French health insurance requirements

Article L321-1 modified by LAW no 2007-1787 of 20^th December 2007 – art. 8

Sickness insurance comprises:

1. Cover for the costs of general and specialist medicine, costs of care and dental prostheses, costs of drugs and dressings, costs of analyses and laboratory tests, including cover of the relative costs of individual investigations, hospital charges and charges for treatment in care institutions, rehabilitation[I T1] and vocational training or retraining, as well as the costs of necessary surgical interventions for the insured person and the members of his family, in the sense fixed by article L313-3, including cover for medicines, products and contraceptive devices and the costs of analyses and laboratory tests arranged with a view to contraceptive prescriptions;

2. Cover for transport costs for the insured person and for those beneficiaries who have to travel for treatment or to undergo appropriate examinations for their condition as well as to submit to a test stipulated by applicable social security legislation, according to the rules defined by articles L162-4-1 and L322-5 and, taking account of the condition of the sick person and the cost of the transport, in the conditions and limits fixed by Council of State decree;

3. Depending on the decision of the commission mentioned in article L, 146-9 of the code for social action and families, cover for the costs of accommodation and treatment for handicapped children and adolescents in institutions mentioned in 2 and 12 of I of article L312-1 of the same code as well as the costs of treatment concurrent with the education they receive outside of these institutions, with the exception of the part of the charges which are the responsibility of the State in applying articles L112-1 to L112-4, L123-4, L123-4-1,L351-1 to L351-3 and L352-1 of the education code;

4. Cover of the costs of care and hospitalization relating to the voluntary interruption of pregnancy which is effected in the conditions foreseen in section I of chapter IIIbis of the 1st title of book II of the public health code;

5. Concessions [I T2] for daily allowances for the insured person who is physically incapacitated as stated by the medical practitioner, according to the rules defined by article L162-4-1, to continue or restart work; the incapacity may equally be stated, in the same conditions, by the midwife within the limit of her professional competence and for a time period fixed by decree; nevertheless, stoppages of work prescribed at the time of a thermal cure do not give rise to daily allowances, except when the situation of the insured person justifies it following the conditions fixed by decree.

6. Cover for the relative costs of actions and treatments with a preventative aim undertaken in the framework of programmes mentioned in L1411-6 of the public health code and in particular, relative costs of check-up examinations and preventative consultations effected by virtue of the programmes foreseen by article L1411-2 of the same code as well as the costs relating to vaccinations, the list of which is fixed by order of the ministers responsible for health and social security;

7. Annulled

8. Annulled

9. Cover for the relative costs of the examination for the prevention of dental cavities mentioned in article L1232-2-1 of the public health code.