How to get access to French healthcare system and why you must have a top up health insurance

Well, getting onto the French health system can be a bit complicated and stressful but so important. I have met some of you that are still not affiliated to the French health system and think an EHIC card is sufficient but the EHIC card is for holidays so won’t work if you are a permanent resident in France.  The process is hard work but worth it as the French health system is one of the best in the world (you don’t have to wait one year to get a hip replacement) so here is how to do it:

1. How to get in the French Health System:

First of all, the French health is called. There are differents ways to access the French health system: via the S1, via working in France (as an employee or self-employed) or by simply living in France permanently!

1. You are in receipt of a state pension: That’s good news as you can phone Newcastle (department for health and pension) and ask for an S1 form which automatically entitles you to be on the French health system. Once you have received your S1, you go to your local CPAM office with your birth certificate, copy of passport, marriage certificate, proof of residency (utility bill less than 3 months old, copy of rental agreement or deeds of the house, letter from your Mairie saying you are resident, etc.) and a RIB (French bank details). CPAM, which stands for Caisse Primaire d’Assurance Maladie (is the equivalent to NHS), will then ask you to fill in a form and you get a letter from them one month later with your social security number which means you are on the system. Note that you are on the system as soon as you gave them a copy of your S1 so if you have some bills you can claim them back once you have obtained your social security number. Your carte vitale comes another month after that.
2. Your spouse is still working in the UK: Then you need to phone Newcastle and ask for an S1 for you (that your spouse can get as he or she works in the UK) and you will be covered by the French health system under the S1 of your spouse.
3. You are working in France: Well, if you are an employee, you have nothing to do and will be on the system automatically. Your employer and URSSAF (Institution that deals with stamps for employees) will do everything for you.

If you are self-employed (as an auto-entrepreneur for example) it will be automatic as well. Then, one month after that, you get your number and then, one month after, your carte vitale (like a credit card but for health cover).

Note that your income must be above 3 973€ per year, otherwise the French government will ask to contribute 8% on your other income above 9 933€ (rental from UK, interest on savings, etc..). If you don’t have any other income or if it comes to less than 9 933€, you will not be asked to contribute more.

1. You are early retirees: You can apply to be onto the French health system as long as you have been in France for 3 months and you are entitled to (if you are non-European, a copy of carte de sejour or proof you have applied is necessary). It is called PUMA (Protection Universelle Maladie). You make your application to your local CPAM office (but best to go to the main office of your department).In order to make application you need to complete the application Form 735 Demande d’affiliation au régime général sur critère de résidence and Form 710 Questionnaire « recherche de droits » Ressortissants Européens Inactifs (if you are European). Print them off, complete them, and include all the necessary documentation with it (copy of passport, birth and marriage certificate, proof of address and residency for at least 3 months, RIB, etc) The more the better! You will be required to provide information on your income/resources and will be charged a contribution for your affiliation (same as if you were working!). You also need a letter from Newcastle stating that you are not entitled to an S1. Your application will be transferred to a CREIC office BP 39037 30971 NIMES CEDEX (office who deals with PUMA) but still have to go through your local office.

This process takes ages (more than 2 months) and they will do everything to make you give up! Everybody I met who applied got accepted so don’t give up and always make sure you are as much as a pain as the people that are in front of you are.

Note that if your income (rental income, interest on saving, etc.) is above 9 933€ per year, you will be asked to contribute 8% on what is above 9 933€. Pensions are not considered as income so it’s only rental income or financial income.

1. You are living in France but working for a UK company: You will be on the French health system but your company will have to register with CLEISS so that they will pay your social charges into the French system and stop paying to the UK one.

To set this all up, you need to write to CLEISS, 11 rue de la Tour des Dames 75436 Paris cedex 9. CLEISS means: Centre des Liasons Europeennes et Internationnales de Sécurité Sociale.

Yes, I can hear you say: Brexit! But non-Europeans are entitled to be on the French health system as long as they have authorization to stay in France and note that if you have a Visa or carte de sejour, the forms are simpler!!

2. How does the French Health System works:

The French Health system only pays an average of 70% of the cost of your medical expenses (ex: Visit to GP 70%, medicine 65%, hospital 80%). To see the complete listing go to www.ameli.fr (CPAM web site).

If you are affected by a long term disease (or life threatening condition) the French Health System covers you 100%. You can find a list of those conditions on the above web site. Please note that the 100% cover is only applicable for the treatment related to that disease or conditions.

Unfortunately the “Forfait journalier” (food in hospital) which is around 25€ per day is never paid by the French Health system (top up insurance pays for it).

Finally 100% does not mean much because it is 100% of the price set by the French Health System. Unfortunately, consultant, surgeon, private hospitals, etc. are allowed to apply a surcharge (and most of them do in private hospital).

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%) because the surgeon likes to go golfing every week end!!(Joke) and 1000€ is not enough for him so he can charge 3000€, therefore, you would be 2200€ (instead of just 200€) out of pocket!!

3. Why you must have a top up health insurance:

The example above is why people take out a top up health insurance. If you have an accident and have to call the ambulance, you will have to pay 30% of the cost of the ambulance (1400€ by road, around 4000€ for air lift). So, you should at least have what we call the hospital cover top up which would cover ambulances and any hospitalization and cost half the price of the full top up which covers GP, medicine, etc.

With the normal top up insurance, you will find different cover going from 100% to 400% or even “Frais Reel” (whatever it costs). Be aware that your insurance will never pay you more than what you actually paid. If you are covered 400% and were only surcharged 250%, you will not get extra money! This insurance can include other advantages such as individual room, TV, help with cleaning or to look after your animals in case of hospitalization, etc… There is no health questionnaire to take out this insurance and you can change insurers once a year on the anniversary date of your contract (2 months before the renewal date or within 20 days from receiving your renewal notice). Your top up is automatically linked to your carte vitale number so when the French health system pays you back, the top up insurance is told and tops it up automatically. For certain things (like hospital stay and medicine), the French health system and the top up pay in advance for you.

4. Allianz Composio:

Most top up health insurance offer covers based on levels (level 1 to 6 for example) which means that if you want the best hospital cover, you will also pay for the best dental and optical cover. With Allianz, you can pick and choose what you want which makes it cheaper! This is quite good, especially for British who usually go and buy their glasses in the UK as it is much cheaper than in France. So, you can have the best cover for hospital and nothing for glasses. Feel free to contact me for a free quote. You will be surprised to know that we are usually much cheaper than all those specialized British expat health insurances! And we can do the cancellation for you so don’t hesitate to contact me for a free quote. Finally, self-employed have an automatic 10% discount.

5. ameli.fr:

This is the website of the French Health System. 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 CSS (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.

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. I can also help with the forms.

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…