The social security system in Mayotte

Affiliation

The conditions for registration with the Mayotte health insurance scheme are as follows:

• Be a resident of Mayotte.
• Be in a lawful situation, if of foreign nationality.

Application for registration must be submitted to the CSSM, which will issue the carte vitale and the certificate of registration.

Policyholder contribution to healthcare

The CSSM reimburses healthcare costs at the same rates as in mainland France.

The costs incurred are borne in part by the insured party: this is referred to as the “patient contribution”.

For example, in the event of a consultation with a general practitioner:

• CSSM reimburses 70% of the consultation price
• the insured pays the remaining 30% of the consultation price, referred to as the patient contribution. These costs may be covered by complementary health insurance.

100% coverage of the healthcare costs of Mayotte policyholders is available, in certain situations and sometimes subject to income conditions. Further information can be found at the CSSM’s website.

Health Insurance

The insured party is entitled to daily sick pay from the day work is required to cease due to illness.

The insured party must provide evidence of:

• at least 200 hours of work over the previous 3 months;
• payment of a minimum level of sickness/maternity contributions on the remuneration received during the previous 6 months.

Universal health coverage (PUMA) is not applicable to Mayotte.

Compensation in the event of sick leave

In the event of incapacity for work due to illness, employees may be prescribed sick leave by their doctor.

The Health Insurance system pays compensation to employees not able to work, from the 5th day of sick leave. The allowance paid is referred to as the “daily social security allowance” (IJSS).

The daily allowance is calculated based on the insured party’s base daily salary. This salary is computed by taking into account the individual’s last 3 months of salary

View the brochures made available by the Social Security Fund of Mayotte (CSSM)

• “Sick leave” Booklet
• “Reimbursement” booklet

Maternity

The insured party is entitled to daily maternity allowances:

• At the beginning of the 9th month before the presumed date of the birth or on the date of the start of the pre-natal rest period for maternity leave,
• In the event of adoption, on the date of the child’s arrival in the home.

To benefit from daily maternity allowances, the insured person must provide evidence of a minimum period of activity of 10 months on the presumed date of birth or the date of the child’s arrival at the home in the event of adoption.

Universal health coverage (PUMA) is not applicable to Mayotte.

To receive maternity benefits, the insured person must send the CSSM, by the end of the 3rd month of pregnancy, the pink form from the “first prenatal examination” document provided by the doctor. She will then be expected to send the CSSM the 7 forms provided at the compulsory prenatal examinations.

Disability insurance

If an insured person becomes partially or completely unable to work due to incapacitation not arising from work, the insured person may apply for a disability pension to compensate for the loss of earnings.

In Mayotte, in order to be entitled to a disability pension, the insured person must meet the following conditions:

• be registered with the CSSM;
• be in possession of a medical certificate declaring the person to be incapacitated;
• not have reached legal retirement age;
• have work or income capacity reduced by at least 2/3;
• be able to prove a period of registration with the general health insurance scheme of at least 12 months and 600 hours of work.

The amount of the disability pension may not exceed the annual amount of the social security contribution ceiling in Mayotte (i.e. €1,934 as at 1st January 2020).

Death insurance

Covered by death insurance under the general scheme, the family of the deceased insured person may claim death benefits, under certain conditions.

The application must be submitted to the CSSM (“Application for death benefit – declaration to be completed by the applicant”).

For more information, please visit the CSSM website.

Any employees who are the victim of a workplace accident, i.e. an accident stemming from their professional activity (including a commuting accident), or who suffer from an occupational illness, are covered by the public health insurance scheme.

To receive benefits, employees must declare the workplace accident to their employer within 24 hours. The employer then has 48 hours to report the accident to the CSSM within 48 hours and provide the employee with an accident form, to be shown to the physician, exempting the bearer from advancing the related expenses.

Temporary medical leave

If, as a result of an occupational accident or illness, an employee is temporarily unable to resume professional activity, the said employee’s healthcare costs are covered by the public health insurance scheme up to 100% without the insured person having to advance any expenses, not subject to registration conditions or prior working time.

The insured employee receives daily allowances from the first day of sick leave due to an accident or occupational illness.

Family allowances are managed by the CSSM.

Insured persons benefit from family allowances if they:

• reside continuously in Mayotte;
• are legal residents and hold a valid residence permit if they are of foreign nationality;
• do not receive family benefits from another family allowance fund or another scheme.

The eligibility conditions for the Mayotte Back to Work Assistance Allowance (ARE-M) are as follows:

• being involuntarily deprived of employment;
• being registered as a job seeker with France Travail and in search of employment;
• residing on the territory of the Mayotte department;
• having worked at least 182 days or 955 hours (6 months) in the 24 months preceding the end of the employment contract;
• not having reached the minimum legal retirement age;
• being physically fit for employment.

The existing framework in Mayotte is progressively converging towards that of mainland France since 2018.

New rules have been introduced relating in particular to the legal retirement age, the age for benefiting from full pension, and the increase in the duration of insurance for children.

Find more information on Cleiss website

Find the contribution rates in force in Mayotte on the CLEISS website: click here.