Voluntary health insurance in France or as it is often called “top-up” is an insurance policy which goes towards the cover of healthcare costs for residents registered for state healthcare.
In order to apply for top-up insurance, first you must register with the State health service.
For British expats who are covered by a UK health service S1 form this means via the CMU (Couverture maladie universelle) a branch of the state health service.
Read here for more info about CMU, how to join the CMU an eligibility for expats.
Employees will have their state health service registration taken care of by their employer.
If you are self-employed, your health service registration will take place as part of the process of your business registration.
Once registered with your local Caisse Primaire dAssurance Maladie (CPAM) office – they administer the CMU, you are free to take out top-up (voluntary) health insurance.
There is a huge choice of top-up insurance providers in France and it can be quite daunting to search for one that is right for you. There are more than a 1000 companies in France – private companies or mutual non-profit organisations, including some companies with English language services.
Non-profit mutual organisations may sound as though they should be cheaper, after all they are “non-profit” but this isn’t necessarily the case – however they are more accepting of pre-existing medical conditions and do not require a medical questionnaire. Private insurance companies will almost certainly require a medical questionnaire and may not accept some conditions or increase premiums because of a known health issue.
In France the voluntary (“top-up”) insurance is called “assurance complémentaire”. If you are looking for provision from a French company you need to search online or through the telephone directory for Assurance or Assurance complémentaire.
There are also brokers who may be able to help you search for the appropriate insurance vehicle.
You can search online and complete an online questionnaire with most insurance providers to get an idea of costs; comparison sites like Assurland or Empruntis may be helpful – though you will need to be able to complete the forms in French.
The choice of a top-up insurance policy is important.
Most contracts are based on a percentage of the social security tariffs – called Tarif de Convention. The price you pay depends on the percentage level you choose. If a contract offers 100% – this means 100% reimbursement of the official rate. However, the charges that doctors or consultants apply may be higher than the official rate and some contracts therefore offer 200% or more reimbursement.
Standard doctors’ visits and medicine costs are usually well covered by the normal 100% cover but specialist treatment and hospitalisation could leave a gap.
There is a list of 30 serious diseases and illnesses where costs are reimbursed by the state at 100% including cancer, heart disease, insulin dependent diabetes or long duration diseases like a stroke or where hospitalisation exceeds 30 days.
Outside of these circumstances, the state reimburses 80% of hospitalisation costs, a “top-up” insurance policy will cover more but may not cover all costs – it depends on the level of “top-up”.
Sounds complicated? Well, yes it is and it pays to do your research or to speak to someone with experience before you come to France so that everything is sorted out and ready to use straight away.
More on the different levels of “Top-up Insurance“