bilateral agreement). The French-New Zealand working holiday agreement creates no right to care: a young person on a working holiday visa is not eligible for the host country's health insurance (CLEISS), and no programme of this kind is described for Tokelau.
• Employee on a local contract: the expatriate is subject to the scheme of the country of work and is no longer insured in France; they hand back their carte Vitale and may contribute voluntarily to the CFE (CLEISS).
• Secondment: without an agreement, the employer may keep its employee in the French scheme for 3 years renewable once, with a 2-year waiting period before a new secondment in the same country; care is covered within the limit of French benefits, on paid invoices sent with form S 3125c (CLEISS). The formalities go through Urssaf (international mobility department).
• Retiree: health insurance contribution of 3.2% (basic pension) and 4.2% (supplementary pension) as a general rule, as long as they fall under a French scheme; no CSG, CRDS or Casa if tax residence is no longer in France (CLEISS).

Tax treaty. The BOFiP list of tax treaties concluded by France includes New Zealand (treaty of 30 November 1979, in force since 19 March 1981) but no entry for Tokelau, and Tokelau does not appear either in the BOFiP list of tax information exchange agreements. The text of article 3 of the New Zealand treaty, which defines its territorial scope, could not be read on impots.gouv.fr: the application of this treaty to Tokelau should therefore not be presumed, and should be checked in the text of the treaty before reasoning by analogy. A French national remains taxable in France on all of their income as long as they have their tax domicile there, that is, their home or main place of stay, their main professional activity or the centre of their economic interests (article 4 B of the French general tax code, BOFiP). The income tax regime applying in Tokelau was not found in the sources read.

1. Before departure: notify French agencies of your departure (health insurance fund, CAF, France Travail, pension funds); hand back your carte Vitale if you are expatriating.
2. For any stay, including a short one: take out an assistance contract or insurance covering all medical costs, evacuation and medical repatriation, imperative according to France Diplomatie.
3. Contact Tokelau's Department of Transport and Support Services, in Apia, to find out whether an entry permit can be issued, then book the crossing; book no ticket or accommodation before having the permit.
4. Plan entry to Samoa (no visa for up to 90 days in 180 for a French national, passport valid 6 months after the end of the stay, proof of onward departure) and private accommodation with a host family or in the villages' guesthouses.
5. Bring your medication for the whole length of the stay, a clinical summary, repellent and plasters; bring your health forms to the department on arrival in Apia, as a check is planned on departure and arrival (Tokelau Department of Health).
6. Seconded employee: request continuation of the French scheme from Urssaf (international mobility department) before departure; then send paid invoices with form S 3125c.
7. Long-term settlement: choose health protection (employer's contract, individual contract or CFE), before departure or within the deadlines indicated by the CFE.
8. Taxation: have your situation validated with the French tax administration and Tokelau's administration; read article 3 of the French-New Zealand treaty before assuming it applies.
9. Retiree: contact CLEISS or your pension fund before departure, then compare the CFE (retirees' plan) and private insurance.
10. Register on the roll of French nationals living abroad with the French embassy in Wellington, responsible for Tokelau (free).