All you need to know about health insurance in France 2023

Health care in France through France Today we will learn everything you need to know about health insurance in France

France's healthcare system offers some of the best standards in the world, although private health insurance is necessary in certain circumstances. Medical insurance in France has been a hot topic since the French healthcare system reform in 2016.

This guide explains the public and private health insurance offered in France, and how you can access treatment. It includes information on the following topics:

The health care and health insurance system in France

French law states that all residents of France must have health insurance. This could be through the public health care system or a private scheme.

In 2016, the government introduced a new and universal public health care system -  Protection Maladie Universelle  (PUMA). The introduction of the scheme means that most arrivals are now eligible for French state health insurance  (l'assurance maladie  ).

Individuals who are not covered by PUMA or who wish to increase their health coverage may choose  private health insurance policies  instead.

Who needs health insurance in France?

Under the PUMA system, permanent residents receive state health insurance if they have lived in France for three consecutive months.

Major healthcare reforms have simplified the requirements for workers and residents in France, which means that unlimited access to healthcare is now a right for all residents.

This applies regardless of age, medical history, and record of social security contributions (  social cotisations)  .

Previously, French health insurance for foreigners was only offered if a number of conditions were met. Now, PUMA ensures that legal residents retain their health insurance despite any changes in circumstances.

The new system saw France reach eighth place out of 89 countries in  the  2019  healthcare index ,  after only Austria, Denmark and Spain in Europe.

Public health insurance in France

France operates a co-payment system for public health care, with most medical costs paid for through state health insurance.

Payment varies by service. For example, it is usually within 70% to visit a doctor, dentist or specialist. The cost of visiting a French hospital is about 80% of the costs. For prescription drugs, costs can be up to 100%.

If you have a health card (Carte vitale), you do not need to make advance payments. However, patients without a card will have to pay the appropriate medical fee at the point of service. You will receive the refund in your bank account after five to 10 business days.

Who covers public health insurance in France?

• Residents: Anyone who has a fixed and regular residence in France for at least three consecutive months per year can register for health insurance. Your family or main home must be in France, and you must intend to live there for at least six months (183 days) per year.
• Employees: Employees working in France are entitled to health insurance through social security contributions (cotisations sociales).
• Self-employed and self-employed: Solo traders (small entrepreneurs) and limited business owners (Société à Responsibilité Limitée) can access medical insurance in France through the Régime Social des Indépendants (RSI ) system.
• Children: Children are automatically entitled to health insurance in France regardless of their nationality.
• Students: Foreign students are not usually recognized as residents, so most students must have the required Student Social Security (Sécurité Sociale Etudiante) , which covers health expenses while in France. Exceptions are available to EU/EEA citizens holding EHIC cards, scholarship recipients, unemployed non-EEA nationals over 28 years of age, and students studying in France for less than three months.
• EU, EEA and Swiss citizens: These citizens can usually use an EU Health Insurance Card (EHIC) if they are staying temporarily. However, health insurance is necessary for legal residents.
• EEA and British pensioners: Those retirees who receive pensions from their home countries and reside in France can apply for French health insurance with a valid S1 form.
• Unemployed/low-income workers: Unemployed or low-income legal residents are eligible for French health insurance and can receive benefits through the CMU-C.

What does public health insurance cover in France?

• Doctors: Under the state system, you will usually need to pay a flat fee of €25 when you see a doctor. Insurance providers partially reimburse the costs thereafter.
• Emergency Care: A&E services are part of the state's health care system, and all large cities and towns have an emergency ambulance service.
• Specialized care: Specialists in France may charge higher fees than GPs, but this will be set within the parameters of standard government healthcare costs. In order to be compensated for a visit to a specialist, you will need to be referred by your GP.
• Medicines: Pharmacies work a little differently than other items in the health care system. Instead of paying the full amount and then asking for a portion of your costs to be reimbursed, you will only pay the amount that is not covered by the state when you buy the drug at the pharmacy.
• Dental care: The French government health care system covers visits to the dentist. However, dental care comes with its own tariffs and reimbursement rates. General dental treatments are reimbursed in the same way as other specialized care, but reimbursement for advanced procedures are usually lower due to the higher cost.
• Maternity care: The majority of costs associated with pregnancy and childbirth are covered by public health care. 70% of the costs of the first two surveys are covered, then after six months all costs are covered in full.

How to apply for general health insurance

The first step to obtaining health insurance in France is to either join the social security system or visit your local CPAM (Caisse Primaire d'Assurance Maladie).

Employers usually register their employees with Social Security and arrange their own health care procedures. However, it is your responsibility to verify that this happens. Self-employed people apply through the Régime Social des Indépendants (RSI).

If you qualify under PUMA, visit your local CPAM or mail your application. The CPAM assesses your rights, but the Social Security Authority determines whether you contribute to your health care costs. If you earn less than a certain limit, you qualify for free health care under the CMU-C.

First, you will need to submit a CERFA form, proof of identity and residency, translated birth and marriage certificates, proof of three months’ residence in France, bank details, proof of income, and your doctor’s declaration (doctor’s registration). During registration, you can add beneficiaries or dependents.

After your health insurance is activated, you may need to formally request your resume. This may take a long time to process, but you can request a temporary insurance card (couverture sociale endorsement) to cover you while you wait.

You can update Vitalik on demand annually by entering it in the green box in CPAM offices, hospitals and pharmacies.

Register with a doctor in France

Residents over 16 who are covered by state medical insurance are required to register with a family doctor (medicine traitor). This is to arrive at full reimbursement of their medical costs.

Failure to do so will result in higher penalties for medical fees and lower reimbursement rates.

Anyone 16 years of age or younger can visit any GP without fear of being fined. Once you register, you will receive an acknowledgment from the Médecin Traitant Organization.

Private health insurance in France

Many French residents increase their coverage with a private health insurance policy, known as a mutuelle. Mutuelles can sometimes cater to workers with specific occupations, some of which are specifically aimed at English speakers.

Employers often offer a place in the exchange as part of your benefits package.

Students can either choose cover from their parents mutuelle or select their own.

Advantages of obtaining private health insurance coverage in France

Consultations with psychologists, orthopedists, chiropractors, and some specialists are not usually covered by state insurance.

If you need any specialized treatment, private insurance offers the same treatment you would get at home.

The costs of private care depend on the type of coverage required and factors such as the age of the applicant; However, a few mutuelles ask for your health details before agreeing.

Basic packages focus on hospital care and medications, but may include limited dental coverage. Therefore, you should always research and compare plans before moving in in order to get the best insurance coverage for you.

How does private health insurance work?

Most French insurance companies reimburse the remaining 30% of your general healthcare costs, including emergency hospital treatment.

Many professionals are independent but receive public health funds from the state. The state sets the prices for services. However, some carry excess fees that the individual must pay if the other party does not cover it.

Thus, some policies indicating 100% coverage may seem misleading.

Reimbursement only refers to tariffs set by the state, such as the standard fee for a doctor's consultation. Surplus amounts are not covered by the mutual and therefore paid by the individual.

The process may seem complicated at first, so don't be afraid to ask for advice. For prescriptions, private insurance may offer partial or total refunds.

Health insurance fees and reimbursements

Anyone working in France whose social contributions (cotisations sociales) will be automatically deducted from their salaries. This is covered by state health insurance in France.

There are a number of factors that affect costs, such as income and family. It averages about 8% of your net income above the minimum set by the state.

Visit CLEISS (Centre des liaisons Européennes et internationales de sécurité sociale) for the full list of French health insurance contribution rates as of January 1, 2019. The government adjusts the percentage of social contribution deductions annually.

Health insurance for the unemployed and low-income

Unemployed and low-income workers are entitled to free state-funded supplemental health care, known as the CMU-Complémentaire (CMU-C).

The current income thresholds per household for 2019 are set at the following levels:

1. House for one person: 8,951 euros
2. Family of two: 13,426 EUR
3. Family of three: €16,112
4. Family of four: €18,129

Each additional person in a household of more than four people: 3,580 euros per person.

Arrivals must first activate PUMA before qualifying for CMU-C. After that, all medical and dental costs are covered by state health insurance.

You will not be charged for advance payments after the Services have been rendered. You can apply for a CMU-C by filling out this form and sending it to your local CPAM.

9853