Healthcare in the Dominican Republic: no CAK, no S1, so you insure yourself
The Netherlands has no healthcare treaty with the Dominican Republic, so there is no CAK route and no S1 form. Your Dutch basic insurance ends when you leave. The Dominican system is open to foreigners with legal residence, but runs mainly through an employer. For those who come without a job, the public insurer SeNaSa offers a voluntary plan, and the migration service itself asks for insurance.
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Anyone moving to the Dominican Republic arranges their own health insurance. No Dutch safety net comes along, and the Dominican system is built around work.
Three things to know in advance:
- The Netherlands has no social security treaty with the Dominican Republic. That is why the country is not on the CAK list of treaty countries.
- Foreigners with legal residence may join the Dominican system. But the usual way in is through an employer.
- For a temporary residence the migration service asks for a guarantee policy covering health and repatriation costs.
What happens to your Dutch insurance?
Your Dutch basic insurance belongs to living in the Netherlands. It ends when you emigrate; how to arrange that without a gap is explained in cancelling your health insurance. The Dutch Tax Administration writes that anyone with no Dutch income after emigrating is no longer insured under the national insurance schemes. There is then no longer any right to the Long-term Care Act either.
In Spain or Portugal the CAK fills that gap. With a Dutch pension you then arrange your care through an S1 form, at the Netherlands' expense. That is only possible in a treaty country, NederlandWereldwijd writes.
The CAK list consists of the EU, the EEA, Switzerland, the United Kingdom and eight countries from Bosnia to Turkey. The Dominican Republic is not among them. It is also missing from the list of 36 social security treaties the minister gave in 2024. So there is no S1 and no CAK contribution. You insure yourself privately, also with a pension.
How does the Dominican system work?
The basis is the social security law, Ley 87-01. Article 5 gives all Dominicans and all legal residents the right to join. For health insurance the law names foreigners who have their residence in the country. SISALRIL, the supervisor of the health insurers, writes the same: foreigners with legal residence should also be registered.
The system has three regimes:
| Regime | For whom | Who pays |
|---|---|---|
| Contributivo | salaried employees | employer and employee |
| Subsidiado | self-employed below the minimum wage, unemployed, people with a disability, the poor | mainly the State |
| Contributivo subsidiado | self-employed | the insured person, with a contribution from the State |
The insurance itself runs through an ARS, an Administradora de Riesgos de Salud. That is a health insurer that provides the basic package. SeNaSa, the Seguro Nacional de Salud, is the public ARS.
If you are an employee, your employer arranges the enrolment. If you come as a retiree without Dominican income, none of the three regimes fits automatically. The sources name no specific route for that group.
What can a retiree without a job do?
SeNaSa offers the Plan Larimar: a voluntary plan for Dominicans and foreigners who want a plan in their own name. The conditions on SeNaSa's website:
- an online application form;
- a copy of your cédula, the Dominican identity card;
- for your partner a marriage certificate or proof of cohabitation;
- payment in advance per quarter, half year or year;
- from age 55 a medical examination.
The cover has limits you need to know. The plan pays for a hospital stay up to RD$ 250,000 per case. For expensive conditions there is a limit of RD$ 500,000. Medicines from the pharmacy are reimbursed at 80% up to RD$ 4,000 a year. The plan also covers the repatriation of mortal remains to the country of origin. The premium is not on the page.
SeNaSa also has a plan for retirees. It is only for those who receive a pension from the Dominican State or from the armed forces fund. A Dutch pension gives no access to it.
The Larimar plan's list of requirements asks for a copy of the cédula, and you only get that after your residence. SeNaSa also describes the plan as open to foreigners with a passport; ask SeNaSa what applies to you. For the first months, and for any stay that costs more than the limits, you need an international or private policy. Have it start on the day your Dutch insurance stops.
Which insurance does the migration service ask for?
For a temporary residence the DGM asks for a póliza de garantía: a policy with an insurer approved by the DGM, for your health costs and the costs of repatriation. It asks for it again at every renewal.
The investors' desk, which pensionados and rentistas go through, also asks for a guarantee policy. According to the regulation, that covers the DGM's costs if you break the rules, not your healthcare. Which route fits you is explained in the residence routes.
Such a guarantee policy is a requirement of the migration service, not health insurance. Read the conditions and check what it covers, and up to what amount.
What do you look for in a policy?
Three things:
- Limits. Compare the maximum per stay and per year with what a private clinic charges. The Larimar plan stops at RD$ 250,000 per case.
- Age and examination. From age 55 SeNaSa asks for an examination. Ask in writing what the result means for your cover.
- What your AOW does. Your healthcare costs come out of the same budget as your pension, and for a single person the AOW is lower outside a treaty country. Work it out with AOW, pension and tax.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- CAK — the treaty countries for health insurance (the Dominican Republic is not among them) — hetcak.nl
- NederlandWereldwijd — health insurance through the CAK, only in a treaty country — nederlandwereldwijd.nl
- NederlandWereldwijd — the treaty countries for health insurance (the Dominican Republic is not among them) — nederlandwereldwijd.nl
- Dutch Tax Administration — after emigration no more Wlz and no Anw — belastingdienst.nl
- Ley 87-01 on social security, articles 5 and 7 (text published by the Consultoría Jurídica del Poder Ejecutivo) — consultoria.gov.do
- SISALRIL — frequently asked questions on the system, the ARS and SeNaSa — sisalril.gob.do
- SeNaSa — Plan Larimar, the voluntary plan for foreigners — arssenasa.gob.do
- SeNaSa — the plan for pensionados and jubilados of the Dominican state — arssenasa.gob.do
- Reglamento 631-11, article 48 — the guarantee policy for health and repatriation costs (text published by the DGII) — dgii.gov.do
- Answers to parliamentary questions 2024Z02891 — the 36 social security treaties — open.overheid.nl
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