Guide to health insurance in France
France's healthcare system provides some of the best public healthcare in the world, although private health insurance is necessary for certain circumstances.
All legal residents in France are obliged by law to have health insurance. Many residents in France are eligible to apply for state health insurance (via sécurité sociale) to access France's CMU (Couverture Maladie Universelle) healthcare scheme, otherwise they need to apply for private health insurance.
Who is eligible for French health insurance?
In general, all legal residents in France who are employed and pay into the French social security system will be eligible for state French health insurance. Alternatively, those who have been a legal permanent resident in France for more than five years may also be eligible for state French health insurance.
Expat retirees who hold an E121/S1 form are also able to access CMU healthcare. This form is issued by the Department of Work and Pensions and confirms the holder's long-term commitment to remaining in France.
Students in state-supported French universities may find they are covered by the local healthcare system, while students in private universities will generally need private health insurance.
European nationals who are temporarily in France can access state healthcare if they have a European Health Insurance Card (EHIC), but will need to apply for state French health insurance once they become residents in France.
People who live in France for less than six months per year (183 days) will not generally be eligible for public healthcare. Those who are not eligible for state health insurance will find a range of affordable options for private health insurance in France.
Applying for French health insurance
The first step to acquiring French health insurance is to join the French social security system. If you're employed the formalities will generally be handled by your employer, otherwise you need to obtain proof of employment and visit the CPAM (Caisse Primaire d'Assurance Maladie). You may be asked to show proof of identity and legal residence, birth and marriage certificates, proof of residence (utility bills, rental agreement), evidence of income and so on. You can call the CPAM's English-speaking helpline for more information: 3646 (from France) or +33 811 70 3646 (from abroad); fees apply.
After you have registered, you'll receive a Carte Vitale (green card), which is the national insurance card in France. It includes information necessary for making healthcare claims but does not store medical information. You will need to present your Carte Vitale at every health appointment (doctor, hospital, pharmacy) and will generally receive reimbursement directly into your bank account within a week. You can update your Carte Vitale annually by inserting it in the green box that can be found at CPAM offices and some hospitals and pharmacies.
French health insurance and healthcare costs
Anyone working in France will have health contributions automatically deducted from their salaries, enabling the state to care for all citizens, regardless of age or income. Costs vary according to a number of factors, including your income and household, but it averages some 6–8 percent of your net income above a minimum threshold set by the state.
Patients are free to choose which doctor they want to sign up for, and in most cases an appointment with a GP will cost a flat fee. The majority of the cost is then reimbursed by the state, usually in the region of 70 percent for doctor visits and some 80 percent for hospital visits, leaving the rest to be covered by the patient.
To make up the difference of what the state does not cover, many French residents subscribe to a private medical insurance policy, known as a mutuelle (mutual society). There are many mutuelles to choose, some of which are catered to specific professions while others are aimed at English speakers. If you're an employee of a company, you will most likely be able to join the company's policy as part of your benefits package. Students in France, meanwhile, can either choose to be covered by their parents' mutuelle or select their own individual one.
Most of these companies will reimburse the remaining 30 percent of your general healthcare costs, including emergency hospital treatment. The cost of private care depends on the type of cover required, as well as factors such as the age of the applicant. Very few mutuelles ask for your health details prior to approval. Basic packages tend to focus on hospital care and medicine, but may include limited cover for dental treatment.
Unlike health insurance in some other European countries, however, the French private cover does not guarantee faster treatment nor is it associated with private practitioners. It simply acts as a way of bridging the 30 percent gap left by the state cover.
If your income sits within a certain bracket, and you do not have a mutuelle, you are eligible for complementary state-funded healthcare, known as CMU complémentaire, which will pick up what regular reimbursements do not.
State insurance does not cover consultations with psychologists and psychoanalysts, osteopaths or chiropractors, however. It is therefore important to find a policy which covers any specialist treatments you may require. This especially applies to anyone moving to France with an existing illness or chronic condition. It's imperative to acquire medical insurance which covers your specific condition, in order to ensure you receive the same treatment in France as you would at home, with the exception of some retirees who may be covered by state healthcare. It's therefore important to start researching and comparing plans before moving, in order to ensure you obtain the best possible cover for your condition.
The majority of specialist practitioners are independent, but are paid from the public health funds. The price of their services are fixed by the state, but some carry a surplus charge which must be paid by the individual if their mutuelle doesn't cover it.
Thus some policies, for instance, may refer to 100 percent cover, but at first glance can appear misleading. This only refers to state-fixed tariffs, such as the standard charge for a consultation with a GP. Any surplus charged will not be covered by the mutuelle, and is therefore payable by the individual. It may seem complicated at first, but understanding the French healthcare system is part of the process of integrating into the French way of life, so don't be afraid to ask for advice.
Dental care is covered by the health service, but comes with its own tariffs and reimbursement rates. General dental treatments are reimbursed in the same way as other care that falls under the specialist category, but more advanced procedures will include reimbursement at a lower rate, due to the cost. It is therefore important to ascertain what dental cover, if any, prior to committing to a specific private plan.
For prescriptions, your mutuelle may also offer partial or total refunds depending upon your specific policy.
Expatica / Bupa Global
Bupa Global is a leading international expatriate health insurer that provides coverage in more than 190 countries.
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Updated 2013; July 2015.
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