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 31st July 2010
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French government healthcare cover changes - what does the official statement The French authorities have announced that Britons and other EU nationals resident in France who are not working and who have not reached retirement age are to have their entitlement to French state health cover removed. Originally this ruling appeared to apply to all such residents - however in November 2007 it was confirmed by a spokeswoman at the British Embassy that after consultations with the French Health Ministry, the French government has confirmed that the ruling only affects those who have lived in the country for fewer than five years or who are yet to move over. (However, this confirmation has yet to filter down to CPAM offices around the country so there is still an unclear situation at a local level - see 'Tell me more about the five-year rule' below) Those affected are classified as economically 'inactive', and will lose their right to a carte vitale - the green card that bestows health treatment rights in France. The new ruling - see the full statement here - follows the application of EU directive 2004/38. This was brought into force in the French administrative system by law 2006-911 of the 24 July 2006 and decree 2007-371 of 21 March 2007. It brings France broadly into line with other EU countries such as Spain and Portugal. The ruling was circulated to all CPAMs in France during October 2007. Coincidentally, or not, this move coincides with the French government tackling the issue of early retirement benefits for French nationals. What exactly does this mean? In the past those expats arriving in France without an E121 (given to those who are officially retired - 65 years for a man and 60 for a woman), E106 (given by the British government to those who had fully paid their National Insurance contributions, and valid to a maximum of two years) or E109 (given for those who work in the UK but whose family lives in another EU member state) were able to join the French healthcare system by paying a subscription to CMU (Couverture Maladie Universelle) which entitled them to a carte vitale and therefore the standard medical reimbursements. This meant, for example, a 70% refund on the cost of a doctor's appointment, which is what French citizens receive (unlike in the UK healthcare in France is not free). This is no longer the case. Now any EU expat not officially retired and not working whether this be because they cannot/ don't want to find a job in France or because they have taken early retirement, and who has not lived in France for more than five years will have their right to French state healthcare taken away. This means they will not be able to have a carte vitale. Instead, they will be expected to take out private medical insurance. Costs vary enormously due to age and circumstance, but you are unlikely to be looking at less than 2,000€ a year. For those people with pre-existing medical conditions, private insurance may not be an option as private insurance companies do not usually allow such conditions to be covered. The new law beings France into line with other EU countries, such as Spain and Portugal, who have tightened their provision of healthcare cover to EU expats after a ruling in the European Court of Justice. Says Larry Fulton from Exclusive Healthcare Insurance: 'On 23 March 2006 there was a judgement by the Cour de Justice des Communautés européennes (CJCE) regarding the rights of citizens of EU member states to reside in another member state. In it the CJCE reiterated that to live in another member state, EU citizens must have health cover and they must have sufficient resources to support themselves without recourse to the social assistance of the host Member State.' However, there are some questions about the legality of the move. According to a letter from the European Commission to a FrenchEntrée reader, they are looking at the legislation. 'The Commission services are currently examining whether this French decision is contrary to Community law, in particular to Regulation 1408/71 on the coordination of social security schemes of the Member State.' According to the legislation new arrivals now have to register with their mairie within 3 months of arriving, providing evidence that they have sufficient financial resources to live here and evidence of personal medical insurance, either an E106/E121 or private insurance. They will then receive a Certificate of Residence. But what if I already live in France? Currently the change in French law is RETROSPECTIVE - but see French government healthcare cover changes: official announcement this week?- so it originally affected all 'economically inactives' living in France - however, as stated earlier this has now been amended so that it only applies to those who have lived in France for fewer than five years. To clarify: if you have not been living in France for five years, are under retirement age and not working, and currently have a carte vitale you will continue to be covered until March 31, 2008. After this period the right to French state healthcare will be taken away, and you will need private health insurance. Tell me more about the five-year rule As stated earlier, the British Embassy has confirmed that after representations made by it to the French Health Ministry, the French goverment has confirmed that those expats who have lived in France for five years or more will be allowed to stay within the French healthcare system, and retain their a carte vitale. The is due to the fact that under France's Code de l’Entrée et du Séjour des Etrangers, after five years or more of 'legal and uninterrupted' residence in France a person gains the 'permanent right of residence.' However, while the French Health Ministry has promised that a circular detailing this information will be sent to local CPAM offices 'shortly', this has yet to be done. This means that all expats who are not working and are under retirement age are currently receiving letters stating that they will be covered to March 31, 2008 only. Does that mean that although I am not eligible for state healthcover now, I will be once I have lived in France for five years? Yes, because after five years of 'legal and uninterrupted' residency in France, you qualify as a resident and therefore are allowed access to the French healthcare system as all other residents. I have already lived here for at least five years and have received a letter from CPAM. What should I do? You can either sit tight - the circular from the French Health Ministry should be sent out before March 31, 2008, making the current letters null and void. If you feel the need to reply, send a letter stating that you have lived here for five years and that under France's Code de l’Entrée et du Séjour des Etrangers, you have the 'permanent right of residence' and therefore are entitled to stay within the health system. If you need help sending a letter click here. What will I need to prove that I have lived here legally? Good question. Hopefully this information will be confirmed in the circular, but it is likely to include documents such as tax statements, utility bills and previous healthcare statements. If you originally received a carte de sejour, this should also help. What if I have a pre-existing medical condition? The problem is greatest for those who already have serious health issues and who therefore may have trouble getting private health insurance. Campaigns - see The way we are being treated is inhumane - have already begun in an effort to overturn this change. There are reports that an appeals procedure will be introduced so that those who have been refused private medical insurance can argue their case of coverage by the French healthcare system. We are, though, still awaiting confirmation of this. If you have lived in France for five years or more - or will do so before April 1, 2008 - you will continue to be covered (although as previously said, this will only happen when regional CPAM offices receive a French government circular informing them of this). I plan to move to France in the future - what does it mean for me? If you are yet to arrive in France or have not yet applied for your carte vitale, you will be refused state cover. Instead, you will be expected to get private health insurance before or immediately after arriving in France. As mentioned earlier, all new arrivals will have to register with their mairie within 3 months of arriving, providing evidence that they have sufficient financial resources to live here and evidence of personal medical insurance, either an E106/E121 or private insurance. They will then receive a Certificate of Residence. At this moment, if you have a pre-existing medical condition, unless you feel you have sufficient funds to totally finance your medical costs in France, or have already got private medical insurance, you may need to re-think your immediate plans. What if I am at or over the retirement age and have a E121? If you are over the UK and French retirement age - 65 for men and 60 for women - and have an E121 the changes DO NOT affect you now or in the future. You are retired and therefore your contributions during your working life, whether in the UK or France, give you access to the French healthcare system as normal. This is part of reciprocal agreement between EU member states. What if I am legally retired but my wife or husband is not? If it is the husband that is retired then the wife will be eligible for a carte vitale as a dependent of the husband. In the past this was also the case if the wife was at retirement age but not her husband. But this too appears to be in some doubt. A few health authorities are now questioning whether a husband can automatically be considered a dependent although what they consider evidence of dependency has yet to be made clear. Given the recent change in the early retirement law DO NOT assume a husband will be covered by a wife's E121. Remember, it is the French government who determines whether it will be accepted, not the British, although it is the British government that reimburses the French for any health costs. If I have an E109 what should I do? These changes do not affect you. Your family will still be covered by the French healthcare system. I have been given an E106 – what should I do? If you have an E106 these changes will not affect you while the E106 covers you. So, if you have an E106 check when it expires. It is at this latter date that your circumstances will change. Then, unless you are then entitled to an E 121 or have been a resident for five years, you will need to get private health insurance or work. It is unclear whether those who currently have an E106 are considered to be affiliated if the rules do change (see above). However, this is the advice being given by the Charente-Limousine Exchange, who are campaigning for change: 'those whose E106 is due to expire shortly and who have pre-existing medical conditions should start contacting private insurers and obtain refusal letters ready for the appeals procedure. Don’t wait until your E106 expires. 'Where relevant, it is also important to maintain a legal resident status until you reach the 5 year deadline. You must take out private insurance to cover this period as if you choose not to do so, the French could declare that you have not been 'legally' resident in France and refuse you entry to CMU.' I live in France and work and pay cotisations - does this ruling affect me? No, it does not. Anyone working legally and paying cotisations (social charges) - whether as an employee or self-employed - is not affected by this ruling. So, what should I do? * If you have an E121 or E109, nothing at all. Again, these changes DO NOT affect you. * If you have a E106 your healthcare coverage will continue until it expires. In the meantime take this time to work out what you will do when you are no longer covered by the E106. See more information above. * If you have another E document such as an E123 the situation is complicated and it would be best to take professional advice. It would also be worth contacting the Department of Work and Pensions in the UK to see whether, especially in the case of invalidity, it can be changed for an E121. * If you have lived in France for five years or more, have neither the E121 or E106, and are not working - either as an employee or self-employed - then, according to the change in ruling, you will continue to have access to the French healthcare system. If you receive a letter from CPAM advising you otherwise, do nothing or reply as mentioned earlier. * If you already live in France, but for fewer than five years, and have neither the E121 or E106, and are not working - either as an employee or self-employed - then you have six months to work out what to do next. Your options are to get private health insurance or start working, even part-time and therefore contributing to the system, resulting in a carte vitale and its advantages. Regarding private health insurance, Nick Chubb of French insurance experts, Asttral says these are the three questions to ask when checking out private health insurance: - what is the price, including details of the initial excesses that you are expected to cover? - what is the quality and extent of the cover I am receiving - what is the attitude to pre-existing conditions? When it comes to work, FrenchEntrée has been asked by many people about the minimum level of work required to qualify for a carte vitale. As an employee you must work at least 60 hours per month. As self-employed there is no minimum income. In theory you can register as an Enterprise Individuelle, earn no money and only pay your healthcare contributions - about 1,300€ a year - and get a carte vitale. However, while this may work in the very short-term, long-term you may be seen as perpetrating fraud. Also the cost of registration and the continuing costs of being self-employed (legal, accountancy, business taxes) are significant so you would have to add these costs onto your health social charges. Plus, in France payments are calculated retrospectively so for the first year of trading you will have to pay the full cost of social charges - about 3,500€ - and then wait for them to be reimbursed. Even with a minimum income you will need to pay siginificant cotisations (social charges). If you considering being self-employed seek professional advice first. If you are working on the black then becoming legal and paying cotisations like most other working people will get you a carte vitale. If I lose my French healthcare cover now, or am ineligible for it at the moment, will I be able to claim it when I reach retirement age? Yes, you will be admitted/re-admitted into the French health system, as part of reciprocal (E121) agreements between EU countries. *** IF YOU NEED MORE HELP, CONTACT CPAM'S ENGLISH-SPEAKING HELP-LINE, TELEPHONE + 33 (0)8 20 90 42 12 By Rachel Loos & Michael Streeter This article is updated whenever new - and confirmed - information is available so do please check back. SEE ALSO: Healthcare cover changes: 'The way we're being treated is inhumane' PLUS! JOIN THE CAMPAIGN Healthcare in France Home Page Looking for a property in France? Use FrenchEntrée's Property Finders to help you find your property and to help you through the buying process 
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