Healthcare Reimbursement in Wallis and Futuna: Who Pays What Depending on Your Situation

Wallis and Futuna is not a foreign country: there is therefore no social security agreement. According to the Assurance Maladie, the territory is not among those that have signed bilateral agreements with mainland France, and the overseas countries and territories do not apply the European coordination regulations. Care on site is funded by the State (Article 68 of the 1972 Finance Act): “reimbursement” therefore takes the form of free care at the point of treatment, not of a statement. The Caisse des prestations sociales (social benefits fund) only manages pensions and family benefits.

The right cover is chosen before departure, according to status and how often you travel. The notions of out-of-pocket cost and of reimbursement base apply to insurance contracts taken out for care outside the territory. The organisation of care is presented in the guide to the healthcare system of Wallis and Futuna.

An employee living in the territory benefits from free care provided by the Health Agency. The applicable labour code also provides, in case of illness certified by an approved doctor, for suspension of the contract for six months at most and an allowance equal to the pay paid by the employer, within the limit of normal notice (Articles 47 and 48). Industrial accidents come under allowances provided by order, for lack of a social security scheme comparable to the mainland one (Court of Audit). Outside the territory, no local cover is provided for care chosen by the person.

A State civil servant assigned to Wallis and Futuna benefits from free care on site. The Assurance Maladie specifies that they must have kept their carte Vitale despite leaving so that their care is covered during their temporary stays in France. The IGAS (the French social affairs inspectorate) notes that the cover arrangements for posted civil servants during their stay in mainland France leave “blind spots”. It is prudent to ask your fund for written confirmation on this point.

An employee sent by a mainland company may come under a secondment or a local contract. The official sources consulted describe no arrangement for maintaining the French scheme specific to the territory; the Assurance Maladie’s reply on the transfer of residence applies to any non-civil-servant. Any continued affiliation to the French scheme follows the rules for secondment outside an agreement, to be checked with the Urssaf (the French social contributions collector) and the CLEISS (the French centre for international social security links) before departure. The guide to secondee or expatriate compares the two statuses.

A self-employed person comes under the same scheme as an employee: free care for a resident, no health insurance contribution, patente (business licence tax) for the activity. Any affiliation to the Caisse des prestations sociales, which manages pensions and family, is confirmed with it. For care outside the territory, insurance covering hospital care, outpatient care and repatriation remains the most complete solution; see digital nomad insurance.

Spouse and children living in the territory also benefit from free care. The Caisse des prestations sociales pays family benefits (XPF 11,000 per child per month, i.e. €92, according to the Court of Audit), a birth bonus of XPF 20,000 (€168) funded by the territory and the maternity leave allowance. In mainland France, no agreement allows the family to be covered: see expat family insurance.

A retiree living in the territory benefits from free care provided by the Health Agency. The State pensions service deals, on its health cover page, with pensioners living in French Polynesia, New Caledonia or Wallis and Futuna, but names a local body only for the first two territories, which have a health insurance scheme. As no local health insurance body is designated for Wallis and Futuna, the pensioner checks with their pension fund what it maintains. The page on retiring in Wallis and Futuna complements this point.

A student studying in Wallis and Futuna does not open entitlement to the European health insurance card, as the overseas countries and territories do not apply the European regulations. They benefit from free care for treatment on site if they are a resident; for care in mainland France, New Caledonia or abroad, student insurance fills the gap.

The Caisse des Français de l’Étranger (CFE), the voluntary health insurance scheme for French people abroad, is aimed at expatriates. Its form lists Wallis and Futuna among the places of residence, but the sources consulted do not specify the eligibility conditions for a resident of the territory: a written reply from the CFE is needed before any membership. See the glossary entry on the CFE and the guide to CFE reimbursements.

International health insurance from the first euro reimburses actual costs within its limits, after any deductible, waiting periods and exclusions: it serves for care in mainland France, New Caledonia, Australia or Fiji, and for the evacuation of a companion or a relative. The State services strongly advise taking out supplementary insurance for any trip outside the territory. The tourist is not covered by the free care reserved for residents in the texts consulted: the charge for a passing visitor should be asked of the Health Agency, and travel insurance with assistance and repatriation covers medical costs.

• Consultation: free in a dispensary (by appointment) or in the emergency department for a resident; specialist opinion requested by the GP, which counts as a prescription; no private-practice sector tariff, as this form of medicine does not exist.
• Hospital care: free for a resident at Sia and Kaleveleve hospitals; the costs of a transfer outside the territory are borne by the Agency when it prescribes the evacuation.
• Medicines: dispensed by the Agency’s pharmaceutical service on prescription; whether non-prescription products are free is not detailed by the sources consulted.
• Dental: the Agency provides outpatient dental care with three dentists (State services); prostheses are not described by the sources consulted.
• Optical: ophthalmology relies on temporary missions (a few missions and more than a thousand consultations a year); the cost of glasses is not documented and should be asked of the Agency.
• Maternity: Sia hospital with 14 gynaecology-obstetrics beds; leave of six weeks before and ten weeks after childbirth, with free care and half the salary (Article 116 of the applicable labour code). A birth that takes place in Wallis and Futuna is not covered by the mainland primary fund.
• Medical evacuation: transport, care and accommodation organised by the Agency (New Caledonia, mainland France, Australia), companion included for a minor, a disabled or a dependent person.

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

On returning to mainland France, affiliation follows ordinary law, the Assurance Maladie specifies: if the person already has a social security number, they follow the steps linked to returning to France; otherwise they attach their birth certificate to the file sent to the primary fund of their place of residence. The stable and regular residence condition applies, hence the value of the page on returning to France and of the guide to reducing the waiting period. During a stay in mainland France, only the civil servant who has kept their carte Vitale is covered, according to the Assurance Maladie.

For patients evacuated to mainland France, the State services mention an agreement with the Assurance Maladie providing for provisional registration in Paris and referral to the central hospitals; its current status has not been checked. Evacuations to New Caledonia are the subject of agreements with the New Caledonian bodies.