Most certainly you have already noticed that the French Health Care system is slightly different from the one in the UK.
CPAM, SECU, RAM, URSAFF, CAISSE MALADIE getting dizzy…? Don’t worry, you are not alone.
Caisse Maladie = Sécurité Sociale (Sécu) = Basic Health Cover
In 1946, the French government decided to establish a social security system that covered 100% of its inhabitants, from president to peasant. Every inhabitant is covered under one of several caisses that are related to the profession of each individual (artisan, commerçant, retraité’, salarié, etc). Unfortunately for foreigners coming to live in France the rules applicable for registration with Social Security have been sharpened. The French government has decided that a difference will be made between those that are considered ‘active’ (anyone living in France that is either employed or self-employed and registered as such) and those that are ‘non-active’ (retired, working in the UK or in any other country than France, unemployed, etc).
Up till now anyone that was considered ‘non-active’ could be covered under the umbrella of CMU (Couverture Maladie Universelle) that is part of Social Security. However since this new law came in to force on the 23d of November 2007 affiliation to the health system will strongly depend on one’s situation. The good news is that anyone who had already registered before this date can continue to benefit from the health service and will not be ‘thrown out’ contrary to earlier decisions made by the government.
At present the following situations are possible:
Newcomers that work in France either by employment or self-employment will be able to register with Social Security without problems as before. They will need to address themselves to the appropriate ‘caisse’ according to their profession (for example CPAM if you are employed and UNIO, RAM, RADIANCE if you are self-employed). The running of gîtes and chambre d’hôtes is considered an ‘active’ business and therefore owners should apply and register with the appropriate ‘caisse’ (RSI=Régime Social des Indépendants). Premiums will be calculated based on income.
People that are retired and receive a pension from the UK can apply for a so-called E121 in England and with this form they can register without problems with Social Security as before. For those who live in France but continue to work in the UK a so-called E106 is available which allows you to register with Social Security as before without problems as long as the E106 is valid. The inconvenience is that once the E106 expires and will not be extended, you are not entitled to stay in the system. You will have to re-apply if possible according to your new situation.
In any other situation (unemployed, income from interests, personal pensions, etc) it will be complicated if not impossible to apply for registration in the French Social Security system. If you are considered non active you will be refused and you will not be entitled to enter the system before having lived in France permanently for a period of 5 years. In the meantime the solution is to take out private insurance available for those that cannot or do not want to register with Social Security. Private health-insurance offers an alternative for the basic cover one normally would have through Social Security plus a small top-up.
If you are ‘active’ and you have registered… how does the system work?
When you have managed all the paperwork with patience and successfully registered through this Social Security system, the amount of health cover to which you are entitled will not cover 100% of the cost ... and the difference can be considerable. For example, a stay in a major University hospital in France - even without surgical intervention - can cost in the region of 800 euros a day. No more than 60-70% of this will be paid by the state, the remaining 30-40% would have to come out of your own pocket!
Top-up insurance
Now, to cover the gap of 30-40% it is possible to buy a so-called ‘top-up’ insurance. However this is not as easy as it seems… unless you know the system it is rather difficult to distinguish the differences between the numerous possibilities amongst the insurance companies that offer these ‘top-up’s.
The Rates
It is important to know that in France Social Security works with standard rates (= tarif de convention) for all medical acts. The percentages of reimbursement are related to these rates. However, any medical institution or doctor is free to choose if they work with the rates fixed by Social Security (conventionné) or if they use their own (non-conventionné). This means that if you visit a doctor that charges more than the standard rate, Social Security will reimburse based on the fixed rate, so your gap will be greater, which means that a 100% top-up will not be enough because the top-up reimburses related to social security, in other words related to the standard rate. In this case you would need a cover of for example 150%, 200%, 300% depending on how expensive your doctor is.
This is why in France people ask their dentist for a quote when they need a major surgical treatment for example.
A complicated story… indeed! The small print can often be confusing, so you need to choose your policy carefully. We will make sure that you understand what you pay for.
If you would like to receive more information regarding the registration with Social Security or the possibilities of taking out private health insurance, if you would like to receive a quote for a top-up, or if you would like to make an appointment to discuss various options, please do not hesitate to contact Maartje Schalk at Assurances Benoit, telephone number 00333.80.24.24.01, or per e-mail: mschalk@agence.generali.fr.
