Introduction in to the French Healthcare System Healthcare and health facilities in France are excellent. France spends a greater proportion of her GNP on health than on defence. Standards are high; the public and private sectors operate alongside one another and the quality of treatment offered by each one is virtually the same. It should be noted also, that there is no lack of capacity. You will not have to wait for treatment or for a bed and unless you are hospitalised in an emergency, you can go into a clinic or a general hospital of your choice. It is worth comment that a ward in a French hospital generally consists of not more than four beds and usually only two in the more modern establishments. Private rooms are readily available. A recent report on world medical care produced by The World Health Organisation placed France before all other countries in the world.
This is one of many reasons why more and more people are moving to France to set up a new life.
However, if you are not familiar with the way things are run and arranged in France, you could find some difficulty.
 Due to the number of clients moving to France and / or enquiring about the French Healthcare System, we have put this website together to try and provide a definitive source of information and resources.
We have focused two insurance providers as part of this. There are other providers available in France; however we have selected both Exclusive Healthcare and GoodHealth Europe as they operate a system aimed at the English speaking expatriate living in France.
Understanding CPAM...
On 1st January 2000 an event of great significance occurred in France. "Couverture Maladie Universelle" [CMU] came into existence.
The enacting Law, No 99-641 of 27th July 1999, provides that all residents of Mainland France and her Overseas Departments will have the right to State Healthcare at a relatively low cost and that it will be provided free to the poorer sections of the community.
This section aims to answer a number of questions and concerns readers may have when considering a move to France to live and work.
The notion that private insurance and private treatment is superior to publicly provided treatment is possibly correct in many countries but it is not correct in France. The fact is that the state system, supplemented by a good top-up, is superior in many respects, to any health insurance that the private sector could offer at affordable prices.
The public service does not impose any age limit, there is no medical test, anyone will be accepted without question regardless of their physical condition and there is no excess per claim to pay. Treatment in the best private establishments is freely available at the patient’s choice. CPAM settles its share of hospital bills direct and reimbursement of cash payments for such items as routine visits to the doctor are automatic and made within a few days.
CPAM - an overview...
France does not operate both a state healthcare and private sector like in the UK. In France, all providers are combined and regulated with the state. At the point of need, a patient can rest assured of receiving the highest standard of care; however, their medical expenses may not be met in full.
The system provides full cover for the 65+ and for serious medical episodes such as heart attacks and cancer. The majority of cases will be paid up to a level of reimbursement; normally between 70% and 80% of the total amount. The difference becomes the responsibility of the patient.
The tariff which healthcare professionals use to gauge their fees on is called the Tarif de Convention; however in some cases, doctors, surgeons and even hospitals may charge slightly more – this is why you can choose differing levels of cover.
It is worthy of note that establishments and practitioners in France are comprehensively classified by the state. The two principal classifications are Conventionée and Non-conventionée. Conventionée means that the doctor, consultant, hospital or clinic etc. has agreed to observe the price levels negotiated by their associations or in the case of hospitals by themselves with reference to their annual budgets. This price level is known as the Tarif de Convention and on it the whole system of charging and re-imbursement is based. Both the state service and the French insurance companies use percentages of the Tarif de Convention to define the payments they will make.
Certain establishments and practitioners, especially consultants, are free to charge more than the Tarif but this is limited as it was established in the courts by a case in Nantes that the extra charged must be "tactful and reasonable."
CPAM - how it works...
The French system is probably very different from anything you have experienced before. For instance you do not register with a doctor you go wherever you please. You pay the bill before leaving and then claim re-imbursement if you are insured either privately or under the state health scheme [CPAM]. The doctor you have chosen may keep a record of your visit on his computer but you keep copies of such things as X-rays, specialists' reports and the like yourself.
The French service however, unlike the UK National Health Service is not a completely free service so even if you are registered with CPAM you need a top-up insurance policy. It should be noted that the French service plus a good private top-up policy will give you the best medical insurance possible.
CPAM - in detail...
The cost of health care world wide has increased exponentially as the equipment and technology that keeps us all alive longer has become more sophisticated and expensive. France is no exception. An associate of ours suffered an accident in 1994 which resulted in 13 days in hospital. An operation was not necessary but the cost including scans was more than £6,000. A simple prostate operation costs up to £4,000 and open heart or brain surgery can cost £20,000 or more.
It would occupy many pages to examine the regulation and operation of the French state health insurance system and to fully understand why nearly all French people have a "Mutuelle" as they call it. If you are admitted to hospital you will be asked for your CPAM card and normally for your mutuelle card. This is because there is always a part of the bill to pay which is not met by CPAM.
f you qualify for the maximum because you have one of the thirty serious classified diseases, a long term illness or are to undergo significant surgery, you will only pay for food and extras or "Depassements" as they are called, such as consultants fees in excess of CPAM scales. Normally your share will be between 5% and 10% of the total cost.
If however, you are admitted neither for surgery nor for one of the thirty diseases (for instance cancer) the position is quite different. In such cases CPAM pays only 80% of the scale leaving you to pay 20% plus Depassements, food etc. Your share then, is usually 25% to 30% of the total cost and you may be facing a bill for several thousands of pounds. Add ambulance charges, consultants’ fees, diagnostic costs etc. prior to admission and then after care and the figure can become daunting.
Every one living in France needs health insurance of some sort. Depending on our circumstances this may take the form of private insurance, French state insurance or a combination of the two. The following sections deal with the rights of expatriates living in France, your situation if you are insured under the state system and the options open to you in finding an ideal solution.
CPAM - Qualifying for cover
The French Healthcare System is radically different from that of the UK. You must join the state scheme if you qualify, check to see whether you fall into any of the following sections: Receipt of an industrial injury or occupational disease benefit
The E123 covers you in another member state for 100% of the cost of treatment of a specific condition only.
You have selected Long-term Incapacity Benefit, which in France is called Invalidity Benefit. This entitles you to very special treatment.
Long-term Incapacity Benefit replaces Short-term Incapacity Benefit where the person concerned has been unable to work for more than 12 months. Long-term Incapacity Benefit when moving to another member state entitles the beneficiary to an E121, even if under retirement age. The E121 in such cases has the Invalidity box ticked and this provides significant extra advantages. CPAM’s percentage scales that are normally used to calculate the amount to be reimbursed do not apply and reimbursement at 100% of the Tarif will be made. This not only covers the disabling condition; all treatment including routine dental care is covered 100%. As an example, the Tarif price for a consultation with a Doctor is €20. The normal reimbursement is 70% = €14 - €1 Statutory Charge. With the Invalidity Box ticked the reimbursement should be €20 -€1 Statutory Charge. The same level applies to treatment in hospital.
If you are still in the UK in the short or long-term planning stage or are just considering a move you can contact us and we will help with information and advice,
or
Contact the (Department of Work and Pensions) DWP
If your plans are advanced and you will leave the UK for France during the next three months you should not delay making contact. If you leave it to the last minute you can become part of a long waiting list. This can be expensive; you cannot use the E111/EHIC as once you arrive with the intention of staying you are no longer a visitor you are a settler. To be safe you will need full cover private insurance and this should never be necessary if you plan forward and act in time.
During the process of obtaining the E121 you will be asked for your address in France if you have one and your date of departure from the UK. The E121 should have the same Start Date as the date you leave the UK and affiliation to the French NHS should be effective from your date of arrival.
Please remember that the E121 does not work on presentation like the E111/EHIC. It has to be registered with CPAM and a French Social Security number issued. Registration should take place as soon as possible after your arrival. You will find the address and contact number of your nearest CPAM branch in your local ‘phone directory under CPAM. If you find difficulty at any stage contact us and we will help you.
You may consider that you do not need a Top-up Policy in view of the level of cover provided by CPAM and that you will meet any extra charges yourself. This is entirely for you to decide..
The view has been expressed that whilst these forms are issued as described by the DWP in the UK, it is advisable to check the application of cover with the French Authority on presentation.
Where the words “covered 100%” have been used it should be clearly understood that this means 100% of the Tarif de Convention, which is not necessarily 100% of the actual cost.
A long stay visitor
An EHIC provides you with any necessary medical treatment during a stay of not more than 180 days in another member state.
Qualifying Conditions:
To be resident in your home country and visiting another member state intending to stay for not more than 180 days. If you arrive intending to stay permanently the E111/EHIC does not cover you at all.
THE EHIC (NEW EUROPEAN HEALTH INSURANCE CARD - E111 REPLACEMENT)
One of the primary purposes of the founders of the European Union in 1971 was to make it possible for the populations of all member states to travel, work, and live freely and securely throughout the new Super State.
The old E111, for emergency treatment in all member states has been replaced by a plastic card that allows not only emergency but necessary medical treatment that arises during a temporary stay in another Member State The words “necessary medical treatment” are important. They recognise the principle that you are no longer a citizen of one member state visiting another member state; you are a citizen of one country with the right to the same care and routine medical treatment as all others in the area you are visiting. It should be noted that you cannot go to another member state especially to obtain treatment for an existing condition or illness. An E112 is required for this.
Unlike the old E111 the EHIC is valid for stays in a holiday home for up to six months or even more in any one year. However, please note that if you live continuously in France for over 183 days you may become Resident and Tax Resident. Also, you may lose your right to free NHS care in the UK.
An important point that is often missed is that the French NHS system is very different from the UK NHS system. It is classified by the WHO as the best NHS in the world and there are no delays or shortages of treatment facilities. But it only pays about 70% of the cost of medical treatment and you need extra insurance to bridge the gap. Everybody has this in France and most people call it“Top-up insurance.”
Going on ahead leaving one spouse working at home
You may decide that during a planned long term moving process one spouse should remain working in the UK whilst the other becomes resident ahead in France. There may be a variety of reasons such as one working out a contract of employment whilst the other spouse sets up home in France and gets the children to school at an early age. Whatever the reason affiliation to the French NHS (CPAM) can be effected by the use of a Form E109.
The E109 is used to record all family members living in a different member state to that of the person insured under the UK NHS. As with Form E106 the country receiving the Form should enter details of all dependants on the Form E109.
The E109 is issued by the DWP at the request of the spouse remaining in the UK. An application should be made well ahead of the date of departure to ensure that cover can be put in place immediately on arrival in France.
The E109 should be registered at your nearest CPAM office without delay. Passports, Birth Certificates etc will be required.
To be safe a Top-up Policy will be required to cover all members of the family including the one remaining at home if frequent visits will be made using the E111/EHIC.
French Employer
You may be employed in France in which case you and your employer will be paying contributions which will bring you into the state scheme. If you are self-employed you are also required to contribute.
However, depending on your age and circumstances there may be gaps during which you have no entitlement under the E Forms until you reach retirement age and have a state pension.
If you are working for an employer based in France, we recommend that you speak to them in the first instance as they will be in a strong position to explain how to qualify, and explain how the CMU system works.
If you are unable to resolve your query at this point, please contact us.
Single / Working… The E106 may be issued to people coming to work for a UK employer in France or the E109 to cover the family in France of a person working and continuing to pay NIC in the UK. The “E” forms are complicated and you are advised to contact the DWP and seek their advice before leaving the UK. This can save you a lot of trouble later. If you have arrived in France without having done so Exclusive Healthcare and GoodHealth’s Help Service can assist you with information and contacts...
If you would like to discuss alternative options in more depth, please contact us. If you are employed outside of France and frequent France, you may be able to use an international style policy to cover both France and other countries.
Retired
You have selected RETIRING because you have reached the official age of retirement in the UK and are in receipt of a State Pension, this is usually an OAP though other State Pensions may qualify.
This entitles you to make an application for an E121 that will affiliate you to the French NHS (CPAM) normally for the rest of your life or until you leave France to return to the UK or another member state.
If you are married and you or your wife is the first to qualify, the E121 may cover the other as the holder’s dependant beneficiary. Dependant children living with you may be covered also.
Whatever your situation, if you have done nothing so far you should take immediate action.
f you have already arrived in France make contact with the DWP with full information about the date you left the UK or the date you decided to live in France, your address and contact details.
If you are still in the UK in the short or long-term planning stage or are just considering a move you can contact us and we will help with information and advice,
or
Contact the Department of Work and Pensions (DWP)
If your plans are advanced and you will leave the UK for France during the next three months you should not delay making contact. If you leave it to the last minute you can become part of a waiting list. This can be expensive; you cannot use the E111/EHIC as once you arrive with the intention of staying you are no longer a visitor you are a settler. To be safe you will need full cover private insurance and this should never be necessary if you plan forward and act in time.
During the process of obtaining the E121 you will be asked for your address in France if you have one and your date of departure from the UK. The E121 should have the same Start Date as the date you leave the UK and affiliation to the French NHS should be effective from your date of arrival.
Please remember that the E121 does not work on presentation like the E111/EHIC. It has to be registered with CPAM and a French Social Security number issued. Registration should take place as soon as possible after your arrival. You will find the address and contact number of your nearest CPAM branch in your local ‘phone directory under CPAM. If you find difficulty at any stage contact us and we will help you.
You will need a Top-up Policy under most circumstances; CPAM does not pay the complete cost of treatment unless you have Long-term Invalidity Benefit. Mind the Gap !!As already explained, the French (CPAM) does cover a large amount of treatment, but not in full. It is for this reason, people living in France and using the health service also purchase a low cost health insurance to fill the gap between what the state pays and the actual cost of healthcare provision.
As specialist insurance brokers, we have studied the French Healthcare system and determined that there is only one provider who can provide the widest array of benefits and quality of service; Exclusive Healthcare.
We are able to add to the service offered by Exclusive by managing areas of your healthcare needs not otherwise covered such as Life / Term Assurance, Pre-paid Funeral Plans and even Travel benefits. Exclusive Healthcare Exclusive Healthcare was launched exclusively for people from other countries coming to live in France. The founders have lived in France themselves and have worked in the healthcare insurance industry for many years. Their work has brought them into close contact in many countries with a great number of families on the move south, their needs and their problems. Help and advice about which Plan to chose, your personal situation and affiliation procedures is readily available from our office in France or through Essential Health Ltd . Many people arrive in France under the mistaken impression that the French NHS and the UK NHS are similar and their health cover will be easily transferred. This is not the case. Having the right information is of vital importance as you settle into a new life in France. Enquiry Form:Request a free quotation and advice by completing the form below:
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