Amid the furore, excitement and packing for those preparing to make that permanent move to France there always remains a few deep seated worries of moving to another country. One of those high on the list will be the issue of healthcare. You will have done your homework and, no doubt, have heard that the level of healthcare in France is very good but trying to understand how it works can be confusing. It all sounds so complicated. And yes, it can be complicated!

It really does not matter how fit and strong you are there will always be a time when you, or your family, need to call on the health and medical services, particularly the young and the elderly. The most important thing for us all is that you feel confident in the people, facilities and service you can call on for treatment and care. We are extremely fortunate in France that we live in a part of the world that is able to provide us with an extremely high level of skilled medical care, excellent Doctors and Hospitals.

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The French Health system is not the same as the UK and its NHS!

The French system is a combination of State Provided Health and Private Services. In most instances you will pay up front for services, hospital and specialist care. Even to visit your doctor. Payments returned to you, up to set percentage levels, usually hovering around 70%), are via a system of reimbursement, some by the State Health System which sets a tariff of percentage levels to conditions and various services and some by a personal health insurance taken out by the individual. The nearest equivalent in the UK would the NHS and you taking out a health cover policy with BUPA etc which allow you an improved level of personal care and facilities combined with shortcutting the NHS waiting times. The downside of the insurance system is that it can be expensive, depending on age and circumstance. The upsides are that the medical treatment you receive is excellent and, usually, much easier and quicker to access and obtain than in the UK’s National Health Service.

In France you are expected to keep and maintain your own health dossier and take it with you as required. It seems like a burden but it does seem to work well. How many times have people visited doctors or consultants in the UK to find they have not received your medical history or documentation and the time is wasted? In France it is down to the patient to bring the information and x rays/reports. A lot of information is still put through the French medical system as well and can possibly get lost but it is a rare event, having your own dossier is better than you, or your Doctor, relying on memories and serves as an information back up.

For British Expats it is important always to have your passport or a French resident’s card if you have one, with you to identify yourself. You could well be refused treatment without it.

The system means that everybody who is resident in France is legally obliged to have health Insurance, (except the very poor in certain cases). The most basic form is under the state health or social security under CPAM, (Caisse Primarie d’Assurance Maladie), or l‘Assurance Maladie. CPAM covers pensioners, those working in industry, business and service sectors. There are other state agencies such as RSI which cover the self employed, skilled sectors, (Artisans), retailers and other independent business. Another one called MSA covers those in Farming and Agriculture. The cost of these state health covers is usually covered by contributions made under your working or business life. If you as an expat, are retired and over retirement age, you should be covered by reciprocal arrangements between countries as British retirees are between England & France, whereby your treatment in France is paid for by the NHS if you are British or by the French health system if you are French but as a former resident of England you, when becoming a French resident, would still need to register under CPAM and take out additional insurance cover unless your income is at a very low level. The reciprocal arrangements do not mean you will pay less for your treatment. Effectively, everyone here in France has to take out private health insurance. Indeed, most people in France would have additional private health insurance irrespective of their circumstances. None of this should be confused with the myriad of tax regimes-an even more complicated subject.

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Where it all gets so complicated and difficult to understand is that the French State health system has an extremely complex variety of percentage allowances and necessary contributions subject to status and the level of medical practitioner and treatment you receive which can be over and above the standard tariffs set by CPAM . For British Expats the simplest way to get to grips with all this is to recognise that some serious treatments and diseases of long duration are covered in full, (cancer, diabetics etc) but also, many are not. Depending on what you have wrong with you, who you see, where you go, what you need and that combined with all of those things, the cost of treatment and care in France is usually covered only up to a percentage of costs, not always 70%, rather than totally covered as you would be under the UK NHS system, leaving you, the recipient, to meet the extra costs incurred.

These additional costs are usually met by having a ‘Top up’ or Mutuelle insurance which, depending on the degree of cover you pay for, is intended to reimburse you for the extra costs, but again, only up to a certain percentage amount set out under your insurance cover. So, here again, you may be unlikely to get the full costs paid as fees as certain procedures or specialists vary in price and the ‘Mutualism’ also have limits on their cover. Meaning you really need to read the small print and compare. The highest price cover does not necessarily mean you get the most back. Mutuelle cover tends to be in two general forms i.e., Hospital cover only, which as it implies, covers your basic costs of a stay in hospital, or a Full health cover which will also include hospitalisation, specialists, treatment cover and, maybe, a, (small), proportion of dental, hearing and glasses costs.

To sum up, when you go to the Doctors or many specialists you will pay them directly and get some reimbursement by the state and some by your top up Mutuelle insurance. Anything over and above you will pay for. If you go to a pharmacy or hospital the first thing they will check is the level of your Top up Mutuelle Insurance via a note of ‘Attestation’. Effectively, a cover note stating what you have, or have not, covered. Together with a health card called a ‘Carte Vitale’.

Now the good news is that, once registered, CPAM issues you with a ‘Carte Vitale’ card which streamlines the repayments service. It will have a photograph of you on it, your CPAM health number, your name and the card commencement date. This card carries all the standard information about you, name address etc, but not your personal medical information. Virtually everywhere which operates under the CPAM auspice in France will have a machine into which the card is put into, (just like a credit card), which extracts the essential information the care or medical provider requires to ensure that they have been paid for their service. Automatically the card sends the treatment information back to CPAM who, in turn, will send your reimbursements to your allocated bank account, mercifully, very quickly. The system also has connections with the various mutuelle companies which means that their reimbursements will also be generated offsetting the need to claim back the insured costs. In certain cases reimbursement does not happen automatically and you may have to claim for some treatments directly with the mutuelle company. Thankfully this does not happen often.

One big mistake made by some Expats is to think that the EHIC card provided by the UK social security office is a cheap way of providing them with medical cover in France or other participating European countries. It does not! The EHIC card is only for emergency state aid providing medical treatment during a temporary stay in member countries, in other words basic state provided cover in an emergency for non residents. If the aid or treatment is given by private clinics or specialists the EHIC card is unlikely to cover you. Which is why you are encouraged to take out travel insurance on any holiday trip abroad. British Expats moving to France need to contact the UK social security office to be supplied with a new, updated, EHIC card which enables them to emergency medical cover in England. The new EHIC card will not then be applicable for use in France as you would be assumed to be in receipt of cover in France under the French system.

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The dreaded B….. word !

This system may well change as a result of the UK leaving the EEC. This is, of course, a major concern for all non European residents and particularly for UK citizens wanting to make the move to France. Whereas the outcome of the Brexit negotiations are unknown, and will be for some time, there are encouraging signs on the horizon. It is recognised both within Europe and the UK that there are many people from across Europe that live and work in Great Britain as well us Britons living and working across Europe and potentially everyone would be in the same position as each other as regards to Health care. A suggestion, which emanated from a UK MEP, and now taken up by the senior level of the European commission, is that expats could all have ‘associated citizenship’ in their resident countries and maintain the same reciprocal arrangements we all enjoy today.

Behind this suggestion, which is gaining ground on both sides of the channel, (or if you are French, the sleeve), is based on reasonably solid foundations. First, it is not a totally new thing. Many foreigners and non Europeans have made new lives and careers in Europe and the UK over the years, even before the formation of the European economic commission and its previous names, without experiencing too many problems. Besides which, speaking as an Englishman in France, Europeans generally like the money and vitality that expat residents bring to their economies. We have heard it said that if Britons leave France half of the ‘Brico’s’, (builders merchants), would close! Be that as it may but it looks more and more likely that the negotiating countries will all want to protect their nationals abroad ahead of the probable, long drawn out discussions to come.

Back to health issues. Want to know what generally happens when you need medical treatment or advice in France? Read about it here in next month’s blog. Plus, for those of us without a full command of the French language, some information which you can put in your home and car which you could find extremely useful in an emergency, accident or medical problem.