The health care system in France
The health care system in France is not simple. This is very far from being a definitive explanation of every aspect - it's more of a quick start guide to set you on your way to understanding the different aspects of it and how they work.
We begin here with a general outline of the health care system, and then by explaining how things work now, during the transition period.
On the next page, we take a look at what will happen under the Withdrawal Agreement, from the end of the transition period (currently set to be 31 December 2020).
We begin here with a general outline of the health care system, and then by explaining how things work now, during the transition period.
On the next page, we take a look at what will happen under the Withdrawal Agreement, from the end of the transition period (currently set to be 31 December 2020).
Background
The French healthcare system covers both public and (most) private hospitals, doctors and other medical specialists who provide French healthcare to every resident in France regardless of age, income or status. Nationality is irrelevant - all you need is to be legally resident. It's compulsory for anyone living in France for over 3 months to be registered in the system, unless they have equivalent private health insurance.
The system is funded
The system is funded
- partly via social security contributions;
- partly by central government; and
- partly by the patient, who in most cases is responsible for paying a percentage of costs for medical treatment or prescription drugs and other items.
Eligibility and application
If you're permanently resident in France (as opposed to a temporary or holiday stay) you are entitled to healthcare provided by the French state healthcare system.
There are currently various ways of accessing the French health system:
Your health insurer (your 'caisse') will depend on your circumstances, although most people are now covered by the Régime Générale, which is administered by a health authority called the Caisse Primaire d’Assurance Maladie (CPAM). All those with S1 forms and those in PUMa come under this, and self-employed people are gradually being moved over to it too.
When you first register with your health insurer, you'll need to take (as a minimum) proof of address and passport. You'll almost certainly also be asked to provide a birth certificate, marriage or divorce certificates or any other documents that support any change of name (for example, statutory declaration or deed poll). You may need to have these translated into French by an official translator, though there is a huge variation between different areas and offices on this. Other documents will almost certainly be needed depending on your circumstances.
There are currently various ways of accessing the French health system:
- via employment or self employment;
- via a UK issued S1 form if you’re in receipt of a state pension or if your spouse works in the UK; or
- if you are not economically active and don't hold an S1 form, via the French universal health coverage system known as PUMa (Protection Universelle Maladie).
Your health insurer (your 'caisse') will depend on your circumstances, although most people are now covered by the Régime Générale, which is administered by a health authority called the Caisse Primaire d’Assurance Maladie (CPAM). All those with S1 forms and those in PUMa come under this, and self-employed people are gradually being moved over to it too.
When you first register with your health insurer, you'll need to take (as a minimum) proof of address and passport. You'll almost certainly also be asked to provide a birth certificate, marriage or divorce certificates or any other documents that support any change of name (for example, statutory declaration or deed poll). You may need to have these translated into French by an official translator, though there is a huge variation between different areas and offices on this. Other documents will almost certainly be needed depending on your circumstances.
In due course you'll receive an attestation - proof that you are now part of the heath care system and containing your social security number - and a form to apply for your Carte Vitale.
This is a small, credit-card sized photocard which is swiped at doctors' surgeries, pharmacies, hospitals etc and allows you to be automatically reimbursed. Until you receive that, you'll need to pay 'up front', and it's important to request a 'feuille de soins' each time you have treatment - this is a brown form that will allow you to claim back the reimbursable part of your fees. |
Mutuelles - top up insurance
Most people choose to take out a complementary insurance policy - a mutuelle - to cover the percentage of their health care costs not reimbursed by the state system. These are offered by private insurance companies and you can choose from a bewildering range of different levels of cover.
It is NOT compulsory to hold a mutuelle and proof of having one can't be required for a carte de séjour application.
It is NOT compulsory to hold a mutuelle and proof of having one can't be required for a carte de séjour application.
Particular situations
How you affiliate to the health system differs according to your individual circumstances, and there are a number of different 'caisses' (health care agencies) that will look after you depending on those.
French employees, French state pensioners and the self employed
- Your health care is set up automatically as part of your employment or registration as self-employed, including as a microentrepreneur.
- You'll pay health insurance contributions as part of your other social security contributions.
UK state pensioners
- If you receive a UK state pension you need to inform the Department of Work and Pensions (DWP) when you move permanently to France. They will send you an S1 form which you take (along with the documents listed above) to your local Caisse Primaire d’Assurance Maladie (CPAM): this means that your health care will be funded by the UK, or to put it into more correct language, that the UK is your 'competent state'.
- You join the French health system and receive its benefits in exactly the same way as a French citizen - so you still have to fund the percentage that isn't covered - but France is reimbursed by the UK for your individual health expenditure. This happens automatically - you don't need to do anything about it or even to know anything about it.
- But having the UK as your competent state gives you additional advantages: for example, you won't pay social charges on your pension income as you are not à la charge of France for your health care.
- If you have a spouse who is not yet in receipt of state pension, they can be included on your S1 form and will then be covered for health care as your dependent, in the same way as you.
Cross border workers
- If you and your spouse/family are resident in France but one of you works permanently in the UK, the 'competent state' for the health care of you and your family will be the UK.
- You'll need to apply for a Form S1 from HM Revenue and Customs in Newcastle: see this page. Once you have this, you take it to your local CPAM office and follow the same procedure outlined above.
- If you and your spouse/family are resident in France but one of you is working temporarily in the UK, you need to apply for a Form A1. This is normally issued for one year (and renewable for a second year). A1 holders usually have their health care in France assured through the use of an EHIC and may not join the health care system through CPAM.
Early retirees and others who are economically inactive
- Anyone who is living permanently in France (and has done for 3 months) who doesn’t qualify for health cover in any other way may apply to join PUMa under the rubrique 'sans activité professionnelle'.
- It’s contributory - think of it like paying NI contributions in the UK.
- You’ll be assessed on your taxable income and will pay a contribution of 6.5% on capital income only over a threshold.
- Pension income is excluded from the calculation of income.
- Capital income includes rental income, non-professional gîte and chambre d'hôte income and all investment income.
- In 2019 the threshold was doubled and is now 20,262€ a year - which means that in practice few people will pay.
- Spouses each have to make their own application - the old practice of ayant-droits (piggy-backing onto a spouse’s cover) has now been abolished.
- You’ll need to provide documents relating to residence, income and (usually) proof of refusal of an S1 from the UK. Your application will be sent off to the central processing office in Nîmes.
HEALTH CARE ABROAD
If you are working or self-employed in France then you should apply for a French-issued CEAM card, which will cover you for travel in other EU countries on the same basis as a resident of that country. You can apply for this on the Ameli website.
If you are a UK state pensioner you need to reapply for an UK-issued EHIC card (an EHIC-E). You may already have one from before you came to live in France but this is no longer valid. You can’t apply for this card online - you have to phone DWP in Newcastle on 0044 191 218 7777, or contact them on the enquiry form here for them to send you the form in the post. You won't be given a French CEAM card as your health care costs are met by the UK.
If you are a UK state pensioner you need to reapply for an UK-issued EHIC card (an EHIC-E). You may already have one from before you came to live in France but this is no longer valid. You can’t apply for this card online - you have to phone DWP in Newcastle on 0044 191 218 7777, or contact them on the enquiry form here for them to send you the form in the post. You won't be given a French CEAM card as your health care costs are met by the UK.
Receiving treatment in the UK
If you are a UK state pensioner who holds an S1 form registered in an EU/EEA country, following a change in the law in April 2015 you are entitled to full medical care in the UK, on the same basis as someone who is ordinarily resident in England.
Should you ever encounter problems using this provision, here is a link to the Department of Health's guidance on implementing the regulations: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/842210/Guidance_on_implementing_the_overseas_visitor_charging_regulations.pdf The relevant paragraphs are paragraphs 9.58 to 9.62.
For anyone else, your EHIC or CEAM only entitles you to receive treatment that is medically necessary during your visit.
- This applies to planned as well as unplanned treatment, though you'll need to pay any charges which also apply to UK residents, such as prescription and dental charges, and you're unlikely to be granted treatment that wouldn't be offered to a UK resident living in the same area.
- The same provisions apply to dependents. You'll need to produce evidence that you have registered a UK S1 here in France - your attestation will do this (there is a code on there which confirms it), though for planned treatment you should take your S1 with you. You'll liaise with the hospital's Overseas Visitor Manager who will oversee the formalities and the form filling.
Should you ever encounter problems using this provision, here is a link to the Department of Health's guidance on implementing the regulations: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/842210/Guidance_on_implementing_the_overseas_visitor_charging_regulations.pdf The relevant paragraphs are paragraphs 9.58 to 9.62.
For anyone else, your EHIC or CEAM only entitles you to receive treatment that is medically necessary during your visit.
- If you want to visit the UK to obtain planned treatment for an existing condition, you should contact the French authorities to apply for a form S2 and tell the UK hospital you want to be treated under the S2 arrangements.
- You'll need to produce form S2 or you will be charged for treatment as an overseas visitor - again, the Overseas Visitor Manager will deal with all of this. If you give a false UK address and outdated GP details, this could be seen as an attempt to defraud the NHS and there may be further consequences so this is really not advisable.
- Beware - every 2-3 years GP practices clear their computer systems of ‘ghost’ patients and if hospitals check up you could be found out!
Complémentaire santé solidaire - a state run 'mutuelle'
If your income is low - below certain thresholds set by the government - you may be eligible for the complémentaire santé solidaire. This effectively offers you a free or low cost (depending on your income) mutuelle that will cover the percentage of the cost of your treatment not covered by the regular health care system, in the same way as a mutuelle does. It covers consultations, in-patient treatment, plus dental, optical and hearing.
The complémentaire santé solidaire replaced the CMU-C scheme at the beginning of 2020.
The complémentaire santé solidaire replaced the CMU-C scheme at the beginning of 2020.
There are two versions of the scheme, with or without a financial contribution.
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