Health Insurance Forms
Make sure you have the right forms

The “E” forms are EEC forms agreed by all member states pursuant to the Treaty of Rome. They all provide health insurance under the member state’s NHS in the same way as to a citizen of the state of residency. There are many but those that affect expats in France in particular are:

The E121

This form is issued on qualifying by meeting two conditions. These are to have reached the official age of retirement and to be in receipt of a State Retirement Pension (OAP); no other type of State Pension counts for qualification. A person who has a Long Term Incapacity Benefit (LTIB) qualifies on that basis alone and the normal related E121 rights are not affected.

There are a number of questions when qualifying which may be asked:

A UK OAP can only qualify if they have paid NIC for an accumulative minimum of 10 years. Paying for 9 years does not qualify but the contributions actually paid can be aggregated with other contributions towards pension rights paid in other member states during the working life.

A woman’s age of retirement is variable depending on the date of birth. Prior to 1950 it is 60 years of age. Thereafter is rises on a sliding scale until 1955 when it becomes fixed at 65 years of age.

A married woman qualifies for an OAP in her own right by paying NIC for 10 years. If she has paid married woman’s reduced rate contributions her OAP will not become payable until her husband qualifies for his OAP.

A woman becoming a widow prior to April 5th 2001 is entitled to a widow’s pension unless her circumstances change, usually on remarriage. After the cut–off date she receives a widow’s bereavement benefit consisting of a lump sum (£2000) and 52 weeks widow’s pension. Thereafter she has no entitlement including the E121 until she qualifies for this in her own right. However, to qualify for the widow’s pension she must be over 45 years of age, if she is younger she may still be entitled to a reduced amount but would need to check as it is dependent upon circumstances.

The E106

The primary purpose of the E106 is to provide cover for workers and their families working at a fixed address or working on the move in other member states. This is a highly complex subject and for the moment it is best to refer questions directly to the appropriate authority in the UK, which is the Inland Revenue Department (IRD) (see contact list at the end).

The E106 is also issued to cover Short Term Incapacity Benefit (STIB) and this is used by the UK to cover early retirees on the assumption that an application made on the basis of early retirement amounts to self-declaration of STIB. The UK is the only member state we have found in the EEC that applies the E106 in this way.

Because the underlying principle is STIB the qualifying conditions, are to have worked and paid NIC during the two years immediately before leaving the UK as early retirees. The many years before the last two during which NIC may have been paid are ignored. This provokes much protest.

The E106 provides cover for up to two and a half years, which is the same as the maximum period for STIB.

It should be noted that people covered under this head are regarded as being in the care of the UK authority even though they have the right to treatment exactly the same as a French citizen. For this reason some CPAM areas refuse to issue the Carte Vitale and the CEAM (EHIC) either or both. There seems little that can be done about the Carte Vitale but on application directly to the UK authority together with a photocopy of the E106 an EHIC will be issued and posted. See below (how to apply) for the correct address.

Dependant Beneficiary Status

Both the E121 and the E106 provide cover for members of the holder’s family. Ever since January 2002 when France first recognised the “one E121 per person” ruling there has been confusion over the word dependant and arguments about who is in fact entitled and who is not have been general throughout France. Definitions have now been published both in EU and French law that effectively put an end to the dispute.

The EU regulation states that the common form of marriage in church constitutes mutual Dependency and any civil marriage contract legal in the country of residence has the same effect.

Examples illustrating this are:

1. Living together as man and wife in a married state: If the wife is the first to qualify, the husband is classified as an entitled Dependant Beneficiary without reference to any further consideration. Husband and wife are required to make a joint tax declaration together and are regarded as mutually dependant each on the other. When the husband qualifies in his own right he will no longer be a Dependant Beneficiary.

2. A couple living together having entered into a civil marital contract called PACS in France: The definition, rights, and responsibilities are the same as in 1. above. CODE CIVIL ART 515-1 to 515-7 specifically states that if one of the partners of a PACS Contract benefits from assurance maladie the other can benefit as a Dependant Beneficiary to the same extent. The children of either partner can benefit in the same way too.

3. Living together as man and wife in an unmarried state: Here the definition of the term “Dependant” is taken into consideration. Under French law the definition of “Dependant” is financially dependent and it has to be demonstrated that the one seeking classification as a Dependant Beneficiary is wholly, completely and permanently dependent on the other. Under this head the examining authority (CPAM) is entitled to ask for proof of means whereas under 1. and 2. above it is not.

It should be pointed out that there are wide variations in the interpretation of the above regulations from department to department and sometimes even between individuals in the same department. The only way it is possible to find out how a particular CPAM office will react is to pay a visit and discuss your case. A “please can you help me” approach can take you a long way.

Since the introduction in 2002 of the Dependant Beneficiary principle there has been confusion about the way in which the regulations are implemented and after a period during which complicated procedures have proved unreliable, the following has now been adopted:

The cardinal principle under EEC regulations is that every person must have his/her own E121. This is to enable accounting by individuals rather than by family units.

From this it follows that the first member of a family to qualify for an E121 (the Qualifier) should be issued with a Form in his/her own name and no other person. A duplicate of the Qualifier’s Form should be issued with the Dependant Beneficiary entered in the appropriate section on the back. For a husband and wife, a Form and a Duplicate should be issued; for a husband, wife, and child, a Form and two duplicates should be issued.

In the case of 1. above, married couples, contact the International Pension Centre requesting the E121s a month before the first member of the family qualifies.

In the case of 2. above, couples who have entered into a PACS Contract,
contact the International Pensions Centre and proceed exactly as for a married couple. It is important to ask for the two forms.

In the case of 3. above, couples living together in an unmarried state, the procedure should be through CPAM as outlined above. However, if you press the International Pension Centre the appropriate Dependant Beneficiary E121(s) may be sent to you although CPAM has the absolute right to accept or reject them for registration.

The procedure in the case of the E106 is different. Duplicates are not issued for the Dependant Beneficiaries and CPAM is required to enter them on the back of the holder’s E106 using the same basis of definitions as for the E121. The applicant needs to support the application with marriage certificate, birth certificate, passports etc.

The E109

The E109 covers the family, living in and resident, in France of a person remaining resident, working and paying NIC in the UK. It is issued in the name of such person and is the only one of the E forms that does not cover the holder. However he/she is entitled to use the EHIC to provide cover during visits to his/her family in France making sure that he/she does not overstep the legal limits to retain NHS insurance in the UK or to become tax resident in France.

The EHIC (FRENCH CEAM)

The European Health Insurance Card replaces the previously used forms:
E111 and E111B used by tourists,
E110 used by international haulage companies,
E128 used by workers posted to another Member State and by students,
E119 used by unemployed people seeking work in another Member State (only for benefits in kind).

See our article on The European Health Insurance Card to find out what treatment is covered.

Claiming can be complicated and long winded but homeowners who stay for longer periods should visit their local CPAM branch and register their EHIC. Generally CPAM will send statements to their French address and reimbursements to their French bank account. A new Form Cerfa 12267*02 has just appeared.

Without doubt this form will be required by CPAM when claims are made for treatment on visits to the fifty plus countries outside Europe with which France has reciprocal agreements as well as member states of the EU.

From 1st April 2008 under a specific instruction from the EEC the EHIC (France CEAM) is required to obtain treatment if you are visiting the UK. The instruction has been copied in to all member states with a reminder that it applies to them also. In future you will have to present the EHIC or a Temporary Replacement Certificate (TRC) or pay the bill. The TRC can be printed while you wait if you have forgotten to order you card in time or for faxing to a hospital if you have left it at home. This applies to residents in France using the CEAM.

Applying for the “E” Forms and the EHIC (CEAM)

See the application information in the article How changes in French health law are affecting expatriates

Larry Fulton,
Chief Executive Officer,
Exclusive Healthcare
+33(0) 494 403 145
[email protected]
To discuss the above and your French health insurance needs, visit the exclusive healthcare website: www.exclusivehealthcare.com

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