Healthcare Reimbursement in the Turks and Caicos Islands: Who Pays for What Depending on Your Situation

CLEISS lists the Turks and Caicos Islands neither among the States linked to France by a social security agreement nor among the territories covered by the European regulations: for a temporary stay, it places them in the “other countries or situations not covered”, where there is, on the spot, no possibility of cover outside the provisions of an agreement. The CLEISS directory of foreign schemes has no entry for this territory. There is therefore no European card, no aggregation of periods and no cross-border cover. Four players may be involved depending on status: the NHIP of the National Health Insurance Board, the retained French scheme (secondment), the CFE and an international health insurance.

The notions of reimbursement basis and out-of-pocket cost help compare offers. The conversions on this page are based on the ECB reference rate. How care is organised is presented in the guide on the healthcare system in the Turks and Caicos Islands.

The local-contract employee is registered by their employer with the NHIP and the National Insurance Board: the NHIB indicates that the employer withholds the employee share from pay and pays it by the 14th of the month at the latest, and that proof of up-to-date NHIP and NIB contributions is requested to renew a work permit. You may keep private insurance, but registration with the NHIP remains compulsory. See the glossary entry on the local contract.

The seconded employee remains affiliated to the French scheme during the assignment, for three years renewable once according to CLEISS. Their contributions are paid in France as if they worked there, but they may also have to pay those of the host country. They are covered up to what they would have received in France: they send their paid invoices with form S 3125c to their fund, and a private top-up is advised if care is expensive. Their dependants follow the same procedure; those who stay in France remain attached to the fund. Sick leave is declared to the fund within 48 hours. Depending on residence status, local registration with the NHIP and the NIB may also be required: this should be confirmed with the NHIB. See seconded or expatriate and the seconded employee glossary entry.

The self-employed person comes under the NHIP “self-employed” category, with a dedicated registration form, and may join the CFE voluntarily for sickness and maternity. The NHIP contribution amounts for self-employed workers are not detailed on the pages consulted and can be read from the NHIB. International insurance complements the arrangement for medical evacuation and care abroad. See digital nomad insurance.

The student has no European card. The NHIP provides a “student” category for those who fall under no other, with a student visa required for a foreign student. Before age 30, the CFE offers a youth offer (with a contribution that depends on age and the plan chosen). See student insurance abroad.

The spouse and children of an insured person come under the NHIP dependants category, which covers certain spouses, children, grandchildren and ascendants, on presentation of the dependants registration form. For a seconded employee, the reimbursement procedure is the same as for the policyholder. The CFE and international insurers both offer family contracts. See expat family insurance.

The retiree does not come under form S1, which is valid in Europe. CLEISS indicates that they check with local institutions to what extent the local scheme covers their care, and that they can join the CFE voluntarily or take out private insurance. The NHIP has a “pensioner” category and a “voluntary contributor” category; their conditions of access for a foreign retiree and their amounts are not detailed on the pages consulted. The CFE retiree offer has a contribution that depends on age and the plan chosen, with no health questionnaire, for holders of a pension from the French basic scheme. See the guide on retiree health insurance abroad and the page on retirement in the Turks and Caicos Islands.

During a temporary stay in France, French cover concerns holders of a French pension showing at least 15 years of insurance in France and with no professional activity; an accompanying spouse is not covered and must take out insurance before the stay, and a hospital stay of more than a month requires prior recognition by the CPAM (the French local health insurance fund). CFE members send their claims for care received in France to the Seine-et-Marne CPAM.

The CFE is a voluntary social protection body. In France, it reimburses according to the principles of the Assurance Maladie (the French national health insurance); abroad, reimbursement depends on the country of care, with a rate or flat amount applied to actual expenses. The scale specific to the territory can be read in the CFE's table of benefits: the difference with the price charged remains the member's responsibility. The guide on CFE reimbursements details this mechanism.

• Offers: main offer, youth offer (under 30) and retiree offer, each with a contribution that depends on age and the plan chosen; the final price depends on the country, age and family composition. The main offer also covers stays of less than three months in France.
• Waiting period: cover starts immediately if you join before departure or within three months of settling abroad; beyond that, the waiting period is three months before age 44 and six months from age 45.
• Maternity: conception must be after joining or after being attached as a dependant.

On returning to France, service-public states that a CFE member may keep their expatriate benefits for three months, subject to conditions. Without the CFE, someone who does not start work immediately must show three consecutive months of residence in France before submitting their application for universal health protection (form S1106); someone who resumes a job is covered from the first hour worked. See reducing the waiting period and the page on returning to France.

International health insurance with first-euro cover reimburses actual costs within the limits of its contract, after any deductible, waiting periods and exclusions. It answers the weak point of the NHIP abroad, which is reserved for emergencies and essential care not available on the spot, with a co-payment. Contracts are compared on the annual cap, the coverage zone, evacuation and the handling of medical history.

The tourist is not eligible for the NHIP and pays for all their care on the spot. CLEISS recommends taking out travel insurance suited to the real cost of care in the country, or checking existing cover such as that of a bank card. Reimbursement on return to France of unforeseen care is a possibility and not an obligation, and medical repatriation is not covered by health insurance. See long-stay travel insurance.

The benchmarks below use the pages of the NHIB and the Ministry of Health; they describe the public scheme, not private contracts, and amounts not read are not given.

• Consultation: anticipated co-payment of about $10 (about €9) for most services in InterHealth Canada facilities and public clinics; $35 (about €31) reimbursed per visit with a private doctor participating in the plan.
• Hospitalisation: essential care is covered by the NHIP, with no benefit cap according to the FAQ; the patient pays uncovered expenses. The amounts of the hospital co-payment are not indicated.
• Medicines: those on the approved list are covered during hospitalisation; on an outpatient basis, cover applies to certain selected chronic diseases.
• Dental care: the NHIP benefits presentation page does not mention dental care; the Ministry of Health runs public dental clinics, notably at the Cheshire Hall Medical Centre and the Cockburn Town Medical Centre.
• Optical care: no information on optical cover was read on the pages consulted; it should be requested from the NHIB.
• Maternity: maternity is among the care covered by the NHIP, with no amounts or limits published on the page consulted. On the CFE side, conception must be after joining.

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