If you live and work in France then you are entitled to state healthcare cover, however this is very different to the healthcare system in the UK. Find out how the healthcare system works for expats, how to register and why you might need top-up healthcare insurance
The French healthcare system is different to the UK – rather than free healthcare, the French state covers about 70% of healthcare costs for those paying social contributions, but you have to pay upfront and are then reimbursed.
What free state healthcare in France am I entitled to?
Expats who work in France have to register with and pay into the French social security system. Most people use the Caisse Primaire d’Assurance Maladie (CPAM), nicknamed La Sécu, although there are other medical insurance organisations for different trades though, such as the Régime Social des Indépendants (RSI) for freelance workers. The easiest way to get basic healthcare in France is to be employed for more than 60 hours a month for more than three months.
This doesn’t guarantee you free healthcare but will cover the amount the French state agrees to reimburse (usually around 70%). If you want 100% healthcare cover then you will have to buy a private health insurance policy, called a mutelle (see below) as a top-up.
A patient can receive 100% coverage under certain conditions, such as having a chronic or acute medical condition (including cancer, insulin-dependent diabetes and heart disease), requiring long-term care, having a long-standing condition or requiring a hospital stay of more than 30 days. There are standard costs for doctor consultations and hospital visits, which you can see in the table below and find on www.ameli.fr
How do I register for state healthcare?
If you are living and working in France then you have to register for state healthcare through your local CPAM, which you can find here: http://www.ameli.fr/assures/votre-caisse/index.php
You will need to show certain documents in order to register – your passport or national ID card, proof of your long-term residence, marriage or birth certificates if your family are to be included, evidence of income and proof of address in France.
How does the system of reimbursement work?
You pay for consultations, treatments and prescriptions up front and are then reimbursed by the government, usually within a week.
Once you are fully registered in the French healthcare system you will be sent a carte vitale. You will need to show this every time you use the healthcare system – for example when you visit the doctor, buy a prescription or visit a hospital. It is swiped by the healthcare professional which registers the treatment you receive with the CPAM. You still pay for the treatment up front but are reimbursed a portion of the cost, paid directly into your bank account. If you have a private health insurance policy then you can claim the rest of the cost back from them.
If you haven’t received your carte vitale yet then you will be given a treatment form (feuille de soins) when you pay which you sign and send to the CPAM.
Some pharmacists also run a tiers payant service for regular customers, where you show your carte vitale and only pay your share of the price of prescription medicines, and the pharmacist collects the rest from CPAM on your behalf.
What is top-up insurance and do I need it?
As the state only pays for around 70% of the majority of healthcare costs, many of those living in France choose to purchase a top-up health insurance, called a mutelle, to cover the rest of the cost.
There are numerous insurers to choose from and, as with all types of insurance, a wide range of policies with varying degrees of cover and premiums. Basic packages tend to cover hospital costs and medicine, but you can choose to add things like dental costs. It is worth shopping around and seeking advice to ensure you choose the best policy for your needs and budget. If you’re an employee of a company, you will most likely be able to join the company’s policy as part of your benefits package.
However this complementary health insurance should not be confused with private health cover in the UK. Although bought by the individual, it simply assists financing the personal contribution element of French healthcare. It is inexpensive, does not guarantee faster treatment times and is not affiliated to private practitioners or clinics as with the UK private healthcare model.
In terms of payment, the individual pays for treatment and the relevant State fund is automatically alerted via the carte vitale system. The percentage refunded by the State is then indicated to the relevant mutuelle which calculates accordingly how much it will reimburse.