Healthcare in France
- Credit: Archant
Your entitlement to medical cover in France can be a complex issue, so we’ve asked Johanna Matthews to answer some of your most frequently asked questions
Questions concerning healthcare are frequently put to us by UK citizens who are planning a move to France, and they cover a range of different personal circumstances. Everyone is required to have health cover in order to reside in France permanently, from those who are still in employment to those who have reached retirement age and are in receipt of a state pension. Holidaymakers and people on business trips also need healthcare cover.
The common thread which links most of the questions we are asked is the EC social security regulations. In existence for over 40 years, the state social security organisations throughout the EU, EEA and Switzerland are charged with enforcing these regulations.
Under these regulations, UK citizens coming to France may have transferable healthcare rights via the S1 form, or may be issued with the European Health Insurance Card (EHIC) as a result of their National Insurance contributions record.
The S1 and EHIC forms are part of the EC social security regulations and are issued either by the Department for Work and Pensions (DWP) or by HM Revenue and Customs (HMRC), as the case may be.
There are several types of S1 form which can be issued depending on a person’s circumstances.
Healthcare is a complex issue, so the aim of this article is to provide some general preliminary information based around some of the most frequently asked questions.
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I am retired and receive a UK state pension. Am I entitled to healthcare cover in France?
If you are in receipt of a UK state retirement pension, you are entitled to an S1 form from the DWP in Newcastle upon Tyne. No other pension counts for this purpose. Provided you are not working in France, once registered at your French health office this provides for basic French state health cover at UK expense for your lifetime while in France.
The basic French state health system is a reimbursement of medical expenses system, but it only partially reimburses costs. For example, 70% of costs incurred from a visit to the GP, 80% for hospitalisation, 0% to 100% depending on the particular medication etc. If you are eligible for this type of S1 form, it is the best option for those intending to move permanently to France.
I do not receive a UK state retirement pension. How does this affect my right to healthcare cover in France?
If you are below state retirement age and do not intend to work in France, you can apply to the DWP to see whether you are entitled to a short-term S1 form. The right to this sort of S1 form depends on whether you have paid UK National Insurance contributions in the last two to three years. However, it only lasts for a limited period depending on your NI contributions record.
When it comes to the period of validity of this S1 from, the clock starts ticking from the date when you last paid NI contributions. The short-term S1 form has a start and an end date, and during this period it covers for basic French state healthcare cover as described above for UK state retirement pensioners. When your short-term S1 form expires, your healthcare costs become your responsibility until you obtain alternative health cover.
If a short-term S1 form is issued and you then started to work in France during the period of the form’s validity, you must affiliate to French social security and your S1 would be cancelled. This is because it is a fundamental principle of the EC social security regulations that you can only be covered by one country’s social security system at a time.
Certain people who were entitled to long-term invalidity benefit (which has now changed in both name and nature to employment support allowance) and who are in receipt of either benefit may be entitled to an S1. As this is a complex area, you will need to seek further information from DWP.
I will be working in France when I move. What do I need to do to obtain healthcare cover?
Certain workers may be entitled to yet another sort of S1 form. HMRC in Newcastle upon Tyne is the issuing authority for this S1 and this is dependent on the worker continuing to pay UK NI contributions. Because individual and business situations are often complicated, HMRC always makes decisions on a case-by-case basis, thus you will need to contact them for all further information concerning your individual situation. Only HMRC is in a position to give you an official answer.
If you carry out any of your work in France, HMRC may decide that you must affiliate to French social security. Such affiliation involves paying French social security contributions and this will entitle you (among other things) to: a) basic French state health cover and b) the Carte Européenne Assurance Maladie, which is the French equivalent of the UK European Health Insurance Card (EHIC)previously mentioned.
Am I covered for holidays and business trips to France?
The EHIC can be issued by the UK to individual adults and children as follows:
When you are resident in the UK and while you remain so, the EHIC can be used for holidays and business trips outside the UK but within the EU/EEA/Switzerland.
When you are permanently resident in France and in possession of a current and valid UK S1 form, you must apply for a new EHIC from the UK. This can be used for temporary stays outside France but within the EU/EEA/Switzerland. Note that you must produce your EHIC for holidays in the UK, otherwise you could be charged!
The EHIC covers state medical treatment that may become necessary for you to complete your temporary stay. The card entitles you, in case of illness or accident, to the same medical treatment and on the same reimbursement basis as nationals in the host country.
The DWP overseas healthcare team is responsible for any reimbursements that may be payable for state medical treatment received via the EHIC, so you will need justifying paperwork when claiming any reimbursements.
What is top-up insurance and do I need it?
Once your S1 form is registered at your French health office, you can then choose to purchase complementary health insurance (often referred to as top-up insurance). Unlike the UK NHS, the French state health system is not entirely free, so you can choose to purchase complementary health insurance to top up some or much of the shortfall.
If you choose not to do so you will have to pay any shortfall out of your own pocket, and in the case of a long period of hospitalisation, for example, this could leave you with a sizeable bill.
Top-up insurance works solely in tandem with basic French state health cover and insurers generally offer a range of policies. Top-up reimbursements depend on the exact terms and conditions of the policy you decide to opt for, and you should ask your insurer for further explanation. No medical questions are asked in respect of top-up policies.
Johanna Matthews is a director of
Tel: 0033 (0)5 46 88 22 38