Accessing the health care system in France

British expats in France will need to apply for an S1 EC health form in order to access the French health care system. An expert explains how the form works and who is entitled to receive it

If you’re thinking of a permanent move to France, you need to be aware that there are different sorts of S1 EC health entitlement forms, and that they may only be issued if you meet the criteria set out under EC social security regulations. These regulations apply to all citizens in EU and EEA countries, and also in Switzerland, when someone takes up residence and/or works outside their country of origin.

In France, an S1 provides basic French state health cover at UK expense during the period of its validity, and is issued in duplicate. The S1 is issued on an individual basis to the insured person. Family members such as a spouse or children can be named on the S1 as health beneficiaries of the insured person.

REGISTERING THE S1

The S1 is activated when it is registered at the health office – the Caisse Primaire d’Assurance Maladie (CPAM) – where you live in France. CPAM will keep one copy and send the other back to the issuing authority in the UK, which is either the Department for Work and Pensions (DWP), or HM Revenue and Customs (HMRC). Therefore, before you hand over your S1 in duplicate to CPAM, take a photocopy and keep it in your personal file, as you may well have need of it at some future date. The act of registration means that you have transferred your UK state health rights to France, and France is now responsible for the delivery of your basic state health care.

THE BASIC FRENCH HEALTH CARE SYSTEMThis is a reimbursement of medical expenses system, but it only partially reimburses (for example, 70% of GP costs, and 80% of hospitalisation charges). The UK only pays France for state reimbursements, and so the S1 holder must pay the balance or purchase complementary health insurance to top up some or much of the shortfall. Complementary health insurers generally offer a range of policies and no medical questions are asked. Please note that French complementary health insurance functions solely in tandem with the basic French state reimbursement system for health care.

RIGHT TO AN S1

This right depends on the circumstances of the applicant and this is where things get more complicated. Previously there were different names for each type of EC health form related to each applicant’s circumstances, i.e. E106, E109 and E121. However, now there is only one, i.e. the S1. This now means that each type of S1 has to be described in terms of the applicant’s specific circumstances.

Do I qualify for an EC health form S1 (formerly known as E121) from the DWP?

If you are in receipt of a UK state retirement pension and live permanently in France, you are entitled to this version of the S1, which will provide you with basic French state health cover at UK expense for your lifetime while you remain in France. Your spouse can be added to your S1 as your health beneficiary prior to receiving their own S1 (if so entitled). Health beneficiaries will need to think about their situation in the event that the S1 holder dies, because although the survivor is entitled to a bereavement EC health form S1, this only lasts for a year.

Do I qualify for an EC health form S1 (formerly known as E121) via the former long-term incapacity benefit?

UK long-term incapacity benefit is now called employment support allowance (support group). Some people may be able to obtain this sort of S1 if they plan to live permanently in France (or retain this sort of S1 if they are already residing in France). The procedures involved are complicated, and can be lengthy and even frustrating: you can find out more on www.gov.uk. The quickest way to apply for employment support allowance is by phone (Tel: 0800 055 6688).

Do I qualify for an EC health form S1 (formerly know as E109) from HMRC to cover my family living in France?

If you remain resident in the UK living, working and paying UK/NI contributions, you can apply to HMRC for a family S1. If granted, this sort of S1 is issued in your name because you are the insured person. It provides your family living in France with basic French state health cover at UK expense during the period of its validity. You yourself can use your UK-issued EHIC for holidays in France and elsewhere in the EU.

As a worker, do I qualify for an EC health form S1 (formerly known as E106) from HMRC?

Because individual employment and business situations are often complicated, HMRC always make their decisions on a case-by-case basis. If you’re a worker and need to know whether you qualify, then direct contact with HMRC, Benton Park View, Newcastle-upon-Tyne, NE98 1ZZ is essential in order to obtain their official written decision regarding which country’s social security legislation applies in your case.

Some examples from HMRC:

(a) You may be a ‘frontier worker’, defined under the EC social security regulations as follows: “A frontier worker is an employed or self-employed person who pursues his occupation in a different member state from the one in which he resides and to which he returns at least once a week.” Therefore, if you reside in France but carry out all your work in the UK, you are insured in the UK and continue to pay UK/NI contributions there. You can apply to HMRC for an S1 and if granted, it provides you with basic French state health cover at UK expense during the period of its validity. Family members such as a spouse or children living in France can be named on the S1 as health beneficiaries of the insured person.

(b) You may be a ‘posted worker’, defined under the EC social security regulations as follows: “A posted worker is a person who is normally employed in one state but is sent temporarily to another state to work. The maximum period for posting is 24 months.” In this case, you remain insured in the UK where you are normally employed and you continue paying NI contributions in the UK.

CHANGING YOUR EMPLOYMENT STATUS

It is a fundamental principle of EC social security regulations that you can only be subject to one EU country’s social security legislation at a time. Therefore, if you are covered by an EC health form S1, which has been issued by the UK on the basis that you are retired or not working, and subsequently you decide to start working in France, you must inform both the UK authorities and CPAM of this change in your situation. You must then affiliate to the appropriate French health office: the CPAM for employees or the Régime Social des Indépendants for self-employed people. Affiliation entails paying obligatory social security contributions, and you will be covered for basic French state health cover. The UK will then cancel your S1.

To discuss the above and your French health insurance needs, visit the exclusive healthcare website: www.exclusivehealthcare.com