Healthcare on Sint Maarten: no CAK route, a ZV for employees — and beyond that you yourself

At the EU destinations the healthcare section is a reassurance: the CAK treaty route takes pensioners along into the system of the country of residence. On Sint Maarten the healthcare section is the place where plans founder. This article explains why — and in which order you do arrange it then.

No treaty, no CAK — not even within the Kingdom

The Dutch foreign-country scheme works only in treaty countries, and within the Kingdom there is no healthcare treaty: Aruba, Curaçao, Sint Maarten and the BES islands are not on the list. Your basic insurance ends on the day of deregistration, and nothing takes its place — no S1, no treaty contribution, no CAK letter.

The bitter footnote of this two-country island: whoever goes to live five hundred metres further on, on the French Saint-Martin, does fall under the treaty scheme as a pensioner — that part is France. On the Dutch side of the border you arrange everything yourself.

The ZV: only for employees below the wage limit

Sint Maarten has no residents' insurance like Curaçao's bvz. The administering body SZV insures under the health insurance (ZV) only employees in paid employment below the wage limit — XCG 120,000 a year since 2022 — through a premium that lies largely with the employer. Whoever falls under it is covered for GP, hospital and medicines as soon as the employer has completed the registration.

Everyone else falls outside it: whoever earns more, whoever runs a business, and everyone who doesn't work — pensioners first and foremost. For them private insurance is the system, local or international.

Private insurance: the acceptance question first

And there lies the breaking point. International expat policies accept new customers with age limits and health declarations: premiums rise steeply with age, existing conditions are excluded temporarily or permanently, and above seventy-five many insurers no longer take on new customers. Whoever emigrates at sixty-eight pays heavily; whoever tries it at seventy-eight may find no cover.

Reverse the order: ask the acceptance question first — in writing, with age limits and exclusions in black and white — and only then take irreversible steps such as giving notice on your rented home or selling your house. And cover the gap: between your Dutch end date and your first insured day there should be a bridging policy that carries medical costs in the Caribbean.

Weigh up too what the island itself can do: for complex care you fly to Colombia, Guadeloupe or the United States, and a good policy covers that evacuation. The St. Maarten Medical Center is a general hospital, not an academic centre.

The local national insurances: AOV and AVBZ

Whoever settles does take part in the island's national insurances: between the age of fifteen and the pension age of 65 you accrue Sint Maarten AOV in insured years, alongside what you have standing in AOW (the Dutch state pension) in the Netherlands — the two are later paid out side by side. To give an idea of the order of magnitude: the full AOV pension stands at XCG 1,407 a month as of 1 January 2026, and the premium is 13% of wages up to a premium limit of well over XCG 132,000, split between employer and employee. If you arrive at sixty-five with a handful of insured years, your Sint Maarten accrual is therefore a supplement and not an income — count on your Dutch AOW as the basis.

And on AOV benefits, as long as you live on the island, 1% AVBZ premium for long-term care is withheld.

For the Dutch side the ordinary emigration lesson applies: AOW accrual stops on departure, and the voluntary continuation has a registration deadline of one year. The healthcare allowance stops together with the basic insurance — that item disappears from your budget, the private premium takes its place, and that second one is almost always larger.