The French state healthcare system is officially classified by the World Health Organisation as the number one NHS amongst over 191 examined . It offers all who join a level of care in both public and private medical establishments that is not equalled anywhere else. It is available to everyone from the poorest to the wealthiest in the land.
However, the full range of treatment that may apply to a resident of France does not necessarily apply to the EHIC. An example is the registration of a special condition such as chronic arthritis for long-term free treatment. So, what are your rights using the EHIC?
Guidelines issued to member states and insurers by the EU on 7th February 2007 defined this in some detail. A brief summary follows below:
“A patient in possession of a European Health Insurance Card is entitled to all benefits in kind which become medically necessary during a stay in the territory of another Member State, taking into account the nature of the benefits and the expected length of the stay. You must therefore provide all the types of medical care and treatment that the patient's state of health necessitates to enable him to continue his stay in your country under safe medical conditions. The key is that he should not be obliged to cut short his visit in order to return to his country of residence for treatment. However, you are not obliged to provide certain kinds of treatment that can wait until the patient has returned home (most types of dental treatment, for example). The patient might well have problems obtaining reimbursement for treatment that goes beyond what is strictly necessary in the context of a temporary stay.
In addition, some types of treatment extend over a period of time and necessitate follow-up which is not compatible with the temporary duration of the patient's stay in another country. In these cases, once the patient has received "holding" or primary treatment, generally speaking it is preferable for him to return to his own country of residence and his own doctor for further examinations or certain types of treatment.”
The French State’s reception of the new EHIC concept of freedom of movement for all has been enthusiastic. People with holiday homes (Long Stay visitors) can usually register their EHIC with the French Authority (CPAM) and receive reports to their French address by post and refunds directly to their French bank account. This is a great convenience that saves much delay and cost.
It must be understood that treatment will be supplied according to the terms that apply to citizens of the member state in which you are staying for a period, better or worse than in your own country. This means, to be safe, you need a Top-up Policy just like people who live in France full time.
Entitlement in France under the French State medical insurance system differs widely from that in other EEA states. The following outline applies all residents and visitors whatever their age or however they are affiliated to the system and to users of the EHIC; all reimbursements are based on an official price list called the Tarif de Convention.
Reimbursements as a percentage of the Tarif de Convention are:
Visits to doctors
70%
Pharmacy costs
35% to 65%
Specialists’ fees
70%
Routine dental costs
70%
Hospitalisation costs, depending on the illness, vary from
80% to 100%
The above percentages need explanation as the system is complex and varies with different medical conditions. The following are important classifications and normally qualify for reimbursement of 100% of the Tarif de Convention: -
a. A list of 30 serious diseases that includes for instance, cancer, heart disease, insulin dependent diabetes etc.
b. Surgery superior to KC 50. KC 50 is a very low level indeed.
The state pays hospital costs only up to 80% of the Tarif de Convention where the illness falls outside the above two classifications. This limitation can result in a costly shortfall.
The system is complicated and many people coming to France find it difficult to understand. Here are some examples that may help. The deduction of €1 in the following illustrations is non-reimbursable by either CPAM or the insurer and represents participation by the patient as required by the French reforms of 2004.
Routine visit to a doctor.
Tarif de Convention = € 22.00 CPAM pays 70% less €1 = € 14.40 At the 100% level of guarantee the insurer will reimburse the unpaid balance up to € 21.00 the consultancy fee not being reimbursable by law.
Visit to a specialist
Specialists invariably charge more than the Tarif that is € 25 or more for a consultation. The charge depending on the practitioner and the condition is seldom lower than € 35 and can be as much as € 60 or even more.
You are advised to ask for the cost of treatment before treatment is given. If you feel that you are being overcharged you should take it up with your local CPAM office.
We hope the above examples help you to understand the French system. It is not a complete cover system like the UK NHS and this is one of the ways that the excellent service is financed.
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