Healthcare Reimbursement in Tokelau: Who Reimburses What Depending on Your Situation

The list of bilateral social security agreements in force published by CLEISS includes neither New Zealand nor Tokelau. There is therefore no S1 form, no EHIC and no cross-border cover between the two systems (see the bilateral agreement). Tokelau is a non-self-governing territory within the Realm of New Zealand: its health services are those of its government and not of the New Zealand health system, even though its inhabitants, New Zealand citizens, have access to New Zealand’s public services (MFAT; Health New Zealand).

For a French national, care received on site or during an evacuation is therefore at their own expense, unless a rule specific to their status applies (seconded employee, holder of a private contract, CFE member). The following sections review each situation.

Local contract. CLEISS specifies that an expatriate is subject to the social security scheme of the country where they work and is no longer insured in France: they hand back their carte Vitale, which can be used only if they reside and are insured in France. They may join the CFE voluntarily for sickness, work accidents and the basic pension, without being exempt from the compulsory contributions of the country of activity. No local health insurance contribution scheme is described in the sources read: the employer says what it offers, and the patient referral scheme concerns residents of more than six months, according to the policy cited by MFAT.

Secondment. An employer established in France may keep its employee in the French scheme on the basis of domestic law for 3 years renewable only once; after that term, a 2-year wait is required before a new secondment in the same country by the same company, failing which the employee becomes an expatriate (CLEISS). Care is covered within the limit of what the same care would give in France: the employee pays on site, then sends their paid invoices with form S 3125c to their fund. Family members who accompany them follow the same procedure, while those who stay in France continue to fall under the insured person’s fund (CLEISS). This limit matters for an evacuation: the extra cost over French benefits remains at their expense, hence the value of a top-up contract with evacuation.

Self-employed. No sickness coordination exists with France: the self-employed worker chooses between the CFE, international insurance and an individual contract, and enquires with Urssaf about their French contributions.

Student. The EHIC is valid only in the European Union, the EEA and Switzerland. In a country without an agreement, a student under 20, or on a stay of less than six months, may have their urgent costs reimbursed by their parents’ fund within the limit of French tariffs, on presentation of a certificate of enrolment and provided they return to France at least once per academic year; beyond that, Assurance Maladie invites students to join the host country’s student scheme, topped up by private insurance such as the CFE. No higher education establishment or local student scheme is described for Tokelau: see student insurance abroad.

Working holiday. CLEISS specifies that a young person on a working holiday visa is not eligible for the health insurance of the country they go to, even if they work there, and that private insurance covering sickness, maternity, disability and repatriation is required to obtain the permit. No programme of this kind is described for Tokelau in the sources read.

Retiree. In a country without an agreement, it is up to the retiree to check with local institutions the share of care covered, or to join the CFE or private insurance (CLEISS). No S1 form is issued. A health insurance contribution of 3.2% on the basic pension and 4.2% on the supplementary pension is withheld as a general rule as long as the retiree falls under a French scheme; as long as they are no longer a tax resident in France, neither CSG, nor CRDS, nor Casa is due. See the page retirement in Tokelau.

Spouse and children. Those who accompany a seconded employee follow the form S 3125c procedure; those of an employee on a local contract or of an expatriate fall under the private insurance or CFE chosen by the family. The situation of the spouse and children with regard to the patient referral scheme should be confirmed with Tokelau’s Department of Health.

The Caisse des Français de l’Étranger offers health plans according to age and profile (youth plan, main plan and retirees’ plan), valid worldwide, with a price calculated on quotation based on the country of residence, the age bracket and the family situation. It also offers old-age insurance for employees who want to keep contributing to the French general scheme and insurance against occupational risks. The CFE is a voluntary scheme: it does not exempt from the compulsory contributions of the country of activity (CLEISS).

For Tokelau, three points should be read in the plan’s notice before subscribing: waiting periods, exclusions and cover ceilings, cover for an evacuation from an isolated atoll, and reimbursement of costs incurred in Apia or New Zealand. CFE plans are compared with an assistance contract or international insurance; no amount is given here, as the price is set on quotation.

First-euro insurance. An international health insurance or assistance contract that reimburses from the first euro avoids advancing high costs, notably for evacuation. France Diplomatie deems a contract covering medical costs and medical repatriation imperative, and reminds travellers that the embassy can under no circumstances cover them. See repatriation and assistance.

Tourist and unplanned care. Outside the European Union, only urgent and unforeseen medical care may possibly be covered by the health insurance fund on return. Costs are paid on site, keeping prescriptions, paid invoices and proof of payment; the request is made in the ameli account or with form S 3125. The medical adviser assesses the urgency; if approved, reimbursement follows French flat-rate tariffs and not actual costs, and a refusal cannot be appealed. No daily allowance is paid during the stay (Assurance Maladie).

Return to France. The conditions for resuming health insurance rights on return are obtained from the health insurance fund, before leaving Tokelau.

• Consultation and hospital stay. Care is delivered in the three public hospitals on the atolls; no fee schedule for visitors was found in the sources read. Any price should be requested from Tokelau’s Department of Health before departure. A long or specialist hospital stay means a transfer to Apia or New Zealand.
• Evacuation. The patient referral scheme fully funds, for its beneficiaries, access to care outside Tokelau, in Apia or New Zealand (MFAT); a visitor is not cited among them, hence an assistance contract. In New Zealand, people not eligible for publicly funded services pay for their care (Health New Zealand).
• Medication. The choice of medicines available on site was limited at the date of the MFAT evaluation: a traveller on treatment brings their medication for the whole length of the stay. Treatment bought abroad is reimbursed in France only as part of urgent and unforeseen care.
• Dental and optical. No dental or optical service is described in the sources read: non-urgent care is scheduled in France before departure, as it is reimbursed abroad only if it is urgent and unforeseen.
• Maternity. The MFAT evaluation indicates that pregnant women are sent to Apia from about 28 weeks to give birth at the hospital, and directly to New Zealand if there is a risk of very premature delivery. A female visitor is not among the cited beneficiaries of the referral scheme: maternity and evacuation cover is among the points to check in a contract.