Healthcare options for obtaining cover under the French system

The French healthcare system is renowned for being one of the best in the world. The level of service is based on heavy investment by the French government and this is one of the reasons why French social costs are so high.

The way that the system works in France is that you pay when you see your doctor, or when you buy drugs at the pharmacy and then you are reimbursed by the Caisse Primaire d' Assurance Maladie (CPAM) by a credit direct to your bank account. The cost of treatment not reimbursed by the government can be covered by a private healthcare policy (mutuelle). You can choose the level of cover depending upon your needs. The cost of this cover depends upon your choice of cover - basic or premium, your age and number of family members. For a small family in their thirties expect to pay from 70 Euros per month for a basic policy.

Carte Vitale
The carte vitale is a card which records all the details of your healthcare cover in a chip - this card should be presented whenever you visit the doctor, pharmacy or other healthcare practitioner. The card records that you have made a visit, plus the amount you have paid. This information is that automatically transmitted to the CPAM, and your mutuelle company. The reimbursements for treatment will then be credited to your bank account. The carte vitale also shows your social security number (numéro sécu) on the face of it.

In the interim, once you have cover in place at the CPAM you will have a paper "attestation" of cover which confirms cover from a certain date and mentions all the people that have cover under that reference number. Keep this document safe and show it to your doctor when you visit. You will pay the charges as normal, but you will have a paper form which you need to complete and sign then send or take to your Caisse Primaire d'Assurance Maladie. If you have a mutuelle please also let them have a copy of the forms, as without having your carte vitale the mutuelle company does not give automatic reimbursement.

Entry routes into the French healthcare system

E101 - if you are seconded by your European Union employer you will continue to pay your social security charges in the UK, but will be entitled to French healthcare cover. You will also continue to receive UK Child allowance, and your employer will continue to pay UK National insurance.

E104/106 - if you were employed or self employed within the EU for the two years before arriving in France you may be entitled to initial cover based on historic social charges paid in your home country.

E121 - If you are drawing your state pension in your home country then you will be entitled to cover in France from the day you arrive, but you will need to apply for the certificate from your home country first.

E111 - For business trips and short stays you can get basic cover under an E111 for emergency treatment. A new card system is being introduced and if you apply for a new E111 before the end of the year you will then get into the new card system automatically.

CMU - Cover is also available under the CMU based on your residency. You apply at your local CPAM, and pay contributions into the system based on your revenue for the previous 12 months. Contributions are at 8% of your annual revenue. For those on low income cover may be free of charge depending upon your circumstances. Cover has recently been restricted by qualifying periods of residency, as well as proof that you have declared your income in France.

Working in France - if you are employed full time or if you have registered as self employed then your social charges will get you into the healthcare system from the date that you start your French activity. Dependent cover has to be added separately and you will still need to put a mutuelle en place.

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