The French health system is rated one of the best in Europe. The state controls health expenditures funded by statutory health contributions. Statutory health insurance (SHI) is mainly financed by employer and employee taxes, but also taxes from tobacco and alcohol, health insurance companies and the pharmaceutical industry. Public health care is available to everyone in France regardless of their income. It is obligatory for those earning over EUR 9,654 a year to pay 8% of their income in social security contributions. Those people on lower incomes will receive free health care, including optician and dental care. An estimated 10% of the population require this support.PUMA (protection universalle maladie) as of 2016 is the new CMU. Its primary focus is on foreigners’ rights and their ability to access French health care. It is compulsory by law that if you are residing in France you need to be registered with a French health insurer. This doesn’t have to be private, as the French public health service is available to everyone and offers excellent treatment.
Registration of French social security
After being a resident in France for 3 months you can register for French social security at your local CPAM (caisse primaire assurance maladie). To be eligible you need to be committed to spending over 183 days a year in France.
The documents needed in order to register for French Social Security are:
– Passport or National ID card
– Evidence of income
– Proof of long term residency
– Proof of address
– Evidence you have submitted a declaration to your chosen insurer
– Marriage/birth certificate if you wish to include family.
If you are employed in France most employers will register you with French social security (please check as it is not a legal requirement for them to do so). If you are self employed you need to contact RSI. Their website is in French but a useful alternative is Cleiss.
Registration for French health care
Registration for French health care entitles you to your health care passport, otherwise known as the French health card, or carte vitale in French. This is issued to over 16s only. It is important that you are registered in the social security system first. The process of getting the card is not automatic so do keep checking up. This can be done at your local CPAM office. It is advised you ask for “attestation de couverture sociale”, which is proof you have access to health care until your health card arrives. The card will contain your photograph and details and is microchipped. You need to take this to every health appointment.
Not a resident in France?
If you are not yet a resident in France (waiting for paperwork for example), on holiday, or temporarily visiting France, you may use your EHIC card to receive the same access to the health system as people who live and work in France. EHIC cards can be claimed for your country of residence. If you are not a EU, EEA or a Swiss citizen it is recommended you take out private insurance for the duration of your stay.
Retired EU citizens require:
– Completed S1 form available from your own country.
– Completed CERFA 60-3406 available in France.
– Proof of pension
– Translated birth certificate
– Proof of French residency
For more information call +33 811 70 3646 – CPAM’s English-speaking hotline.
Finding a GP
With over 23,000 registered GPs to chose from this should not be a problem. You have to pick one GP who will be your personal GP, and should you require or seek specialist treatment it is this GP who will refer you. Once you’ve chosen your GP, to make things official you both need to complete, sign and stamp the CERFA and send it to CPAM. It is possible to see other GPs and to change GPs should you wish.
If you need to see a specialist, a referral from your own GP means 70% of the cost will be reimbursed under SHI. If however there’s a certain specialist you want to see it is possible to chose your own. It is advised to have voluntary health insurance if you chose this route (see below).
A visit to the doctor costs EUR 23; this may be higher in the evenings or at the weekend. Most costs will be reimbursed. On average it will cost you 0-6 EUR depending on your age, health and insurance provider.
A benefit of the French SHI is you are entitled to a free medical check up every 2 years.
– emergency dial 112
– 15 serious emergency
– 18 fire brigade and car accident
– 17 police
– 112 sea and lake emergencies
– 116 117 out of hours doctor
There are 2 types of hospital: hôpitaux, which are state run, and cliniques, which are private. Public hospitals are 80% funded by social health insurance contributions. The remaining 20% are funded by voluntary insurance and patient payments. Confusion often arises at the two distinct policy domains. To clarify, the government sets the payment rates for hospital care and the independent doctors negotiate collective agreements with the SHI fund. Hospital care is generally funded by the state but if you need to stay overnight there will be mandatory contribution fee of around 18 EUR for board and lodging.
There are over 20,000 pharmacies in France. The general opening hours are Mon-Sat 8.30-19.30, but call 3237 to find out the nearest out of hours pharmacy. Most pharmacists speak English. GPs and specialists prescribe the medicine and you take the prescription to the pharmacy for collection. Remember to take your French health card as well. At the pharmacy you just pay the amount you will be charged. There’s no need to pay the full amount and be reimbursed as is the case in hospitals and when receiving other treatment. For example if the medication total is EUR 50, you will be charged 0-15 EUR depending on the type of medication and your insurance plan. The 4 types of reimbursement are 100%, 65% (normal rate), 35%, and none. Having a voluntary or complementary health insurance plan will significantly reduce the cost.
Dentists and optical services
Basic treatment and check ups are usually part of the French SHI and you will be reimbursed around 60-70% of your treatment costs. It is likely you will have to pay the entire amount and claim back the reimbursed amount, unless of course your dentist can bill your insurer using your carte vitale. Specialist services such as orthodontists are not part of the state system and you will be required to pay. This extra out of pocket spending is cheap in comparison to neighbouring countries. You can expect to pay a few euros for glasses and hearing aids and a maximum of EUR 200 for dentures.
Top up / voluntary insurance
Please note this is additional insurance to that of the state insurance fund. It is a policy that provides extra reimbursement of medical costs. It is worth noting if you are in employment that around 95% of the population are covered with additional voluntary health insurance (mutuelles) through their employers or means tested vouchers.
France has a huge variety of health insurance companies and the main criteria to differentiate them is by age and the level of cover you require. Some companies are catered towards expats and English speakers, others towards different professions. Your current level of health typically determines which level of cover you should take out. State insurance generally does not cover specialist treatment so if you have a pre-existing condition it is recommended you take out additional cover.
There are 5 levels available, 1 being the cheapest. Basic packages will focus on hospital care and medicine, however dentist cover may be limited. Level 5 is not necessarily the best value but is the most expensive. It is highly likely you will have to undertake a medical examination also. The main difference between the levels of care is how much of the remaining 30% cost of treatment you will be reimbursed. Taking out level 5 cover does not guarantee you any faster or better quality treatment.
Example of cost: A male, aged 62, retired and registered for social security, can expect to pay around EUR 30 a month for level 1 cover and around EUR 100 a month for level 5.
It is strongly advised to do your research into the various types of medical cover before you enter France. If your French isn’t the best then you should seek well-known English-speaking companies to avoid signing something you are unaware of. You can find out more in our comprehensive French health insurance guide or request an insurance quote from major insurers.