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| Healthcare status update January 2008 |
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| Monday, 31 December 2007 | |
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Health cover: better news than expected The Health Ministry has finally published its new guidelines for the terms of access to state health cover. There will still be loopholes and cases which do not fall into the framework of the guidelines. Larry Fulton sums up. For many expatriate residents of all nationalities in France, last year may have been one of the most traumatic periods of their lives. They had sold their homes in their country of birth and had moved to France to live a better life in a better place. An important ingredient was the French national healthcare system which, they soon found out, still deserved its rating as the leading NHS in the world. (For how much longer is another matter, in view of the massive ‘hole’ in the social security and in the French state coffers generally.) Previously, all non-French residents from EU member states were obliged to join the French state healthcover system. According to their income, they could either join for free or could pay a contribution calculated as a percentage of their income. The Couverture Maladie Universelle was introduced by a law1, which sets out the terms of entitlement to the French state healthcover system. However, all this changed dramatically in March 2007 when an EU directive was first applied in France. Since then and until the December announcement of the relaxing of certain applications of this law, several thousands of beneficiaries received letters from their CPAM, advising them that their entitlement was cancelled and their carte vitale would be withdrawn after a period of grace lasting until March 31, 2008. There is not room here to describe the flurry of negotiation, the information, and corrections to the information which was given out under pressure from panic-stricken enquirers. The outcome was finally published on the French social security website on December 14 and while there are still problems for some people it is much better than anyone could have anticipated at the outset. The position now is summed up below, as it affects students, job seekers, retirees and early retirees from the EU and Switzerland, who are already resident or about to become resident in France. Obviously this is not a legal document but a simple translation of what the Health Ministry document appears to mean. As ever, you should check for yourself with your local CPAM centre or préfecture as we have still heard about a few anomalies. Where individual cases are found not to fall into a clearly defined category under the Health Ministry guidelines, local CPAMs may interpret these individually, on a case-by-case basis. As the new Health Ministry guidelines were only published in the run-up to the festive season don’t be surprised if it takes time for the information to penetrate some further-flung CPAMs. Don’t be surprised either if, in the same way as French nationals, you are subject to an examination of your means in due course, to make sure that the income you have declared is correct and that you comply with the other conditions of residency such as filing a tax return. Private full-cover insurance Most people who find themselves with no health cover will look for private full-cover insurance. This type of policy has a number of drawbacks common to most insurers: • The price varies widely. As a price indication, those in their late 50s could pay around 1,700 euros per year for a budget-priced plan covering you in France or 2,700 euros for cover throughout Europe. • Pre-existing medical conditions are excluded. This is a serious matter for many people in an ageing retirement market who may have already developed uninsurable medical conditions. It is best to shop around and compare quotations along with the underwriting conditions. In the meantime, it is of vital importance to let us know how the new regulations affect you. Until we can start identifying trends in action, regulations and laws are no more than words on paper. 1 Loi 99-641, see www.legifrance.gouv.fr/WAspad/UnTexteDe Jorf?numjo=MESX9900011L 2 If anyone needs information about this please contact Larry Fulton, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Official information from CNAMTS (international helpline): 08 20 90 42 12) or the CLEISS 01 45 26 33 41). Who can now benefit from French state health cover? Now, the right to join the French state healthcover system has been withdrawn from all non-French EU nationals with these important exceptions: • Those holding a current valid E form. The E forms are not affected by the new regulations. The forms in everyday use which most people will know are the E121 for retired people, the E106 for workers and early retirees and, the E109 to cover the family, residing in France, of a person living, working and paying state healthcare contributions in another EU country. Questions have also been asked about the continuing validity of the EHIC (previously called the E111) for visitors. This is not affected either. • Those who were already beneficiaries on November 23, 2007 will not lose it now. • Those who can prove five years of regular and uninterrupted residence in France are entitled to benefit from state healthcover. The right to permanent residence is subject to examination by the service des étrangers at your local préfecture. It may take time for the terms and paperwork to be sent out. • Those entitled to reside in France because they have sufficient means and are covered by full private insurance, but who have not lived here permanently for five years and who have a “life accident”, such as involuntary job loss or the discovery of unforeseeable, uninsurable medical conditions, which either deprives them of their financial resources or their private insurance. They and their dependent family members living in the same household will be given access to state health cover. NB there is a short-term work option by which one can work part-time for 60 hours in one month, which may provide affiliation to CPAM for a whole family for a whole year2. Who cannot benefit from French state health cover? • Those coming to France from any other country (including Europe) without full health insurance and without an E form, who are inactive by choice or have failed to find a job. • Holders of an E106 after its expiry. What happens if I’m taken ill or have an accident in France with insufficient means and/or no health cover? If you’ve been in France for less than three months, you will be treated under a special emergency care scheme, the dispositif soins urgents. If you’ve been here for more than three months, you may be entitled to the Aide Médicale d’État (AME), for example, if your means are below a certain ceiling. What about students? Most students here are covered by the state health system of their country of origin. Students aged less than 28 years old may also be covered by the French students’ social security. Getting the best of European healthcare Yet another E form, the E112 covers much of the expense of planned treatment in an EU country if authorised by the social security in your country of residence The E112 exists for those who wish to receive treatment in another European State or Switzerland, under certain conditions. You must be covered by a statutory social security scheme in your EU country of residence or Switzerland (except for treatment without authorisation in the case of Switzerland). Check with your social security if it will authorise the costs of the treatment to be covered. Normally it will only do so if the treatment is recognised as reimbursable in your country. If you are authorised treatment in hospital the refund will be equivalent to that applying in the country where you are treated but if this means a difference in the scale of reimbursement in the two countries you will, generally speaking, be refunded the difference. For full details go to http://ec.europa.eu/employment_social/ social_security_schemes/healthcare/e112/ cost_en.htm Specialised volunteer support group with updates and information: www.frenchhealthissues.eu |
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