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French Health Insurance

 

In order to get your long stay visa, you must show proof that you have health insurance that covers you in France. Not all American health insurance policies cover you abroad, so you have to check with your provider.

Once you have lived in France for at least 3 months, you are eligible for French state health coverage (CMU or Coverture Maladie Universelle). The cost is based on your previous calendar year's income.

To apply for CMU, you must go in person to the local CPAM (Caisse Primaire Assurance Maladie) office to pick up an application. Be prepared to provide the following:

- proof supporting that you have lived in France for at least 3 months (EDF statements or France Telecom statements).

- copy of passport and carte de sejour

- proof supporting income for the past calendar year (payslips, bank statements, etc.)

- latest French tax bill, if available (avis d'imposition)

Affiliation to CMU takes place effective the day of your application, although you may have to wait a few weeks for your confirmation letter (attestation).

The cost (cotisation) is based on annual income thresholds, after tax allowances, as follows:

single person 6,677 Euros

couple 9,604 Euros

3 persons 11,525 Euros

4 persons 13,446 Euros

Thereafter, add 2,531 Euros for each additional person.

This is not how much the insurance will cost you. This is the income "threshold". You must pay 8% of any income OVER the threshold for your family situation.

Up to and including the thresholds, you have nothing to pay.

If your income is in excess of the threshold corresponding to your family situation, then you pay 8% of the amount over the threshold. You are allowed to pay by trimesters.

The coverage is generally 70% (obstetric care is 100%), and there is no deductible. Most people purchase a private health insurance policy called a "mutuelle de sante" that brings the coverage up to 100%. Again, there is no deductible. The cost fo the mutuelle is not based on income.

Usually you pay up front, and receive a reimbursement by direct deposit into your bank account in less than one week!!

FORM FOR INSURANCE (FEUILLE DE SOINS)

Upon receiving medical service, you will be given a brown form, FEUILLE DE SOINS, which states the nature of the service in code, the doctor, amount paid for services rendered and prescription information.

When filling prescriptions be sure to take the brown form along. The pharmacist will stamp both the prescription and the brown form, then fill out the appropriate prescription information. Medications have a sticker (VIGNETTE), which must be removed from the package and placed on the form.

NOTE: Payment for medications must be made when they are provided. This FEUILLE DE SOINS should be sent to your insurance for reimbursement. If you have an insurance company other than the French national insurance (SÉCURITÉ SOCIALE), you should recalculate the fees in the insurance company's local currency.

NATIONAL HEALTH CARE (SÉCURITÉ SOCIALE)

Coverage is obligatory for wage earners. Some countries have an agreement with France making their people eligible for the French benefits while other countries do not. Check with your office to know if you are eligible for the social security benefits.

Coverage is not automatic; you must apply for it. If you are eligible, apply at your local SÉCURITÉ SOCIALE office or at the Caisse Primaire d'Assurance Maladie for your area.

You will be issued a number, NUMÉRO D'IMMATRICULATION, which is to be used on all forms from medical services.

Upon receiving a service, you will be given a brown form, FEUILLE DE SOINS, which states the nature of the service, the doctor, amount paid for services rendered and prescription information, important since this form also serves as your receipt or proof of payment. Complete the FEUILLE with your personal information, sign it, and send it to your local SÉCURITÉ SOCIALE office for reimbursement.

Reimbursement is not total and many French subscribe to MUTUELLE insurance companies that cover the difference. Once the SECURITÉ SOCIALE office has notified you that reimbursement has been made, the notification slip must be sent to your complimentary insurance MUTUELLE for additional reimbursement.

If a doctor feels the patient needs treatment by a paramedic (therapist, chiropractor, etc.), the patient will be given a form that asks the insurance for their agreement. If no refusal has been received within two weeks, one can consider the agreement as effective. After treatment and payment, the patient will receive an orange slip for submittal to SÉCURITÉ SOCIALE.

WAGE EARNERS

A declaration is made to the National Health office, CAISSE PRIMAIRE D'ASSURANCE MALADIE OR CPAM, and the Family Benefits Office (URSSAF) by the employer. The employee receives a social security card. The wage earner's unemployed spouse and dependents are also covered.

The cost for the various insurance is deducted directly from the wage-earner's salary and amount to approximately 20%. The employer pays another 70% of the employee's salary to the government for these same social benefits.

THE CONTRIBUTION SOCIALE GENERALISÉE (CSG) is a solidarity tax to help the ailing National Health System. All workers pay this tax whether they are eligible for national health coverage or not. However, those not eligible pay a smaller percentage of their salary than those who are eligible for the health coverage.

NON-WAGE EARNERS

Self-employed workers must take out a voluntary health insurance policy within 6 months of arriving in France. A list of insurance companies working with the National Health Service can be obtained through the Chamber of Trade.

The self-employed person will also be required to pay for pension programs and family benefits. As some of these costs are fixed sums one must be sure to have a large enough income to cover these costs. Reimbursement rates of medical expenses used to be much lower (50%) than those of wage earners, are now equal to those of everyone else. Thank goodness because that is what my status is. :-)

Students Under 26 Years of Age

If you or a member of your family fits this category you can contact the following offices for more information:

MUTUELLE NATIONALE DES ETUDIANTS DE FRANCE (MNEF)

SOCIETE MUTUALISTE DES ETUDIANTS DU SUD-OUEST (SMESO)

RATES OF REIMBURSEMENT:

Doctors' fees are reimbursed at a fixed rate of Sector 1 of 70%.

Lab analysis, nurses' fees, and auxiliaries are reimbursed at 60%.

Hospitalization is reimbursed at 75%, however a daily rate of 8€ is charged.

Hospitalization for surgery above 7,500€uros is 100% reimbursed, however, the 8 €uros is charged daily. Medications are reimbursed at 40%, 70% or not at all. Other costs such as transportation, medical equipment and glasses are reimbursed at 65%. Dental treatment only, is reimbursed at a fixed rate of 70%.

Mutuelle policies vary as to what part of the remainder they pay. Some pay for orthodontics, contact lenses, and pay to the first €uro for all of your medical and dental care. 


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