There are many wonderful things that could be said about residing here, but one thing that may be challenging is navigating the healthcare system. Depending on where you’re originally from, you might not be used to the level of bureaucracy that exists in this country, but it is possible to make it through, I promise! You simply need to arm yourself with information. Lots of it.
And coffee. Perhaps an apéritif…
Health insurance in France is guided by three things:
Equality for healthcare access,
healthcare quality, and
Here’s a little background to one of the best insurance schemes in the European Union.
In 1945, the social security scheme was created.
This is what it says in Article 1 of the Constitution of 1946:
An organization of Social Security is established for the purpose of protecting workers and their families against all kinds of risks likely to reduce or remove their earning capacity and covering maternity expenses or costs of the family they are supporting.
Three social security funds were established in 1967, and a central agency came into being.
Reform came in 1996 with the aim of creating a universal insurance scheme, including the automatic right to social security for anyone aged eighteen years or older who resides in France.
Also, public and private hospital care standards were updated.
The year 2000 brought the couverture maladie universelle (CMU)—universal health insurance coverage—and the distribution of the personal health ID card (carte vitale) for people aged sixteen years or older. In 2004, financial worries led to further structural reform of the system and redefined the availability of healthcare, attempted to control expenditure and made changes to the managerial bodies. The adage was “curing better by spending better.”
All in all, the system has come a long way and is hopefully the better for it. At least, on the surface.
Still with me?
Great! Sip your wine as I give you an overview.
Infographics courtesy of Mon Quotitien
The National Health Service in France is not free; it is funded by contributions to a social security fund (SCU) which is made up of insurance funds paid into by French residents as well as by fees charged at the point of treatment.
The main health insurance fund is a General Fund called the Régime Général which covers the majority of the working population, the unemployed and those retired and not affiliated to other insurance funds. There are separate health insurance funds for agricultural workers and specialist professions such as doctors, civil servants, railway workers.
Now, before you can access healthcare in France as a foreigner, the necessary papers must be filed in order to prove legal residency. You will need to procure a permanent visa or carte de séjour (CDS), which is an official residency card in France.
Once that is in hand, you can apply for a carte vitale (which grants access to health insurance). All French residents must have health insurance. It involves registering at the local Caisse Primaire d’Assurance Maladie—CPAM—office (the organization that administers healthcare in France), which can be found through the L’Assurance Maladie (Ameli) website.
L’Assurance Maladie, by the way, is the National Health Service in France.
The process includes filling out the application form, as well as proving that you are legally residing in the country; verifying your identity and birthplace through a birth certificate; procuring banking information; and demonstrating gainful employment.
My own personal experience in getting my carte vitale was complicated. It took me a little more than eight months before I had it in hand, with lots of back and forth because of bureaucracy, confusion and red tape. It is helpful to speak the language, but that shouldn’t be taken for granted, as I found out.
Make sure your visa is validated by the Office of Immigration and Integration (OFII) before sending your carte vitale application.
Not having this in place first will cause your application to be rejected.
Have your birth certificate translated by a court-certified translator in France. Nothing else will do.
When you go to the CPAM office to apply for your carte vitale, try to go in the morning (come on a full stomach because you may have to wait). Be prepared; have all your documents, as well as the fee, ready; and have something to read to pass the time, if necessary.
Be aware that the right hand definitely does not know what the left hand is doing in France. Sometimes the French officials were more confused than I was. Patience is key.
The carte vitale
A green plastic card—is the national insurance card issued to anyone eligible aged sixteen and over. It proves you have the right to access French health insurance. The social security number itself has thirteen digits, plus a two-digit clé de contrôle (control key). The numbers indicates, among other things, gender; whether you are foreign-born; and the year, month and place of birth.
This card contains all the administrative information necessary for the refund of care received (except for personal medical information):
Social security number
Information about state health insurance and “top-up” insurance (complementary insurance on top of state coverage)
Information about the relevant health insurance office
Your full name and date of birth, and those of your dependents, if any
Information about any exemption or reduction that applies to payments or supplementary universal coverage, if applicable.
The carte vitale will be used at every doctor appointment, hospital visit, and pharmacy stop that has a computer that can read it. You, the patient, pay up front, and then you are generally reimbursed for your care or prescription purchase directly into your bank account in about five days. Typical reimbursement is around seventy percent from the state. Factors affecting the amount you get back include income level and the Tarif de Convention (current approved treatment cost).
The carte vitale does not expire, but should be updated annually. If you have applied for your carte vitale, but haven’t received it as yet, here’s what you do if you need to see a doctor, go to the hospital or visit a pharmacy. Make sure you get a feuille de soins (a brown receipt) from your visit. CPAM recognizes this as a legitimate medical payment and you will be reimbursed accordingly. If you have a “top-up insurance” card—its color is white—(for complementary insurance coverage) your treatment will be noted and the appropriate reimbursement made by your mutuelle.
A mutuelle provides “top-up” or complementary/voluntary health insurance to its members in exchange for payment. It reimburses medical costs in addition to the State insurance fund. How much additional reimbursement received depends on what level of coverage you have purchased. The “top-up” insurance complements the percentage reimbursed by social security, so less comes out of your pocket, filling in the gaps. As you are required to pay any difference between what your carte vitale covers and the total cost of your visit, it can be helpful to take out such a policy.
Finding the right “top-up” insurance provider can be complicated. The choices are many and complex. When choosing the perfect insurer for you, consider that age, health and your understanding of the French language are all legitimate factors.
The older you are, the more complicated it can be to find complementary insurance coverage (whether private or nonprofit) that is reasonably priced. Some insurers may not cover you over a certain age, or if they do, you’ll pay higher premiums for the privilege. Also, if you don’t speak French, consider looking for an insurer with English-speaking customer service. Pre-existing conditions may also be challenging, depending on the kind of coverage you prefer. You may find it, but it may cost more.
Doctors are self-employed in France but there are official rates that lay out the fees that health professionals can charge patients. Some doctors can charge more, depending on the category of service provided. This is usually found with consultants and specialists and may not be reimbursed by the ‘top-up’ insurer you use. It all depends on the kind of policy you have and what it covers. Going directly to a consultant versus getting a referral from your general practitioner may also affect what reimbursements you receive.
Please note: payment by cash or check is preferred by some doctors.
State registered doctors or dentists are called conventionné. These conventionné fall into Secteur 1: practitioners who charge the official social security rate, and Secteur 2: practitioners who charge an extra fee on top of the official rate. Though a part of the health service, they have the right to impose additional charges. If referred to a specialist by a general practitioner, some may not charge the additional rate.
The few doctors who are completely private are called non-conventionnés. They are free to set their own rates. Doctors and specialists are required by law to show their fees and payment policies to the public. Always ask if you’re not sure about the cost of a service or what secteur applies.
As for drugs and prescriptions, brand medicines will either be reimbursed at a lower rate or not at all if there is a generic version of the drug available. Reimbursement favors the cheaper drug. If you need to take medication frequently, you should consider that when selecting the right “top-up” insurance.
CPAM has an English speaking helpline service based in Normandy and they may be able to help if you have difficulties or questions: 08 11 36 36 46.
The English language CPAM helpline office staff has access to local records but outside of the region they may need a few days to access paperwork in order to help you.
All in all, there is a lot to consider when it comes to health insurance and navigating the system. Bottom line: do your research, have patience, and get someone to help with translation, if needed.
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