HEALTH INSURANCE FOR EXPATRIATES

These notes have been compiled by JF-Assuranes to help you if you are living in France or contemplating doing so. In either case the quality of the healthcare available and the costs involved if you are ill, are a vital matter which merits careful consideration.

This paper is not a complete description of the French system which is the subject of many pages of rules and regulations. We have however, endeavoured to provide an overall picture of the system, of what your rights are and how you can live in France in security and enjoyment of perhaps the world’s best healthcare system at the lowest possible cost..

These informations are made i 4 sections

  • 1. LIVING IN FRANCE

  • 2. THE BASIC HEALTHCARE SYSTEM IN FRANCE

  • 3. AFFILIATION TO CMU

  • 4. CONSIDERATIONS IN CHOOSING A POLICY

  • 5 COMMING FROM USA

1. LIVING IN FRANCE

THE MEDICAL SERVICE IN FRANCE

Health care and health facilities in France are excellent. France spends a greater proportion of her GNP on health than on defence. Standards are high; the public and private sectors operate alongside one another and the quality of treatment offered by each one is virtually the same. It should be noted also, that there is no lack of capacity. You will not have to wait for treatment or for a bed and unless you are hospitalised in an emergency, you can go into a clinic or a general hospital of your choice. It is worth comment that a ward in a French hospital generally consists of not more than four beds and usually only two in the more modern establishments. Private rooms are readily available. A recent report on world medical care produced by The World Health Organisation placed France before all other countries in the world.

It is worthy of note that establishments and practitioners in France are comprehensively classified by the state. The two principal classifications are Conventionée and Non-conventionée. Conventionée means that the doctor, consultant, hospital or clinic etc. has agreed to observe the price levels negotiated by their associations or in the case of hospitals by themselves with reference to their annual budgets. This price level is known as the Tarif de Convention and on it the whole system of charging and re-imbursement is based. Both the state service and the French insurance companies use percentages of the Tarif de Convention to define the payments they will make.

Certain establishments and practitioners, especially consultants, are free to charge more than the Tarif but this is limited as it was established in the courts by a case in Nantes that the extra charged must be "tactful and reasonable."

Establishments that are non-conventionée are unusual and appear to be frowned upon by the system. For example, where CPAM, the organisation that administers the system, pays 80% to 100% of the Tarif in the case of establishments that are conventionée, the Tarif is reduced by 90% for the purpose of making the calculation where the establishment is non-conventionée.

Both public and private establishments may be conventionée and both are excellent. Your doctor will be able to advise you.

The French system is probably very different from anything you have experienced before. For instance you do not register with a doctor you go wherever you please. You pay the bill before leaving and then claim re-imbursement if you are insured either privately or under the state health scheme [CPAM]. The doctor you have chosen may keep a record of your visit on his computer but you keep copies of such things as X-rays, specialists' reports and the like yourself.

The French service however, unlike the UK National Health Service is not a completly free service so even if you are registered with CPAM you need a top-up insurance policy. It should be noted that the French service plus a good private top-up policy will give you the best medical insurance possible.

The cost of health care world wide has increased exponentially as the equipment and technology that keeps us all alive longer has become more sophisticated and expensive. France is no exception. The writer suffered an accident in 1994 which resulted in 13 days in hospital. An operation was not necessary but the cost including scans was more than £6000. A simple prostate operation costs up to £4000 and open heart or brain surgery can cost £20000 or more.

It would occupy many pages to examine the regulation and operation of the French state health insurance system and to fully understand why nearly all French people have a "Mutuelle" as they call it. If you are admitted to hospital you will be asked for your CPAM card and normally for your mutuelle card. This is because there is always a part of the bill to pay which is not met by CPAM.

If you qualify for the maximum because you have one of the thirty serious classified diseases, a long term illness or are to undergo significant surgery, you will only pay for food and extras or "Depassements" as they are called, such as consultants fees in excess of CPAM scales. Normally your share will be between 5% and 10% of the total cost.

If however, you are admitted neither for surgery nor for one of the thirty diseases (for instance cancer) the position is quite different. In such cases CPAM pays only 80% of the scale leaving you to pay 20% plus Depassements, food etc. Your share then, is usually 25% to 30% of the total cost and you may be facing a bill for several thousands of pounds. Add ambulance charges , consultants fees, diagnostic costs etc. prior to admission and then after care and the figure can become daunting.

Every one of us living in France needs health insurance of some sort. Depending on our circumstances this may take the form of private insurance, French state insurance or a combination of the two. The following sections deal with the rights of expatriates living in France, your situation if you are insured under the state system and the options open to you in finding an ideal solution.

To be insured only under the French State system and to take the risk is not an option. The risk if circumstances go against you is too high. You need a good top-up as well.

QUALIFYING FOR HEALTH INSURANCE IN FRANCE

This section which deals with the situation of expatriates in France applies in general terms to all other countries in the European Economic Area (EEA) as the healthcare rights of nationals living in states other than their country of birth or passport are governed by European convention.

It is important to understand that under these conventions a national of any state visiting or resident in any other state where rights are transfered by any means, is not entitled to healthcare as they would be in their mother country, but to that level of care, better or worse, which is provided to a national of the state visited or in which they are resident.

In addition, on becoming resident it may not be possible to return to the mother country for treatment. For instance, if you have been registered under the French service you cannot return to the UK for specific treatment without permission.

The transfer of rights is carried out in a number of different ways depending on your circumstances:-

  • Holiday or short business trip.

    This is done by the issue of a Form E111 which, in the UK may be obtained at any post office. It is valid for emergencies only. The terms and use of this are set out in T5 HEALTH ADVICE FOR TRAVELERS.
  • Becoming Resident

    If you decide to stay in a new country and become resident your E111 is no longer valid. In this case you will find yourself in one of the following situations:-
  • If you are of retirement age and have a state pension you can apply for an E121 which, when accepted by the French authority [CPAM ], will transfer your rights to France for the rest of your life or you cease to be resident in France. Your entitlement will be as a French citizen which is not the same as under the British National Health Service.
  • It should be noted that it is being both of retirement age and in receipt of a state pension that qualifies you for an E121 and you will be asked every year for proof that you are still in receipt of your state pension.

    You or your wife because of age difference or other reason may find that only one of you is entitled to an E121. In France this automatically entitles both partners to registration under the French system. On application to the DHSS in the UK the member of the family not qualifying in his/her own right can obtain an individual E121 as a beneficiary of the other.
  • If you do not satisfy the qualifications in A above, you may be entitled to an E106 which when issued and accepted by the appropriate authority will entitle you to health care for a period depending on your circumstances, normally a maximum of two years. After that you will not be insured under any state scheme until you are of retirement age and qualify for a state pension in your mother country
  • You may be in employment in which case you and your employer will be paying contributions which will bring you into the state scheme. If you are self-employed you are required to contribute also.

However, depending on your age and circumstances there may be gaps during which you have no entitlement under the Conventions until you reach retirement age and have a state pension.

Indeed if you come from a country outside the EEA, before 1st January 2000 private insurance or paying for affiliation to the French NHS which was very expensive were your only options.

On 1st January 2000 there was an event of great significance. "Couverture Maladie Universelle" [CMU] came into being.

The enacting Law, No 99-641of 27th July 1999 provides that all residents of Mainland France and her overseas departments will have the right to State Healthcare [French NHS] at a relatively low cost and that it will be free and complete for the poorer sections of the community.

This has introduced an important new consideration in making a decision to live in France.

The notion that private insurance and private treatment is superior to publicly provided treatment is possibly correct in many countries but it is not valid in France. The fact is that the state system supplemented by a good top-up is superior in many respects, to any health insurance that the private sector could offer at affordable prices.

The public service does not impose any age limit, there is no medical test, anyone will be accepted without question regardless of their physical condition, treatment in the best private establishments is freely available at the patients’ choice. CPAM settles its share of hospital bills direct and reimbursement of cash payments for such items as routine visits to the doctor are automatic and made within a few days.

Entitlement to State Healthcare.

The principle qualification is residence for not less than three months. Your are also, expected to satisfy the legal regulations of residence.

When coming to France to take up residence you should have a valid Form E111 covering both you and your family. Normally this will be accepted as proof of medical insurance which is needed in order to make an application for a Carte de Sejour and will be valid for emergency treatment until you are registered under the state system.

YOU SHOULD NOTE THAT IF YOU ARE RESIDENT IN FRANCE YOU ARE OBLIGED BY LAW [99-641 & 95-116] TO APPLY FOR AFFILIATION TO THE STATE HEALTH CARE SYSTEM. THERE ARE SEVERE PENALTIES FOR NOT DOING SO AND THE COVER PROVIDED BY THE STATE MAY NOT BE REPLACED BY PRIVATE HEALTH INSURANCE POLICIES.

THE COST OF JOINING UNDER CMU                                                                    

If you have filled in a French income tax return, and you have received an ‘Avis d’Imposition’ containing your ‘Revenu Fiscal de Référence’ (or RFR), this amount should be entered on the CPAM application under ‘Déclaration de Ressources Annuelles’. (See calculation of contribution below.)
If you have not filled in a French tax return, life is a little more complicated because, just like your French income tax return, you then have to declare your global income, but to CPAM. If you can show any tax paid in the UK or other country, then this could reduce the final contribution you have to make. Also non-euro figures have to be converted to Euros. It is worth making life easy for the CPAM by copying this documentary evidence and converting all the relevant figures to Euros. A French translation where papers are written in another language would also be helpful to CPAM.

ENTITLEMENT TO A FREE CMU

If your annual income less allowances, i.e. the RFR, is below certain thresholds, then you are entitled to free basic health cover and free complementary health cover. You will not have to pay a subscription of any kind. The thresholds from 1 January, 2002 are:

  Euros Per Month  Euros Per Year
Single person 562  6744
Couple  843 10116
3 persons 1012  12144
4 persons 1180  14160

CALCULATION OF THE CONTRIBUTION TO CPAM

If your income is above the threshold level appropriate to your situation you will have to pay an annual subscription of 8% of the difference between your RFR and an allowance of 6505 Euros, which allowance applies no matter what size the tax household is. In addition you will not be entitled to free complementary health cover.
Example. If the total household income less allowances results in an RFR of Euros 10585 and this is above the appropriate threshold as shown above, the contribution payable is 8% of the difference i.e. 10585 – 6505 = 4080 X 8% = 326 Euros
This contribution will provide the basic health cover offered by CPAM and it is recommended that a good top-up policy be purchased to obtain comprehensive health cover.
If you are of retirement age and have an E121, or you have an E106, you will need to register but you will not have to pay an annual contribution to CPAM for basic health cover. If you have neither of these and are required to pay, as soon as you become entitled to an E121 you will not have to continue making payments for basic health cover.

WHAT SHOULD YOU DO ?

If you decide to take up stable and regular residence in France the first thing you should do if you have not already done so, is to find out exactly what your position is in your country of passport. You may discover that you are entitled to health care in France contrary to your expectation. Also, if UK nationals have taken early retirement, they can opt to pay voluntary NI contributions to DSS and this may help them to get a UK State Retiremenr Pension [UKSRP]. Although this does not give any immediate right to free basic health cover in France, this is more important than the UKSRP alone as entitlement to an E121 goes with it and consequently access to free French State basic health cover.
If you find you do not have the right under the EC Social Security Regulations to free basic State health cover in France, then you must apply for affiliation to basic State health cover under the CMU.* However you are affiliated to the French system you should have a top-up policy to be safe.

If you work, then like all French nationals, you pay obligatory social security contributions, but receive the benefits.

USEFUL ADDRESSES

We conclude with some useful addresses and the sincere hope that you will find this paper useful.

DEPARTMENT OF WORKS AND PENSIONS [Previously called DHSS]
OVERSEAS BRANCH
MEDICAL BENEFITS SECTION
ROOM TC 001
LONGBENTON
NEWCASTLE UPON TYNE
NE98 1YX
ENGLAND.


TELE: 0044 191 21 87367
FAX: 0044 191 21 87376

When making an application for the E121 etc. make sure you quote your national insurance number.
If you have a pension you will receive a letter confirming the rate each year. CPAM normally accept this as proof that you are still entitled to your pension.

You will find the people you contact at the DHSS very helpful and efficient.

CAISSE PRIMAIRE D'ASSURANCE MALADIE DU VAR.
RUE EMILE OLLIVIER, LA RODE
83082 TOULON CEDEX

This is the authority which will look after you if you reside in the Var.
It is here that you must forward your papers when you receive them from your home authority.

If you live in the Alpes Maritime your authority will be:-

CAISSE PRIMAIRE D'ASSURANCE MALADIE
48, RUE ROI ROBERT COMPTE PROVENCE
NICE


If you need help or advice at any time do not hesitate to call us. We will gladly assist you.

 

2. THE BASIC HEALTHCARE SYSTEM IN FRANCE

Entitlement in France under the French State medical insurance system differs widely from that in other EEA states.

All reimbursements are based on an official price list called the Tarif de Convention.

Reimbursements as a percentage of the Tarif de Convention are:

  • Visits to doctors 70%
  • Pharmacy costs 35% to 65%
  • Specialists’ fees 70%
  • Routine dental costs 70%
  • Hospitalisation costs, depending on the illness, vary from 80% to 100%
  • However, daily food charges and private rooms are not covered.

The above percentages need explanation as the system is complex and varies with different medical conditions. The following are important classifications and qualify for reimbursement of 100% of the Tarif de Convention: -

  1. A list of 30 serious diseases that includes for instance, cancer, heart disease, insulin dependent diabetes etc.
  2. Surgery superior to KG 50. KG 50 is a very low level indeed.
  3. Any illness classified by the attending doctors as being of long duration. A stroke is an example. In the case of hospitalisation exceeding 30 days the condition is automatically classified as of long duration.

The state pays hospital costs only up to 80% of the Tarif de Convention where the illness falls outside the above three classifications. This limitation can result in a costly shortfall. In addition, whilst related outpatient treatment and medication is reimbursed 100% of the Tarif for items 1 and 3 above, this does not apply in the case of item 2, surgical operations.

It should not be taken for granted that an illness classified or otherwise will be covered 100%. You should to ask your doctor to register your condition with CPAM and to obtain a letter of confirmation. If you have serious condition registered for 100% cover, treatment for that condition is normally given without extra charges.

The above is not the end of the matter. Practitioners are permitted to charge more than the Tarif de Convention. This, the ‘depassement’ as it is known, is paid by the patient. The gap between cost and reimbursement is substantial and in certain circumstances can be serious. To be safe, everyone in France affiliated to the state system should have a top-up insurance as well.

The choice of a top-up insurance policy or, “Mutuelle” as it is often known in France, is important. Most offerings are based on a percentage of the Tarif de Convention. The price you pay depends on the percentage level you choose. It should be noted that 100% is not nearly enough. It means that the reimbursement is capped at 100% of the Tarif. This may be enough to cover routine visits to the doctor and normal pharmacy costs but as soon as you suffer from a more serious condition and need specialist treatment and possibly hospitalisation the cost of treatment is always more than the Tarif and at the 100% level you have to pay the excess yourself. To be safe you really need a 300% or even a 400% level.

The best option if you can get it at an affordable price is “Full difference” however much that may be. In France it is called “Frais réel” standing for real cost.

The system is complicated and many people coming to France find it difficult to understand. Here are some examples that may help:

Routine visit to a doctor.

Tarif de Convention = € 20. CPAM pays 70% = € 14
At the 100% level of guarantee the Mutuelle reimburses the unpaid balance up to € 20.

Many doctors are free to charge more than the Tarif and often do so. Thus, if the doctor in the above example had charged € 25 the patient would pay € 5, the difference between the Tarif and the actual charge.

Visit to a specialist

Specialists invariably charge more than the Tarif that for a consultation. The charge depending on the practitioner and the condition. is seldom lower than FRS 250 and can be as much as FRS 750.

Thus:

Tarif de Convention = say € 30 CPAM pays 70% = € 21
At the 100% level of guarantee the Mutuelle reimburses the unpaid balance up to €30. If the specialist had charged € 120 the patient would pay € 90. For the Mutuelle to have covered the complete difference the level of guarantee would need to be 400% of the Tarif.

Hospitalisation is the same. In a recent settlement only a month ago where orthopaedic surgery was involved, the surgeon, reputed to be one of the best in France, charged extra fees amounting to 396% of the Tarif. In this case there was no limit on the guarantees the insurer’s claims office paid the complete difference directly to the hospital. The patient never saw the bill.

We hope the above examples help you to understand the French system. It is not a complete cover system like the UK NHS and this is one of the ways that the excellent service is financed.

3. AFFILIATION TO CMU

MAKING AN APPLICATION FOR AFFILIATION

This paper has been produced to inform you about the law and to help you if you decide you wish to proceed with an application for affiliation to French State Health Insurance. It should be read in conjunction with “Healthcare Living in France” 

Firstly it may be helpful to set out the terms of the Law as it stands.

“Law 99-641 CMU of 27th July 1999 provides for basic and obligatory Universal Health Cover for all people meeting the following conditions (Article 3 of the Law plus Decree 99.005). 

  1. No entitlement to state healthcare. [Note: This is not just French State healthcare]
  2. Residence in France or French overseas departments (DOM’s) for at least three months without interruption.
  3. Compliance with French legislation on Foreigners’ residence (e.g. Carte de Sejour until and if this is abolished.)

The above provisions do not apply to the following groups (article 8 of the Law):

  • Diplomatic and consular staff and foreign civil servants in post in France.
  • People who have come to France for medical purposes.
  • Residents working outside France who are entitled to a foreign voluntary medical insurance that covers them in France.
  • International organisations’ pensioners who do not receive a French pension.
  • People who are entitled to Forms E121, E106, or other European Union Forms that cover them in France [Art 3 1.]

People entitled to basic Universal Health Cover have to pay a contribution of 8% of annual income after French tax allowances after a deduction of € 6505. The Universal Health Cover is free for those earning less than € 6677 or increased thresholds for more people in the family. 

It has been stated by the ministry that the implementation of the scheme is expected to be gradual whilst people become aware of the new Law. 

So, if you wish to apply for, or decide you must apply for affiliation, how do you set about it?

The first step is to collect the documents you will need to present on application. These are:

  • Proof supporting that you have lived in France for at least three months [e.g. rent or EDF statements, telephone bills etc.]
  • Proof of identity (passport etc or Carte de Sejour]
  • Proof supporting income back to one year [e.g. payslips, pension statements, bank statements etc.].
  • Latest tax bill if available [avis d’imposition]

You may not have all of these but the first two items are essential.

You can then go to make your application at your nearest CPAM office or when a CMU officer visits your local Mairie.

After CMU was launched we noticed a marked difference in procedure between various CPAM offices. On consulting CNAM [Caisse National Assurance Maladie] regarding the correct procedure we were advised that:

  • Affiliation to CMU takes place on the day that the person visits CPAM to become affiliated subject to proof of identity and residence and to the condition that he/she is not affiliated to any healthcare system in France or in another European state in line with Art 4 of Law 99-641.
  • On the day of application the person must be given a provisional or definitive statement confirming affiliation. CPAM will issue a provisional confirmation (attestation Provisoire) if the person cannot produce all the required documents to prove identity and stable residence on the day of application. This gives the person two months to produce the missing documents. In the case of a provisional confirmation when the dossier is complete, CPAM will issue an Attestation d’Affiliation backdated to the date of application. In any case the person must receive a document proving affiliation on the day of application and must request it if necessary.
  • Claims that occur from the date of application to CMU (i.e. the date set out in the Attestation Provisoire) are covered by CPAM.
  • A refusal by a CPAM office to give an applicant an Attestation Provisoire is not infrequent. To cover this problem we have issued a letter in French that you can complete with the date and time of your visit, your name and address etc. This is aimed to establish that the request for affiliation has been made and the date that it was made. 

4. CHOOSING A POLICY

There are a number of questions that you should ask yourself:

  • What can I reasonably pay to cover a reasonable risk?
  • What is my life style? Do I spend all my time in France or do I want to travel throughout Europe? 
  • How often do I want to visit my country of passport? 
  • Do I want to travel worldwide? Does worldwide in my case include USA and Canada?
  •  If I have to be hospitalised do I want a private room?
  • Do you want a policy that covers actual illness and hospitalisation or do you want one that covers routine visits to the doctor as well? 
  • How must the premiums be paid? Some insurers specify payment in Sterling,          D Marks or whatever in the country of their establishment. This may not always suit you and a company that will accept payment in any currency may influence your choice. 

These are only some of the points you may want to consider. There may be many others including the insurance company’s response and support service in France. For instance does the company have direct payment arrangements with hospitals and clinics in France and does it make direct payments. 

Does the company offer some form of bonus or cash payment if you are hospitalised and do not need to make a claim for payment? Also will the company allow “existing conditions at no worse terms if you are changing insurers?
Possibly the most important consideration is, is the policy renewable to the end of your life? Some policies are renewable annually without a guarantee that they will always be renewed. It is vital to ensure that the company you select is governed by the French Code d’Assurance. This gives you extra protection including that after two years; the insurer can never cancel the policy.

We have just the right policy for you

5. COMMING FROM THE UNITED STATE OF AMERICA

 

HEALTH INSURANCE FOR AMERICAN EXPATRIATES LIVING OR COMING TO LIVE IN FRANCE

These notes have been prepared to assist you if you are currently living in France or contemplating doing so. It is not surprising that many people choose France as their home after they have retired. France not only offers a new adventure in the Old World but perhaps the expectation of a longer and more active retirement than most other countries in the world. It is a beautiful country stretching from the Channel in the North with the English coast just across the water, to the Mediterranean in the South with Africa just the other side of the horizon. In most cases these places are a short distance away by car, ship or air.


JF-ASSURANCES specialises in insuring and caring for people world wide on the move to France.

The following paper is not a complete description of the French system which is the subject of many pages of rules and regulations. We hope however, we have provided you with an overall picture of the system and an understanding of what your rights are and how you can live in France in security and enjoyment of perhaps the world’s best healthcare system at the lowest possible cost.

THE MEDICAL SERVICE IN FRANCE

Health care and health facilities in France are excellent. France spends a greater proportion of her GNP on health than on defence. Standards are high; the public and private sectors operate alongside one another and the quality of treatment offered by each one is virtually the same. It should be noted also, that there is no lack of capacity. You will not have to wait for treatment or for a bed and unless you are hospitalised in an emergency, you can go into the clinic or general hospital of your choice. It is worth comment that a ward in a French hospital generally consists of not more than four beds and usually only two in the more modern establishments. Private rooms are readily available. A recent report on world medical care produced by the World Health Organisation placed France above all other countries in the world.

The French service however, unlike many national health services is not a completely free service so even if you are registered for healthcare you will need a top-up insurance policy. It should be noted that the French service, plus a good private top-up policy, will provide you and your loved ones with the best medical insurance possible.


SPECIAL NOTE

This paper is primarily concerned with medical care because this is our area of expertise and where we can help you to understand the steps necessary to live out a long and active retirement free of worry. However, it is appropriate to cover the legal aspects of coming to live in France and what you need to do before leaving the US.


As an American citizen you need to visit the French Consulate General nearest your home and apply for a Long Term Visa. Without this Visa you cannot stay in France legally for more than three months. Failure to do this will mean having to return to the US in person to make an application. The Application proceedures take the Consular Service up to three months to complete because your Application along with other required documents must be sent to Paris for approval. You have to collect your Visa in person and it will simplify the process if you allow yourself enough time from the beginning. If you have dual nationality (ie a French citizens passport as well) the situation will be different and may not require any further work by you in preparation for your move to France. As always we recommend that you confirm this and ensure that the French passport is current and has not expired.

If one spouse or the other is French or a citizen of an EU member state a Long Term Visa may not be required. In such cases you should consult with your nearest French Consulate General and confirm that that the holder’s passport is current and has not expired. 


When making an Application you will be asked to provide evidence that you have the means to live in France. 

In addition, it is important to note that you will have to provide proof of medical cover in France effective upon arrival. See Appendix 1.

If you intend to stay in France you will need to apply for a Carte de Sejour as soon as possible. You will need to show evidence of medical cover in France when making an Application. JF-ASSURANCES is able to help you wth this having developed a system specially for our clients.


State National Medical Care is now available to all residents of France. 

This Section applies to all residents of France of all nationalities regardless of whether you are a national of a member state in the European Union or not.

On 1st January 2000 an event of great significance occurred in France. "Couverture Maladie Universelle" [CMU] came into existance.

The enacting Law, No 99-641 of 27th July 1999, provides that all residents of Mainland France and her overseas departments will have the right to State Healthcare [French NHS] at a relatively low cost. 

This has introduced an important new consideration in making a decision to live in France.

The public healthcare service does not impose any age limit and does not require any medical test. There are no medical questions and anyone will be accepted regardless of their physical condition. Treatment in the best private establishments is freely available at the patients choice. The State settles its share of hospital bills directly and reimbursement of cash payments for such items as routine visits to the doctor are automatic and made within a few days. 

Entitlement to State Healthcare.

The principle qualification is residence for not less than three months. You are expected to satisfy the legal requirements of residence (ie.Carte de Sejour). We publish detailed papers on the process you need to follow after arrival in France and these are available to you on application.

We also assist and prepare you before you leave the US and on your arrival in France.

YOU SHOULD NOTE THAT IF YOU ARE RESIDENT IN FRANCE YOU ARE OBLIGED BY LAW [99-641 & 95-116] TO APPLY FOR AFFILIATION TO THE STATE HEALTH CARE SYSTEM. THERE ARE SEVERE PENALTIES FOR NOT DOING SO AND THE COVER PROVIDED BY THE STATE, MAY NOT BE REPLACED BY PRIVATE HEALTH INSURANCE POLICIES. 

HOWEVER POLICIES THAT ARE COMPLEMENTARY TO THE STATE SYSTEM ARE LEGAL AND NEARLY ALL RESIDENTS INCLUDING FRENCH PEOPLE HAVE THEM. THEY “TOP-UP” THE STATE’S GUARANTEES AND ARE RELATIVELY INEXPENSIVE.

A good basic top-up policy for a single person in his 50s would cost € 24.00/ month and 
€41.00/ month for an extended top-up Policy. The French national system combined with the the basic top-up policy provides more than adequate coverage and with the extended top-up policy the most expensive private insurance policy available could not match the level of service and care this combination provides.

On applying for CMU you will need to provide some evidence of your income. Normally this will be based on your French Tax Declaration. However, if you have just arrived in France you will not be making such a declaration until March of the following year for the current year. In such a case evidence from your home country will be accepted.


USEFUL ADDRESSES
We conclude with some useful addresses and the sincere hope that you will find this paper useful.

JF-ASSURANCES 
CHEMIN DE ST ANTOINE
83600 BAGNOLS EN FORET
FRANCE

Tel: +33 4 9440 6094 or +33 49811 3259
Fax: +33 4 9440 6087
E-mail jf@jf-assurances.com      www.jf-assurances.com

If you need help or advice at any time please do not hesitate to contact us either by’phone or e-mail. We will gladly assist you whether you are insured with us or not. Our Help Service for Expatriates is free and without obligation.

Issued by 

EXCLUSIVE HEALTHCARE SA

January 2004-

APPENDIX 1

French Consulates General in America

WASHNGTON. D.C.
French Embassy, Consular Services
4101 Reservoir Road NW - Washington DC 20007
Tel: (202)9446195
Fax: (202)9446148
Website for the Embassy: http://www.ambafrance-us.org
Website for the Consular Section: www.consulfrance-washington.org
District of Columbia, Delaware, Maryland, Ohio, Pennsylvania, Virginia & West Virginia

ATLANTA French Consulate General
Prominence in Buckhead - Suite 1840 - 3475 Piedmont Road, NE — Atlanta, GA 30305
Tel: (404) 495 1660
Fax: (404)495 1661
Website: www.consulfrance-atlanta.org
Alabama, Mississippi, North Carolina, South Carolina, Georgia & Tennessee

BOSTON French Consulate General
Park Square Building, Suite 750, 31 Saint James Avenue, Boston, MA 02116
Tel: (617)5427374
Fax: (617)5428054
Website: consulfrance-boston.org
Maine, Massachusetts, New Hampshire, Rhode Island & Vermont

CHICAGO French Consulate General
737 North Michigan Avenue - Olympia Center - Suite 2020 — Chicago, IL 60611
Tel: (312) 787 53 59/61
Fax: (312)6644196
Website: www.consulfrance-chicago.org
Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, North Dakota, South Dakota, Nebraska & Wisconsin

HOUSTON French Consulate General
777 Post Oak Boulevard - Suite 600 — Houston, TX 77056
Tel: (713)5722799
Fax: (713)5722911
Website: www.consulfrance-houston.org
Arkansas, Oklahoma & Texas


NEW ORLEANS French Consulate General
1340 Poydras Street - Suite 1710 - New Orleans, LA 70112
Tel: (504) 523 5772 through 74
Fax: (504) 523 5725
Website: www.consulfrance-nouvelleorleans.org
Louisiana

LOS ANGELES French Consulate General
10990 Wilshire Boulevard - Suite 300 - Los Angeles, CA 90024
Tel: (310) 235 3200 / 01
Fax: (310)3120704
Website: www.consulfrance-losangeles.org
Arizona, Colorado, New Mexico.
California counties of Imperial/Tnyo/Kern/Kings/Los Angel es/Mono/O range/Riverside/San Bernardino/San Diego/San Luis Obispo/Santa Barbara & Ventura. Nevada counties of Clark/Esmeralda/Lincoln/Mineral/Nye

MIAMI French Consulate General
1 Biscayne Tower - Suite 1710 - 2 South Biscayne Boulevard — Miami, FL 33131
Tel: (305)3729798/99
Fax: (305) 372 9549
Website: www.consulfrance-miami.org
Florida, Puerto Rico, Virgin Islands

NEW-YORK French Consulate General
934 Fifth Avenue — New York, NY 10021
Tel: (212) 606 3600 /88 /69
Fax: (212)6063620
Website: www.consulfrance-newyork.org
Connecticut, New Jersey & New York

SAN FRANCISCO French Consulate General
540 Bush Street - San Francisco CA 94108
Tel: (415)3974330 (415)3622948
Fax: (415)4338357
Website: www.consulfrance-sanfrancisco.org
Alaska, California & Nevada (except LA consular district), Idaho, Montana, Oregon, Utah, Washington & Wyoming, Hawaii & the Pacifïc Islands under the jurisdiction of the United States

OTHER FRENCH CONSULAR OFFICES IN THE UNITED STATES:

France also maintains a consular agent or an honorary consul in many cities in the United States. Their addresses can be obtained from the appropriate French Consulate. They can perform some consular services but do not issue visas.

OTHER USEFUL SOURCES OF INFORMATION

French Government web site.
www.diplomatie.fr

This is a very large site that may be viewed in a number of languages including English. It is interactive and contains information about the country and the legal requirements to visit France or to become resident.

“Blue Book: Guide for US Citizens Residing in France. You can download all of the Blue Book via web site www.amb-usa.fr/consul. This is a consular site of the US Embassy in Paris.If you do not find the information you need, send an e-mail to: citizeninfo@state.gov.


APPENDIX 2

MEDICAL INSURANCE FOR THE LONG TERM VISA 
FOR ARRIVAL IN FRANCE 
FOR A RESIDENCE PERMIT
FOR COVER UNTIL YOU ARE REGISTERED INTO THE FRENCH NHS

A FAST TRACK LOW COST SOLUTION


The system is based on the Gateway Plans. These are low cost castrophe Policies designed for short term cover up to one year. Higher deductables are available to reduce cost still further. There are 6 simple steps:

1. Send us a completed Application Form requesting monthly terms with a
Credit Card Authorisation that you will find in the Application Form.

2. We will debit six monthly instalments and issue you with An Attestation of
Insurance in French to submit to the Consulate with your other papers.

3. The day you arrive in France contact us and we will issue a full set
of Policy Documents and send them to you.

4. We will not start applying your payment until the date of 3. above. This
is perfectly legal as the Consulate requires evidence that you are
covered on arrival in France, not that your are covered by the Gateway Policy in the US

5. As you will have read in "Living in France" you are obliged by French Law
to register with the State Medical Insurance System. We will guide you
through the process of registration and when you are registered we
will cancel your Gateway Policy and give you a credit without penalty for
any unexpired amount of the money you have paid. Thus, in effect you will
have paid by the day.

6. We will offer you a special policy that tops-up the French State
Insurance by reimbursing the full difference between the amount paid by the
State and the actual cost of treatment.

All the above steps can be carried out by e-mail. The Attestation in French will be sent by post as well in case you are asked for it.. 

On arrival in France our Help Lines will be open to advise you at all times.


 
 

 

 

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