Healthy options

Retiring early and going to live across the Channel is a dream for many. But will you be able to access affordable health services once you’re there? Ron Wright from Exclusive Healthcare outlines some of the issues faced by early retirees in France

It is critical that you think ahead and forward plan if you are thinking of retiring early and moving to France, and it’s best not to make any final decisions until you have researched the current and valid healthcare information which applies to you. This is no easy task because there is little information about healthcare for those who have taken early retirement and will not be working in France. Governments often make changes and sometimes move the goalposts in the social security field. In particular, it’s important to note that EC social security regulations are legally enforceable by Member States when you move about the EU. A fundamental principle of these regulations is that you can only belong to one Member State’s social security system at a time.

Healthcare research should be top of your planning list because, to reside permanently in France, you are legally required to have health insurance – either State or if this is not possible, private health insurance. It is worth remembering that pre-existing medical conditions are excluded from private health insurance and there are age limits and pay-out limits as well. On rarer occasions, private health insurance can be refused altogether.

So let’s start with the basics; who is an early UK retiree? This is a person who is not in receipt of a UK State Retirement Pension (UKSRP). A permanent move to France is seen as a definitive act and French health offices (Caisse Primaire d’Assurance Maladie or CPAMs for short) often make a proof of permanent residence the first item in their checking procedures – so do not treat this lightly, because you could fail at this first hurdle!

The French Social Security Code states that a person who has their principal household or residence in France is considered as resident in France. The household is defined as the place where the person normally lives, that is to say their habitual residence, subject to their residence being of a permanent nature. The condition of principal residence is satisfied when beneficiaries are personally, effectively and mainly present in France. People are considered to have their principal residence in France when they stay there for more than six months of the calendar year.

Have you really decided not to work? This decision is important, because those who work in France must affiliate to French Social Security and thus are covered for basic French State health services.

If you do not work in France, you may then apply to the Department for Work & Pensions (DWP) in Newcastle upon Tyne to see whether you are entitled to the EC Health Form S1. The right to this S1 depends on whether you have paid UK/NICs in the last two to three years. But this category of S1 only lasts for a limited period, which may be up to two years, the period depending on your NIC record. Apply a couple of months beforehand, because your application may take some time.

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S1 forms are part of the EC Social Security Regulations. If granted, an S1 entitles you to basic French State healthcare at UK expense during the period of its validity once you have registered it at your local CPAM. Always keep a personal photocopy of your S1 – you may need it later! The French State health scheme is a reimbursement of medical expenses system, but it only reimburses partially (for example, 70% at the GP’s, 80% for sector 1 hospitalisation). Thus most people purchase complementary health insurance to top up some or much of the shortfall – French people call this their mutuelle, English people their ‘top up’. No medical questions are asked as regards top up insurance and insurers generally offer a range of policies. Without top up, you will have to pay the 20% to 30% shortfall in the State reimbursement system yourself.

A further category of S1 can be issued by DWP when you become entitled to a UKSRP. Again, this will provide you with basic French State health cover at UK expense, however this category of S1 is granted for your lifetime.

Everyone in France who has basic French State health cover is issued with an electronic card called a carte vitale, which must be presented to doctors and other health professionals. It contains your French social security number and your health rights (but not medical data) and enables rapid State reimbursements to be made into your bank account. Top-up insurance works solely in tandem with the State health system and you should ask your insurer for further advice concerning the exact terms and conditions of the particular policy you intend to purchase. The carte has your photo on it and may take a little while to issue – but you can ask your CPAM for a paper attestation of your rights, and this can be used in the meantime.

If you are not eligible for a DWP/S1 or your DWP/S1 expires before your UKSRP/S1 starts, then you will need to find alternative health cover, as 100% of your medical costs become your responsibility. Do not let a zero health cover situation drift on, because you will be billed for treatment – in particular serious hospital treatment can be very costly.

• If you work (either employed or self-employed) in France you will be entitled to basic State health cover once affiliated at your CPAM or at RSI (R�gime Social des Ind�pendants) if you are self-employed.

• Provided you have no right to any State health cover whatsoever, as an inactive EU national you can apply to CPAM for basic CMU (Couverture Maladie Universelle) , which is a State health system unique to France. Basic CMU becomes a right after five years of legal and continuous residence in France. You have to pay for basic CMU. But before five years’ residence, the situation is not all plain sailing because CPAMs are autonomous and apply the rules in an inconsistent way nationwide. Thus there is no guarantee that you will be successful. Accordingly you cannot rely on this route to cover you for basic French State healthcare. CPAMs work to rules in the 10-page French Government Circular of 9 June 2011. They work on a case by case basis. One example: if before five years you can establish that unforeseen events and difficulties outside of your control have led to the loss of health cover which you possessed up until then, CPAMs can decide to grant basic CMU.

• If you cannot obtain basic State health cover by any route, then your remaining option would be private health insurance, bearing in mind the caveats mentioned earlier.

EHICs are part of the EC Social Security Regulations and on application are issued by the UK as follows:

(a) When you are resident in the UK

(b) When you are resident in France and in possession of a valid S1. Thus when the limited life DWP/S1 expires, you cannot legally use this EHIC, even if it has a later date of expiry on it. This restriction does not apply once you are in receipt of your UKSRP/S1 because this sort of S1 is for life.

If you have had to purchase private health insurance as a last option, you cannot be issued with an EHIC. LF

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This article is intended solely as an introductory aid and has no legal status. Public bodies empowered to apply the legislation always work on a case by case basis. There are other healthcare aspects which it is not possible to cover in this short article and individuals should always seek personalised advice based on their own specific circumstances.