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 31st July 2010
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 Complementary health insurance A fundamental principle of healthcare funding in France is the element of personal contribution so the state does not cover all a person’s medical charges. To make up the difference between what the state pays and the cost of treatment, most French residents take out an insurance policy to cover the difference (complement). This is called a police complémentaire or mutuelle. Note: this is not private health insurance. Over the past few years, government health reforms have shifted some of the burden of paying for healthcare onto these complementary insurers, with a resulting increase in premiums. This trend is almost certain to continue as the Government continues to wrestle with the health budget deficit, which means your choice of provider is very important. There are two immediate problems in making a choice. Firstly there are well over 1,000 providers throughout France, although not all will be available to everyone. Nevertheless, the number on offer is bewildering. Secondly there is the issue of transparency/ignorance. Insurance in France is a well-regulated business but that does not mean it is transparent and certainly not in the field of complementary health insurance. Providers use all sorts of criteria in applying premium rates. But not all use the same criteria. So if you have no idea of the criteria that can be applied then you are at a disadvantage. Some insurers will issue a table of premiums but many do not. What they will do is give you the benefits and an individual quote based on your personal details. All very professional but that premium may have an in-built loading of which you are completely ignorant. For example, premiums will usually be higher if you live in the big cities, particularly Paris. But the converse is not necessarily true. If you live in a remote rural area some insurers will load your premium because the cost of services as ambulances and doctors/nurses home visits will be more expensive. (In addition to the set tarif home visits attract a charge per kilometre that in turn varies depending on the geography of the commmune). Categories of provider There are two main types of provider available to expatriates - the mutuelles and the commercial insurers. There are differences that go beyond the simple fact that one is non-profit making but because mutuelles are non-profit making does not mean that their premiums are necessarily lower. Most people do not recognise a difference between them and admittedly the dividing line can be a fine. But having a background knowledge of the underlying philosophies and different legislation under which these two categories of provider operate, can pay dividends before you even approach a provider or even an independent insurance broker. Mutuelles tend to put less emphasis on medical risk, which is obviously reflected in premiums. Not as simple as that, of course, since mutuelles receive more favourable tax treatment and many commercial insurers do not require a medical questionnaire for some of their plans. Cover required Assuming you have done your background research, you are ready to purchase. Be aware that an independent survey described a third of all plans examined as faible (weak). What sort of cover are you looking for and at the same time how much would you be prepared to fund out of you own pocket in return for lower premiums? Hospitalisation cover is a number one priority for most. A key factor here is dépassements (see An Introduction to the French Healthcare System. Do you live in an area where these are commonly applied? If so being covered for 100 per cent of the tarif is unlikely to be sufficient as you would still have to pay these extra charges. Are out-patient cover and routine visits to doctors/specialists required? If so, the dépassement factor emerges again. Dental and optical cover? These two often come together. To obtain cover that is going reimburse totally or cover almost the cost of things such as crowns and/or spectacles is going to attract very high premiums. Decide what your priorities are, then go shopping and tell the broker what you want as opposed to being told what you can have! As Peter Owen's experience shows, depassements can significantly increase the cost of treatment. Here's his story... 'I live in a rural area around 8km from the nearest village, 12km from a big village and over 20km from the nearest town. I was cycling home one day when a dog collided with my bike. The animal was unhurt but I fell off, but only seemed to be in some discomfort at that point. During the night, however, the pain became excruciating so in the morning I phoned my généraliste (GP) in the big village and fixed an appointment for that afternoon when my neighbour could drive me in. I arrived 15 minutes early and was seen almost immediately. The GP telephoned the X-ray unit 3km away and explained the condition. I was told to come straightaway. I waited about 10 minutes to be x-rayed, then a further 15 minutes while the X-rays were being studied. The radiologist then explained that I had a fracture and a cracked rib. I was told to take the X-rays back to my GP immediately. The GP studied the X-rays and decided that I should see an orthopaedic specialist. He telephoned the specialist (in the nearest big town) and I was given an appointment for the following morning. In the meantime I was prescribed painkillers, which came from the next-door pharmacy. I would at least sleep that night. The following day I waited only a few minutes before being seen by the orthopaedic specialist, who decided that my current strapping was insufficient and my wrist and lower arm needed to be put in plaster, which he did. I returned after four weeks'. Costs As mentioned in the introduction to healthcare in this health zone, when being treated in France, there is a chance you will incur extra costs via dépassements. I live in an area where these dépassements are frequently applied and a snapshot of my bill, a week after the accident, shows exactly how the charges can mount up, and why choosing the right complementary insurance is very important. Consultation with GP Cost: 40 euros (ie: 20 euros dépassement) Reimbursement: 70 per cent of 20 Euros (The Tarif de Convention), less 1 Euro retained by CPAM. X-rays Cost: 135 euros Reimbursement: 70 per cent, less 1 euro retained by CPAM Painkillers Cost: 15 euros Reimbursement: 65 per cent. (CPAM does not retain a further 1 euro because it is related to the GP consultation). Consultation and plaster with specialist Cost: 60 Euros Reimbursement: 70 per cent of 25 euros (The Tarif de Covention) for the actual consultation and perhaps 65 per cent of the costs of plaster. Until I receive the sheets from CPAM it is difficult to forecast how the total fee has been made up but some sort of dépassement will have been levied. Conclusion Despite living in a rural area I have had ready access to quality healthcare, including specialists. With each step in the treatment there was a minimum of delay. However, the need for a personal contribution is obvious and your choice of complementary insurer (mutuelle) can be significant. Many insurers might well have only reimbursed 100 per cent (ie: up to the level of the Tarif de Convention), leaving me to pick up the remainder of the bill of the GP and the specialist. My legal action against the grossly irresponsible dog owner is a separate subject! Peter Owen Health Topic host NEXT:The cost of going to the doctor in France SEE ALSO: Healthcare in France - an Introduction For a more detailed look at the French health service, including a 15-page supplement on choosing complementary health insurance, see Healthcare in France - A Guide for the Expatriate, a 50-page guide, written by Peter Owen, a French healthcare expert of Expathealth Direct Ltd. The guide can help you plan your healthcare so it is cost effective, and considers key issues such as choosing the right arrival date into France and the link between E-forms and tax/financial considerations. 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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