How does your top up and the French health system work together?

• When you have your carte vitale: When you visit your GP or other medical professionals, you first give them your carte vitale and then you pay. The reimbursement is then automatically done by CPAM and Allianz is linked with CPAM by the “télétransmission” so the top up from Allianz follows within 10 days of CPAM reimbursement.
• If you are under RSI: In this case it depends on who you are with in regard to the health system. If it is RAM, it is just like with CPAM above. If it is anybody else (Harmonie, Radiance, UMRPI, etc), you need to send us your reimbursement statement to get reimbursed for the top up. This is because RAM is the only one that works with top up companies. The others do their own top up insurance, so they are doing everything to make it hard for other top up companies!! You can change to RAM by simply writing a letter to RSI asking for the change. Or ask us and we’ll do it for you.

• Tiers payant card: That is your top up card. This card does not show your level of cover. It simply proves that you have a top up and gives information to the medical profession in case of a “prise en charge”- this is when the top up pays instead of you.

Hospitalisation: When you are hospitalised, the hospital will contact Allianz, so Allianz set up “une prise en charge” meaning Allianz and CPAM will pay instead of you (just as well as the surgery could cost an arm and a leg!!). The only thing you would have to pay for when you come out is the food, the individual room and telephone or TV bill. Simply pass it on to us for reimbursement or send it directly to Allianz santé (remboursementsante@allianz.fr).

• • Pharmacie: Some of the medical profession such as “pharmacie” will ask for your top up card and you therefore have nothing to pay as Allianz pays directly the “pharmacie”. It is called “tiers payant”. So, when you go to the pharmacie, you give them your prescription letter, your carte vitale and top up card and all is paid for.
  • Surcharge: 100% top up cover is 100% of the price set by the French Health System, but the medical professionals are self-employed and are allowed to apply a surcharge. It is mostly done by consultant, surgeon, private hospitals, dentists, etc. Example: the French Health System set price for a hip replacement is 1000€ (not the actual figure, just an example), then you only get reimbursed 800€ (80%) and because the surgeon likes to go golfing week ends!!(Joke) and 1000 euro is not enough for him, he can charge 3000€ , therefore, you would be 2200€ (instead of just 200 euro) out of pocket!! Therefore, a cover with your top up at 300% would cover that surcharge.
  • Excess: There is an excess of 1€ per GP visit, 2€ for ambulance transport (not emergency) and 50p per medicine boxes. This excess is taken back from your CPAM or RSI reimbursement so this why sometimes you get less reimbursement than you should have got.
  • Glasses: Most of my British customers go back to the UK for them or buy the online. But you can choose to have them covered under your top up. Only one pair every 2 years. It’s a calculus to make between what you would get back and how much it increases your premium.
  • Dental cover: Note that maximum dental cover is 200% (the first year) and that might not be enough to cover all cost. E.g. The price according to CPAM for a crown is 104€ so with the maximum cover on dental, you can get up to 208€ But the price for a crown in France is between 500 and 600€! So, it’s also a calculus to make with the premium to see if it is worth adding.
  • ameli.fr: This is the website of CPAM on which you can create your personal account (you only need your carte vitale to do it). Yes, it is in French, but it is full of useful information. You can use the simulator to find out if you are entitled to CMU and ACS (people on low income can get free top up or help to pay for their top up). You can download your reimbursement and you can ask for your attestation de droits (proof of cover). This document is often asked for by insurers to give you access to top up health insurance. If you don’t speak any French at all, there is English speaking phone line created by the French health system to answer all your questions: 0811 36 36 46. RAM and other RSI health providers have a similar web site to download your attestation de droit and reimbursements.
  • fr: From the Allianz web site, you can create your personal account. You simply need your surname, first name, date of birth, email and contract number. Then you can view all your reimbursement, details of contracts, follow claims, etc.
  • Extras: With Allianz top up, depending on your cover, you can get extras like free cleaning if you are in hospital for more than 3 days or 2 hours of cleaning 48 hours after a chemotherapy session or even look after your pets, etc.

  Also, you can get cover for individual room up to 100 or 150€ (normal price is about 75€ so it’s plenty enough). In France, you either share the room with someone else or you can choose to be on your own like an hotel room (with your own bathroom). Note that the cover does not guarantie you will be able to get the room, it simply covers the cost if you can get one. Usually, you can always get one in a private hospital (Clinique).

  CONCLUSION: Feel free to contact me if you wish information on any of the above or to get a free quote for top up health insurance. The first 2 Months are free for pensioners with Allianz at the moment.

  And remember to check out our web site www.bh-assurances.fr/en for all my previous articles (“practical information”) and register to receive our monthly Newsletter.  You can also follow us on Facebook: “Allianz Jacques Boulesteix et Romain Lesterps”

  And don’t hesitate to contact me for any other information or quote on subject such as Funeral cover, inheritance law, investments, car, house, professional and top up health insurance, etc…