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12/05/2008, 16:55 Sunday Driver Joined on 07/10/2005 Deux Sevres (79) Posts 2,880 Re: Is top-up health insurance really necessary? Hospital fees are not automatically covered 100%. From the Assurance Maladie website: Hospital fees: You (or your mutuelle) are responsible for the ticket moderator (that's the shortfall from the state cover) except in the following cases: Vos frais d'hospitalisation seront intégralement remboursés si vous êtes dans l'une des situations suivantes : vous êtes hospitalisé(e) plus de trente jours consécutifs (votre prise en charge à 100 % débute alors le trente et unième jour) ; vous êtes enceinte et devez être hospitalisée pendant les quatre derniers mois de votre grossesse, pour votre accouchement, ou pendant douze jours après ; pour votre nouveau-né, s'il est hospitalisé dans les trente jours suivant sa naissance ; vous êtes hospitalisé(e) en raison d'un accident du travail ou d'une maladie professionnelle ; vous êtes hospitalisé(e) en raison d'une affection de longue durée ; pour votre enfant mineur, s'il est hospitalisé suite à des sévices sexuels ; vous percevez une rente pour un accident du travail (avec un taux d'incapacité égal ou supérieur à 66,66 %). Vos ayants droit bénéficient eux aussi de cette prise en charge à 100 % ; vous êtes titulaire d'une pension d'invalidité, d'une pension de veuf ou veuve invalide, d'une pension vieillesse qui a remplacé votre pension d'invalidité, ou d'une pension militaire ; vous dépendez du régime d'Alsace-Moselle ; vous bénéficiez de la Couverture maladie universelle ou de l'aide médicale de l'État. Note that if you hold an E106 or an E121, then you are not a beneficiary of CMU and therefore the last qualification does not apply.    Waddya mean it's only Saturday......    Report

12/05/2008, 19:42 Patf Joined on 23/08/2004 SW Gers Posts 2,169 Re: Is top-up health insurance really necessary? That's interesting SD. Perhaps I had to pay the 30% because I hadn't at that time been confirmed by my doctor as having an ALD.    Report

12/05/2008, 20:24 NormanH Joined on 10/04/2008 Posts 179 Re: Is top-up health insurance really necessary? I think so Patf. I would also point out that if you have one of the list of illnesses counting towards an ALD that isn't  an automatic guarantee of 100% cover, until your  your Géneraliste has sent in a 'formulaire de demande de prise en charge'  to your local Caisse, and you have the specific 'notification d'exoneration du ticket moderateur' and a list or 'protocole de soins' which shows which medicines and tests etc are covered. I mention this because it might be imagined that this is automatic.  You will be accepted if you apply , but it is much better to go through this rather long-winded process as soon as you are diagniosed  and have the right documents to produce in an emergency arising from your illness. Of course you are only covered at 100% for the things on that list.    Report

13/05/2008, 10:40 Logan Joined on 23/08/2004 Posts 739 Re: Is top-up health insurance really necessary? Last year my wife had a major operation and was hospitalised for 3 weeks. Thankfully she made a complete recovery thanks to the skill and expertise of the hospital. I was expecting a big bill and spoke to the consultant about it. He said not to worry, the condition was life threatening and would be met by the state even though at that time I did have a mutuelle. Eventually a statement came from CPAM indicating the total cost was 15,000 euros and paid 100% by them. Now looking down the list that SD posted, my wife's circumstances did not fit into any of those catagories. So I guess like Donald Runsfeld we must assume "there are knowns and unknowns, as well as knowns where some are unknown and unknows where there are some known knowns and also unknown knowns!" In other words a complete Kafkaesque. Dulce et decorum est Pro patria mori. (Horace).    Report

13/05/2008, 16:21 Blossom Joined on 01/03/2008 Posts 34 Re: Is top-up health insurance really necessary? All of which makes me wonder how the actuaries arrive at their premiums. But, then, I suppose Kafka did work in insurance!    Report

03/06/2008, 13:30 Clair Joined on 23/08/2004 ------- Forum Moderator ------- Lot (46) Posts 6,794 Re: Is top-up health insurance really necessary? Worth reading: http://www.french-property.com/newsletter/2008/6/3/top-up-french-health-insurance/ Clair, a Real Virtual French Person Ma Plus Belle Histoire d'Amour    Report

04/06/2008, 21:13 seb47 Joined on 02/01/2005 Lot et Garonne Posts 145 Re: Is top-up health insurance really necessary? Yes - I agree, but what if you are critically injured in a road accident? Sue    Report

04/06/2008, 22:37 Jonzjob Joined on 23/08/2004 Nr Carcassonne, 11 Posts 2,678 Re: Is top-up health insurance really necessary? Insurance is a total waste of money and no-one ever needs any insurance until they need it ?? John. The only difference between the men & the boys is the size & the shape & the price of their toys!!    Report

05/06/2008, 10:52 Blossom Joined on 01/03/2008 Posts 34 Re: Is top-up health insurance really necessary? As the originator of this thread, I would like to add an update by saying that, after careful thought (and further research), we have decided that, for us, top-up insurance represents bad value for money.  We have therefore decided (at least in the short-term) to insure ourselves by saving each year the amount that we would have spent on top-up insurance.    Report

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France Forum » Living » Health » Re: Is top-up health insurance really necessary?

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