Healthcare cover changes in France - what you need to know from FrenchEntrée.com

3rd September 2010

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Healthcare cover changes in France - what you need to know

In late 2007 new French government rulings restricted access by EU expats to the French healthcare system.

For British expats, the new rulings do not affect those who are retired and holding an E121 form or those who plan to work in France.

However, it does affect some early retirees, including those who will initially be on E106 forms, issued by the UK government.

For those originally from other EU member states, you will need to check your status with your own government in regards to early retirement and other forms of health coverage in France as this story mainly deals with UK expats.

The French government statement can be seen here - here.

The new rules are as follows:

* Inactive EU citizens already living in France and already registered and accessing healthcare via the CMU before and including 23 November 2007 will be allowed to continue to do so as before.

* Those people who were resident in France before and including 23 November 2007 on E106 forms will be allowed access the healthcare system when their E106 form expires. This was a late change announced initially by the British Embassy - see it here - on 24 January, 2008.

* After five years of 'regular, uninterrupted residence' in France, an EU citizen qualifies as a permanent French resident and will therefore have entitlement to healthcare via the CMU, even if they haven't before.

* Those people not eligible for healthcare cover via CMU, and who have not lived in France for five years or more, will have the right to appeal for access to cover under CMU if their life changes due to 'unforeseeable circumstances due to financial or health reasons' which results in them being unable to obtain private health insurance in France.

Examples given include: separation from or death of a spouse, the end of a marriage, denial of private health insurance in the event of a serious illness or something that was unforeseeable at the time of a person moving to France.

How has the situation changed?

It is a long story. Until September 2007 all expats arriving in France from other EU member states were able to access the French healthcare system by paying a subscription to CMU 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).

However, in September 2007 the French government announced that any EU expat not officially retired and not working - whether this be because they could not/did not want to find a job in France or because they had taken early retirement - and who had not lived in France for more than five years would lose their right to French state healthcare. This meant they would no longer have a carte vitale. Instead they were expected to take out full private medical insurance. The irony of this decree was that until then 100% private medical insurance cover was considered illegal in France.

According to the French government this change brought 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 - EC Directive No. 2004/38/EC of 29 April 2004

The biggest problem with the legislation was that it was retrospective, which meant that those who had lived in France for many years suddenly found themselves facing the loss of their right to state healthcare cover, and having to take out private health insurance.

The financial implications were huge. For those with serious existing medical conditions it was even worse as private health insurance companies do not offer cover for such conditions. This meant having no medical coverage at all for conditions such as cancer or chronic heart problems.

However, after a sustained campaign from resident expats, the British Embassy in Paris and other government and MEP officials the retrospective nature of the legislation was withdrawn for all those living in France before and including November 23 2007. This change was also applied to those currently holding E106 forms.

So tell me, what exactly does this all mean?

* If you are an EU citizen over retirement age and are eligible for an E121 (given to those who are officially retired - 65 years for a man and 60 for a woman) you are completely unaffected by these changes. If you live in France now you have access to French healthcare cover as before. If you plan to move to France in the future you will be covered when you arrive.

* If you currently live in France and hold an E106 form (given by the British government to those who had fully paid their National Insurance contributions, and valid to a maximum of two years) you will have immediate access to French healthcare cover as the costs are covered by the UK government, until your form expires.

After your form expires, if you were resident in France before and including 23 November, 2007, you will be allowed to join the French healthcare system via CMU.

However, if you became a resident from this date you will need to take out private health insurance until you reach retirement age and are eligible for an E121 or you reach five years residency.

* If, before and including November 23, 2007, despite not working, you were affiliated to CMU (Couverture Maladie Universelle) and therefore covered by the French healthcare system you will be allowed to stay within the system and claim as you always have done.

* If you plan to move to France in the future and do not plan to work and will not be retired and hold an E121 you will need to take out private health insurance to cover you until you reach retirement age and are eligible for an E121 or you reach five years residency.

If you are eligible for an E106 form, this will give you immediate health cover, paid for by the UK government. Once this expires, you will need to take out private health insurance to cover you until you reach retirement age and are eligible for an E121 or you reach five years residency.

I hear there have been some problems with regional CPAM offices?

Initially, regional CPAM offices were not up to date with the most recent changes which meant many people were finding that they were unable to change their status - this includes those who had lived here for five years or more.

However, as time goes on, the situation has changed to reflect the latest French government rulings.

If you do experience a problem, try this:

- First of all, return to the CPAM office with a copy of the statement announcing the change - see here - printed out.

If you cannot print it out, take along the address of the web page: www.securite-sociale.fr/comprendre/europe/europe/cmu_inactifs

If this does not work, lodge an appeal. If nothing else, this will get you in the system.

I have an E106 that has recently run out. What does this mean for me?

As stated earlier, if you were resident in France before and including 23 November, 2007 you will be allowed to access the French healthcare system via CMU.

You should contact your local CPAM office and ask to be affiliated.

I have an E109 form. What's my status?

You will have access to the French healthcare system until your E109 form expires.

If you moved to France after 23 November 2007, then once your form expires you will be required to take out private health insurance until you achieve state retirement age and get an E121 or five year residency. If your partner has a current E106 form, you can access the health system with this. The same can be done with a partner's E121 form.

If you moved to France before 23 November 2007, the situation is currently unclear. The French government statement only clarified the situation for people on E106 forms. The British Embassy believes that all those resident before 23 November 2007 are entitled to affiliate into CMU.

In a statement it says: 'We have made the [French] Health Ministry aware of these people's special circumstances. They have confirmed that due consideration would be given to any cases of people in these categories living in France before 23 November who might now have reason to apply for access to healthcare via the CMU. For example, in the relatively unlikely event that they lost their existing cover - and had not already lived in France for the five years necessary to secure a right of residency.'

The Embassy also suggests you contact HM Revenue and Customs, the Department of Health or Department of Work and Pensions, or visit the DWP website

I moved to France after the November 23, 2007 deadline – what does this mean for me?

* If you have an E121 you have nothing to worry about. As stated earlier, these changes do not affect you.

* If you have E106 form you will be covered until the form expires. Then you will need to take out private health insurance.

I have a serious pre-existing medical condition? How does this all affect me?

* If you already live in France and have access to French healthcare through affilation to CMU you will continue to be treated and covered as you always have done.

* If you are currently on a E106 form and were resident in France before and including 23 November, 2007, you will be allowed to affiliate to CMU.

* If you moved to France after this date, you will be expected to take out private health insurance.

If you have developed a serious medical condition since arriving, then you can appeal, asking to be affiliated as your life has chnaged due to 'unforeseeable circumstances due to financial or health reasons'

* If you are yet to move to France and you will not be retired with an E121, and you are unable to work, it is doubtful that you will be able to appeal for access to the French health system on your arrival in France as your life here would not be considered to have changed due to unforeseeable circumstances when you were living in France. You, therefore, are likely to need private health insurance.

If you are eligible for an E106 you will be covered by those initially but after that you will need to take out private health insurance.

I plan to move to France in the future...

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.

New arrivals are expected 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.

If you develop a serious medical condition and/or your life changes in a way that you did not expect when you moved to France (see the explanation of the new rules at the beginning of this story) you should, in theory, be able to appeal to be allowed into the French healthcare system. At the moment, how an appeal is viewed is open to interpretation and down to regional CPAM offices. It may well be that over time a procedure to determine the criteria for affiliation is introduced, but currently this is not the case. However, it is clear that if a person is affiliated, their family will automatically be affiliated too.

However, regardless of this, unless you feel you have sufficient funds to either totally finance your medical costs in France, take out private health insurance or work until you reach the UK retirement age or five years residency, you may need to re-think your immediate plans.

How much does private health insurance cost?

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 – however, you will be able to appeal to the CMU for access.

Why does the rule change if I have lived here for five years?

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.'

What will I need to prove that I have lived here legally?

Official 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 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. However, recently 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. For more on this subject see Does your E121 or E106 form also give your partner healthcare cover in France?

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.

I am thinking of working to give me access to CMU. Is there a minimum number of hours I need to work, or money I need to earn?

As an employee you must work at least 60 hours per month or 30 consecutive days; or 120 hours in salaried employment during three consecutive calendar months or three months start date to finish date; or you must have worked 1200 hours in salaried employment during one calendar year (the latter will get yoiu two years cover). This can include the cheque d'emploi system.

For the 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 are likely to have to pay siginificant cotisations (social charges). If you are considering being self-employed seek professional advice first.

By Rachel Loos

SEE ALSO:

* All you need to know about private health insurance

* First I discovered I had cancer, then that I was being ejected from the French healthcare system

* Healthcare in France - an introduction

Contacts:

* CPAM - The French Health Service (English language service): +33 (0)8 20 90 42 12

* Check here to find your local CPAM office

* CLEISS - (France's helpdesk for international mobility and social security):
11 rue de la tour des Dames
75436 Paris cedex 09
Tel: + 33 (0)1 45 26 33 41; www.cleiss.fr

* For holders of E106 and E109 forms, contact:
DWP Overseas Medical Benefits helpline
International Pension Centre
Room Tc001
Tyneview Park
Whitley Road
Newcastle upon Tyne
NE98 1BA
Tel: +44 (0) 191 218 1999 (Monday to Friday 8am - 5pm); www.dh.gov.uk/travellers

* For more information on the healthcare campaign see French Health Issues

How to affiliate to the health system
Private health insurance explained
The “E” Forms and Dependent Beneficiary Status Explained

Healthcare in France Home Page

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