A Votre Santé
Many people assume that being a European citizen entitles them to free medical treatment in France, as with the UK NHS. Unfortunately this is not exactly the case- having social security cover in the UK allows you to benefit from the same levels of social security cover afforded to the nationals in the country that is your host. In France that means that you are covered for the ‘Régime Obligatoire’ like any French national but may need to ‘top up’ cover with a complementary insurance. This is also called the ‘Protection Universelle Maladie’ (PUMA).
For ease we have split this article into 4 main categories concerning visitors to France (Non-residents), Residents in France who are working in France or are of official retirement age and the final category we will call the ‘In-betweeners’ – those people who have moved to France before official retirement age and no longer receive an income from work.
Non-ResidentsIf you are visiting France, you will need an EHIC (European Health Insurance Card). It is important to carry this in case you require medical treatment whilst you are away. The quickest way to get a UK issued EHIC is to apply online on the NHS website. A useful tip would be to download the EHIC app for your smartphone so you have access to this information at all times.
The card will cover you for treatment until you return to the UK. It also covers you for treatment of pre-existing medical conditions and for routine maternity care, provided the reason for your visit is not specifically to give birth.
Please note that for cover to be guaranteed your stay should not exceed 90 consecutive days. However the validity of your EHIC card is longer than this : 5 years in general except for workers classified as ‘Frontier workers’ whose cards are valid for 1 year.
The EHIC does not cover you for private consultations so be sure to know if your doctor or consultant is acting for the social security or is private and that you understand what you will have to pay. For full information regarding this go the NHS website under healthcare in France.
Employed in FranceIf you are coming over to France and will be working you may apply directly to the CPAM (caisse primaire assurance maladie) to obtain a social security number, “carte vitale” and thus state health cover. When you receive your ‘carte vitale’ it will be stuck to a piece of paper entitled ‘Attestation Carte Vitale’. This looks very unassuming but it is marked ‘A CONSERVER’ – TO KEEP; indeed this document is possibly even more important than your carte vitale itself and you will need it in order to set up your ‘top up’ insurance.
You may wish to visit your local CPAM or visit www.ameli.fr for more information on applying for the cover. You will need to complete the ‘demande d’affiliation’ Cerfa form and provide the documents listed later in the article plus your proof of employment (if you already have a contract) and your S1 form from the UK (formerly E106/E121).
If you are living in France and registered with the French Social System, you can obtain a French European Health Insurance (EHIC) card by applying to your local CPAM. In France this is known as ‘La Carte Européenne d’Assurance Maladie’ or CEAM. This will be required if you need any medical treatment when travelling outside of France but within the European Economic Area. You should apply at least 2 weeks before your departure. This is something to think about if you plan returning to the UK to visit family and friends! You are no longer covered in the UK without the French EHIC now!
As you are employed, your employer has a legal obligation to provide a top up ‘complémentaire’ insurance to complement your basic cover. He will make a contribution to this and you will pay the balance. This cover can also be extended (at your cost) to cover your immediate family.
Rules for the self-employed are changing in 2018 but currently your request for cover would go through the RSI ‘régime social des indépendents’ rather than the CPAM. Please note that if you intend to employ staff you must provide a top up health insurance to them.
Retiring to FranceIf you are of retirement age and receiving state pension you will also fall in to the category of applying via the CPAM for your state health cover and you will also need your S1 form.
Generally it takes 1-3 months for your request to be treated by the CPAM therefore for any medical consultations/treatment that you may have during this period keep the receipts and other documentation in order to be reimbursed at a later date.
Once you have reached official retirement age (state pension) your EHIC card must be requested in the UK.
The-InbetweenersIf you intend to live (but not work) permanently in France, your EHIC card will give you short-term cover if you are not yet of official retirement age. In this case, the S1 certificate will not be applicable to you and you must make a demande d'affiliation via your local CPAM. Prior to making your request for cover, you must live in France for at least three months, and once you make your request it takes another three to six months to process.
At any point, you may be asked for further documentation to justify your request.
As a 'non-active' person coming to France before official retirement age, your request will be means tested. The majority of people will fall into the category where they do not have to pay social contributions, but if your income from your savings and investments were over €9,611 in 2016, you will be asked to contribute 8% of this income in social charges for access to social security cover. So, someone who earnt €10,000 in income from investments would contribute €800 per annum. This will be reassessed each year. If your situation changes, e.g. you hit official retirement age, start a business or become employed, you will no longer need to pay these contributions. If you fall into this category, weigh up whether private caver or social contributions make the most financial sense for you.
You may be covered for a certain period by your EHIC card but might possibly need to look for a private cover covering the equivalent to the state health cover or the state health cover plus a mutuelle/top up equivalent.
Basic Documents to provide the CPAM/CREICDepending on your situation the following documents will be requested when applying for your state help cover:
• A full birth certificate
• Proof of address (less than 3 months old)
• RIB (official document provided by your French bank)
• Marriage certificate (if applicable)
Other documents may be requested at a later date depending on your status in France at the time of applying. You will also be asked to provide a passport type photograph for your carte vitale.
What about the ‘Top Up’ ?Please note that even if you are in possession of an EHIC, S1 application form (formally the E106), or have been issued with a Carte Vitale, in France there is still likely to be a proportion of your health treatment costs that you may need to pay out of your own pocket. For this reason, most French people subscribe to a complementary health insurance policy. This is generally referred to as a “Mutuelle” and comes with various levels of cover.
If you are a resident in France and have limited resources, once your carte vitale is in place you may be eligible to financial assistance to help you pay for your ‘mutuelle’ through the “Aide au Paiement d’une Complémentaire” or possibly have access to a free mutuelle through the ‘CMU Complémentaire’ if your income is very low. Enquiries should be made at your local CPAM or online via ameli.fr.
For certain illnesses deemed to be long-term illnesses you may benefit from 100% cover for any treatments/prescriptions linked to these pathologies. In order to have this exemption of payment you need to speak to your French GP or specialist who will inform the social security of which treatments are covered by the 100% cover.
What do I have the right to?
|Top Up health
*depending on age and employment status
**if you hold a carte vitale
***needed if not covered by French state health cover
**** IF TEMPORARY STAY IN France is between 15 days and 1 year
After Brexit?At this stage we do not know exactly what the situation will be after Brexit following the negotiations with the EU and its member states. Based on what is in place today in France expats from the UK would likely fall into the case of the ‘In-betweeners’ above and be dealt with on a case by case basis. You would need to be able to prove that you were financially independent and had lived in France for at least 3 months in a regular situation; this includes having access to healthcare. As a French resident you would not have access to the EHIC anymore and not yet access to the French version, the CEAM , so what do you do?
In this instance you would need to think about a private cover that provides at least the same cover as the French social security Régime Obligatoire. Once you have been accepted into the French system you can stop this cover and revert to the RO plus mutuelle (optional). The worst case scenario here would be that if your request is refused for the PUMA via the CREIC then you would need to pay for the private cover for 5 years until you are eligible to ask for permanent resident status.
The health system in France is excellent but not necessarily straight forward to us Brits when moving from the UK so if you live in France or are about to move to France, please contact us for more information and to discuss the options available to you as these may change in the light of Brexit.
Websites & useful contacts :Securité Sociale Assurance Maladie (find your local office in France) www.ameli.fr
Access to healthcare when visiting France http://www.cleiss.fr/particuliers/venir/vacances/index_en.html
Due to the numbers of Anglophones settling in France, the Normandie Assurance Maladie (CPAM) office has set up an English speaking advice line on 00 33 (0)8 11 36 36 46
To find out more and apply for the EHIC: ehic.org.uk
EHIC app: ec.europa.eu/social/main.jsp?catld=559
Rachel Johnson is Commercial Development Manager at CA Britline, an English- speaking branch of Credit Agricole. Tel: 00 33 (0)2 31 55 67 89.
Published in French Property News, January 2018. www.completefrance.com