If your residency card is the most important card to have in France, the Carte Vitale runs a close second. This piece of green plastic is your passport to subsidised healthcare in France, so how do you get ‘into the system’ and obtain one? And which health services are covered?
How Does the French Health Service Work?
The French health service is called L’Assurance Maladie. The basic rule of thumb is that the State reimburses 70% of health costs and the patient is liable for the other 30%. However, this is usually covered by a mutuelle, (top up health insurance). People on low incomes or with long term illnesses may be eligible for 100% reimbursement from the State. You pay at the time of receiving treatment and are reimbursed afterwards.
Both public and private hospitals are covered by the health service and there is a lot of co-working between the two. Receiving treatment in a private hospital does not carry the same air of exclusivity that it does in some countries: you will still be reimbursed by the State.
Who is Eligible for a Carte Vitale?
Anyone who has been legally resident in France for three months or more is eligible for a Carte Vitale.
There are different pathways to joining the health service depending on whether you are working or self-employed, or retired. If you fall into neither of those categories, you can join the Protection Universelle Maladie (PUMA). This offers the most basic level of health cover, available to foreigners who are not in work.
British state pensioners are still broadly covered by the S1 scheme of reciprocal healthcare between the UK and France. However, Brexit has changed some criteria so check the NHS website for more information.
For pensioners retiring to France from other countries, you may need to take out some form of private health insurance.
Joining the French Healthcare System: Applying for Your Carte Vitale
You will find the application form on the main health service website, Ameli. Under Menu, type in the Search box ‘demande d’ouverture des droits’. You can’t actually apply online; you have to print off the form, and either post it to your local Caisse Primaire d’Assurance Maladie (CPAM for short) or make an appointment to deliver it personally.
This is France, so you will need to include several documents, including:
- proof of residency
- a certified translation in French of your birth certificate, and marriage certificate if relevant. This has to be done by an accredited professional translator and will cost around 50€.
- proof that you have been living in France for more than three months, e.g., three consecutive rent receipts or utility bills.
- your bank RIB (the document with your bank details).
- If you are a salaried employee, you should also include your most recent payslip and confirmation such as your work contract.
If possible, make an appointment with your CPAM to deliver your form in person as you will find out straightaway if your dossier is complete. If you post it, send it by lettre recommendée (registered post).
After a few weeks, you should receive an email with a temporary social security number. Now you can register with a GP.
Eventually, you will receive your permanent number. Once received, ring the CPAM and obtain a code that will enable you to open an online account on Ameli. At this point, you can order the Carte Vitale by uploading a passport photograph and your permanent social security number via your online space.
If you need to visit a doctor whilst waiting for the Carte Vitale, ask for the feuilles de soin (receipts). You can claim back your costs by posting them to the CPAM.
Finding a Doctor in France
To qualify for reimbursement you must have a médécin traitant (be registered with a GP), but you are free to choose any médécin conventionné (doctor affiliated with the health service) and it’s easy to change doctors if you wish. Many doctors work out of their homes or alone in small surgeries, although in larger towns and cities, you’ll find health centres with several services in one building.
However, if you live in a rural area, you may have to travel some distance as there is a severe shortage of GPs in some parts of France. The easiest way to find a doctor is via the website Doctolib.
Choosing a Mutuelle in France
A mutuelle is a top-up health insurance policy that covers the percentage of your costs not covered by the State. But it is not private health insurance like BUPA, for example. Mutuelles are non-profit organisations regulated by the State.
If you are employed by a company, you will be automatically registered with its mutuelle. Otherwise, your bank may offer one, and they are available from multinational insurance companies such as AXA, as well as a multitude of independent French companies. It pays to shop around, as different policies have differing levels of cover as well as special premiums for older people.
How Much of Your Healthcare Costs Are Reimbursed?
As well as GPs and hospitals, treatment from other practitioners such as physiotherapists, paediatricians, and osteopaths is covered. Also covered are gynaecological and maternity services, including cervical cancer screening and comprehensive pre- and postnatal care.
Dental care was previously only reimbursed to a limited extent. However, recent reforms, known as 100% Santé, aim to extend affordable dental care to everyone and the range of dental procedures that are now reimbursable has greatly increased. You don’t have to go to the same dentist for all your oral care so it can be more economical to choose a different dentist for some procedures.
The 100% Sante programme also covers sight and hearing, so if you qualify you will find that prescription spectacles and hearing aids can be reimbursed to a greater extent than before. Eligibility depends on whether your mutuelle contract covers the programme.
Find Out More about French Healthcare
If you need help in English, CPAM has a dedicated phone number 09 74 75 36 46. The Assurance Maladiewebsite has some basic pages in English, which you can find here. And there is always social media for asking questions: the Facebook group Strictly Santé France is very useful for any kind of health-related query.
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By Pat Hallam
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