French medical system

How to get FRENCH COVER ?

To obtain access to the French health system, residents without an "E" certificate have choice between :

      - buying a FULL private medical policy (called 1st Euro) coverage to provide basic + additional cover)

      - obtaining the CPAM (Caisse Primaire d'Assurance Maladie or Sécurité Sociale) cover and getting a Carte Vitale to obtain access

The CPAM refunds around 70% of usual medical expenses and largely less for dental, eyes and strong hospitalisation ...

Then, additional medical cover is advisable.

  

Carte vitale 

Whereas Residents having an E121 certificate have automatic access to the CPAM and get a Carte vitale.

This plastic card contains no medical information but only administrative details.
It is imperative to retain the paper "Attestation Vitale" and you may have to show it to a professional .

In many situations you will not need to send the CPAM document «Feuille de soins» because the card gives exemption in advance.
It is the third part payment " Tiers payant ".

Carte Vitale has no deadline but it must be upgraded (mise à jour) after each important change in your life : wedding, move, maternity, long-term illness ...

 

Advice 

* choose a referring doctor (GP), if not CPAM will keep a penalty on each refund.

* Before dealing with a specialist or surgeon, remember to ask him if he plans to charge some extras over CPAM's refund.  He must tell you if he has signed the "DPTAM" contract which allow your top up to refund largely more than 200% ! 

How much will you reimbursed ?

It depends on:

  • CPAM reimbursement rate, which refers to the cost of your consultation, procedure, treatment or service, determined Social Security system (Base de Remboursement de la Sécurité Sociale, BRSS). These are the standard fees charged.
  • The repayment rate (taux de remboursement). This rate is also determined by CPAM and varies according to the type of care.                        For example, you’ll be reimbursed 70% of the flat fee for a consultation, 65% for medicines for significant medical services, etc.

Here is an example : Your Doctor charges € 40. Social Security reimbursement Rate (BRSS) for a GP consult is set at € 25.

 

Your charges without a top-up cover 

Social Security will reimburse 70% of the standard fee which amounts to €25. The exceeding fee of €15 is not taken into consideration as well as the co-payment of €1 that will be deducted from your reimbursement.

CPAM repayment will amount to € 16.5 regarding the € 40 you paid....

A total of € 22.50 will stay at your charge….

 

Your charges with a French top-up health insurance

If your plan reimburses 150% of BRSS  

Tables of benefits in France often present the reimbursement level as a percentage of BRSS, which stands for Base de Remboursement de la Sécurité Sociale (Social Security Reimbursement Rate).

If your top-up covers your consultations up to 150% of BRSS it means that you will be reimbursed up to the standard fee charge multiplied by 150%, which is 1,5 x 25 = € 37,5.

CPAM will reimburse € 16.5 and your top up will cover the remaining € 21. You will have to pay only €1 co-payment.

Upper limits may sometimes be presented as a fixed amount, for example your top-up might reimburse up to € 500 per year for dental care.

Depending on how often you consult specialists and whether dental or optical care is important to you, it is crucial to choose a suitable cover level. 

 

Waiting periods and exclusions

Waiting periods

Top-up insurance providers might apply waiting periods during the first few months of your cover.

Depending on the insurer, you might not be covered at all during a certain duration or your cover could be limited.

You should carefully read the General Terms ( conditions générales ) .

 

Cover exclusions

Top up insurance usually covers all expenses reimbursed by the statutory scheme.

For example, treatments such as cosmetic procedures or thalassotherapy will usually not be covered. However, some providers might extend their cover and offer to pay for certain procedures not reimbursed by Social Security.

 

Pre-existing conditions will be covered by complementary insurance as they are reimbursed by Social Security.

No health questionnaire will be requested when you apply for top-up insurance.