Healthcare on Sint Maarten: no CAK route, a ZV for employees — and beyond that you yourself
Within the Kingdom there is no healthcare treaty: your Dutch basic insurance stops and the CAK does nothing for you. The SZV health insurance covers only employees below the wage limit of XCG 120,000 — everyone else, pensioners first and foremost, insures fully privately. How the system works, what the premiums are, and why the acceptance question comes before everything.
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Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
On Sint Maarten you usually arrange your health insurance yourself. Only whoever works in paid employment below a wage limit is insured through the island.
At the EU destinations the healthcare section is a reassurance. There the CAK treaty route takes pensioners along into the healthcare system of their new country of residence. On Sint Maarten the healthcare section is the place where plans founder:
- there is no treaty;
- SZV's sickness insurance covers only employees below a wage limit of XCG 120,000 (Caribbean guilders) a year;
- whoever falls outside it pays a private premium that rises with age.
This article explains why, and in which order you then do arrange it.
Why does the CAK not work here?
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 (the form that gives you healthcare in a treaty country), no treaty contribution, no CAK letter.
The wry footnote of this two-country island: whoever goes to live five hundred metres further on in 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.
Who falls under the ZV, and what does it cost?
Sint Maarten has no residents' insurance (an insurance for everyone who lives there) like Curaçao's bvz. The implementing body SZV insures under the sickness insurance (ZV) only employees in paid employment below the wage limit. Since 1 August 2022 that limit is XCG 120,000 a year, XCG 10,000 a month. The premium mostly sits with the employer. Whoever falls under it is covered for GP, hospital and medicines as soon as the employer has completed the registration.
| SZV insurance | Premium | Who pays | Limit |
|---|---|---|---|
| ZV (sickness insurance) | 12.5% | employer 8.3%, employee 4.2% | wages up to XCG 120,000 a year |
| OV (accident insurance) | 0.5 to 5% | employer, by risk class | same wage limit |
| AOV (old-age insurance) | 13% | employer 7%, employee 6% | premium ceiling Cg 132,824 a year (2026) |
| AWW (widows and orphans) | 1% | employer 0.5%, employee 0.5% | same premium ceiling |
| AVBZ (long-term care) | 1% on AOV benefits | withheld from the benefit | — |
| Full AOV pension | Cg 1,407 a month (2026) | — | from 65, by insured years |
Everyone else falls outside it: whoever earns more, whoever runs a business, and everyone who does not work, with pensioners first and foremost. For them a private insurance is the system, local or international.
Why does the acceptance question come first?
And that is where the breaking point sits. International expat policies accept new clients with age limits and health declarations:
- premiums rise sharply with age;
- pre-existing conditions are excluded temporarily or permanently;
- above seventy-five many insurers no longer take on new clients.
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 rental 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.
Also weigh 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.
What do I build up in the local national insurances?
Whoever settles does take part in the island's national insurances. Between your fifteenth birthday and the pension age of 65 you build up Sint Maarten AOV (the island pension), by insured years. That comes next to what you have in Dutch AOW: the two are later paid out side by side. The full AOV pension stands at Cg 1,407 a month as of 1 January 2026, and the premium is 13% of wages up to a premium ceiling of Cg 132,824, split between employer and employee. If you arrive at sixty-five with a handful of insured years, your Sint Maarten accrual is a supplement and not an income. Count on your Dutch AOW as the base. 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 usual emigration lesson applies: AOW accrual stops on departure, and voluntary continuation has a registration period of one year. The healthcare allowance stops along with the basic insurance. That item disappears from your budget, the private premium takes its place, and that second one is almost always bigger. What you earn in wages on the island and what of it goes to SZV is in working on Sint Maarten.
In Vertrekklaar this is phase 1 of 5 of the journey, step 1.2: the same steps, but applied to your situation — in your order, tickable, and with the deadlines monitored. See the whole journey to Sint Maarten or go straight to step 1.2 in the open step-by-step plan.
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.
- SZV — the social insurances of Sint Maarten (ZV, AOV, AVBZ) — szv.sx
- SZV — wage limits and premiums per year — szv.sx
- SZV — premium percentages and the wage limit of the sickness insurance (XCG 120,000 a year) — szv.sx
- SZV — the AOV and AWW amounts 2026 (full AOV pension Cg 1,407 a month) — szv.sx
- NederlandWereldwijd — the foreign-country scheme applies only in treaty countries — nederlandwereldwijd.nl
- SZV — the AOV, the old-age pension of Sint Maarten — szv.sx
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