French Health Issues
Lobbying for your healthcare rights in France and the EU
First you need to register
How to register
Registering with a GP (Medicin Traitant)
Insurance
Getting treatment
Level of
re-imbursements for treatment, etc
Emergencies
Hospitals in-patient and
out-patient
Exceptions
Affections de longue
durée (ALD) details
With the exception of those individuals who either choose or are obliged to take private health cover for all their needs, each individual residing living in France will need to register with the appropriate Caisse d’Assurance Maladie, as soon as possible after taking up residence in the country. Which Caisse you register with will depend on your personal circumstances and where in France you reside. If you are employed in the private sector, retired and drawing a UK state pension or incapacity benefit - ie covered by an E121 (LINK to E121 section) - , “in-active” and covered by an E106 or E109 (LINK to E106/109 section) or living in France but working elsewhere in Europe and covered by a “workers” E106 (LINK to workers’ E106 section), it will be the Caisse Primaire d’Assurance Maladie (CPAM) of your departement.
If you are self-employed, working in the civil service, a state owned company, in an agricultural concern or even a notary’s office, you will register with and contribute to a special Caisse:
You must register with the French Health System in order to be granted any benefits. Contact your local CPAM or appropriate Caisse (office) and they will inform you which documents are appropriate to cover the various members of your household, either in their own right or as dependants.
These will normally include your passports, birth certificates, proof of residence (rental agreement, house purchase documents, phone and electricity bills etc), a “RIB” from your bank - which gives details of your account for re-imbursement purposes (you should find one in the front of your chequebook, or you can ask your bank for one) - plus tax returns, or other proof of income, as appropriate as well as – in some cases – two passport sized photographs for your Carte Vitale (see below).
You can find some of the forms you may need here:
CMU de base (basic contributory scheme)
Once registered, you will be given an “Attestation” (proof) of your healthcare rights, with an expiry date, when you will once again be asked to provide evidence that you are still resident in France (normally an annual process). You should make a note of this date in your diary, so that you do not find yourself unexpectedly without health cover, should your CPAM fail to contact you on expiry.
Eventually, you will also receive a “Carte Vitale” (a green plastic card, the size of a credit card) LINK to Carte Vitale section. These “CVs” are not compulsory - your Attestation is the important document to hold – but it does speed up the payment and re-imbursement process. Note: these Cartes Vitales are currently being changed to include a photograph of the holder, so you should check to see whether your local Caisse operates this system yet.
Each person over 16 years old within the household will also be asked to nominate a Médecin Traitant (treating doctor) who will be the “gate-keeper”, overseeing access to consultation and treatment. Normally, this will be a local GP (médecin generaliste) so you will need to make contact with a GP who will confirm his/her acceptance on the form you return to the CPAM or other appropriate caisse. Children under 16 benefit fully without the need to nominate a médecin traitant. You can change your doctor if you wish, but to get the full level of reimbursements from the state, you should fill in a new Declaration if you do this. It is also permitted for you to choose not to nominate an MT. However, reimbursements for any medical expenses will be reduced significantly if you do refuse.
Declaration of Médecin Traitant
You may take out complementary insurance to cover the part of medical expenses not paid by the national health insurance. The Caisse will be informed of any additional cover you take out by your insurance company so that in most cases reimbursements can be coordinated. See here
With some exceptions, your first step when seeking diagnosis or treatment for a suspected medical condition will be to visit your Médecin Traitant. If you are away from home and in France when you need to consult a doctor just go to a local GP or Hôpital.
He/she may
You will generally pay for your treatment and get reimbursed, thus you should always take your Carte Vitale or Attestation with you, whenever you visit a medical practitioner, pharmacy or hospital.
As many health practitioners in France are now linked to the nation health network, the need to hand over money at the point of delivery is much reduced, but if in doubt have either cash or a cheque-book with you (do not assume that all providers will take credit card as payment). If you have been issued with a Carte Vitale by your Caisse d’assurance maladie then this can be used to cover the proportion of the cost covered by the caisse and any complementary insurance cover.
If you do not have a CV, you will be given a “feuille de soin” (health re-imbursement form), which you must fill in and send to your local caisse. If you are not given this automatically, then you must ask for one, or you may have problems in getting your money back if you claim in retrospect.
There is often a statuary contribution by the patient for any medical act or medication, which you cannot avoid (forfeit). Although these are small amounts, they can add up as each individual test, medicine etc. will be subject to the set fee. Your payment of these may be “hidden” and is often deducted from the total monthly account you receive from the caisse d’assurance maladie. NOTE: It can take some time for a caisse to “catch up” with the forfaits which you owe, so they are sometimes charged for up to three months in arrears.
Details here
Call the SAMU (Services d’Aide Medicale Urgente) dial 15 on the telephone
There is a dual system of hospital establishments, state hospitals known as Hôpital and private hospitals known as Clinque. You are free to choose either, dependent on your needs and preferences; in both cases the state system will cover that proportion of the costs defined for the treatment received. State hospitals have A&E departments but, in general, cliniques will not treat A&E cases.
There are many exceptions to these general practices and for detailed explanations of what is and is not eligible for consideration within the French Health System you must visit one of the official web-sites. Here are just a few of those exceptions:
For a list of ALDs in English, see here
