The healthcare system (l’Assurance Maladie) in France is generally excellent and in surveys which attempt to rate national health services around the world France consistently comes out near the top – every time.
The National Health Service in France is not free; it is funded by contributions to a social security fund (SCU) which is made up of insurance funds paid into by French residents as well as by fees charged at the point of treatment.
The main health insurance fund is a General Fund called the Régime Général which covers the majority of the working population, the unemployed and those retired and not affiliated to other insurance funds. There are separate health insurance funds for agricultural workers and specialist professions such as doctors, civil servants, railway workers.
There is also the CMU – Couverture maladie universelle.
CMU is an affiliate of the Régime Général and is the branch that includes membership for expatriates in France.
For expatriates permanently living in France, it makes sense to join the national state health insurance system via the CMU. Application does not exclude any pre-existing conditions and is almost certainly much cheaper than any private healthcare insurance scheme for the majority of people.
When you are registered in the French national health services you will generally pay charges at the point of treatment (except when in hospital) and then be reimbursed a proportion (in some circumstances 100%) of the charges by the state. Most people in France take out additional voluntary insurance (also known as “top-up” insurance) to cover any shortfall between state reimbursement and the cost of healthcare including the cost of some medicines in France.
I am an expat in France – am I eligible for the French National Health Service?
If you are a British expat who has reached retirement age and you are receiving a state pension you are eligible to join the CMU. The UK NHS Overseas Healthcare Team says that “If you are receiving a UK state pension or long-term incapacity benefit, you may be entitled to healthcare paid for by the UK. You will need to apply for form S1 which you need to present to the French health authorities. You will then be treated on the same basis as a resident of France”.
In addition they state that “Once you have registered your S1 … you will be entitled to a UK-issued European Health Insurance Card (EHIC), allowing you to access state-funded necessary medical treatment when you visit other EEA countries besides the one in which you are resident, including if you return to the UK”.
You should aim to apply for your S1 form at least one month before you move to France.
If you are an expat working in France – either as an employee or self-employed and paying social contributions you will be able to register for the French national health service. If employed your employer will handle your affiliation and may also offer a company based scheme of voluntary insurance, called a prévoyance collective. Your contribution to the state insurance fund depends on your circumstances but an average employed single person will pay around 8% of income. There are breaks for parents and those on low income.
If you are resident in France for five years or more you will be able to join the CMU.
You may be able to claim some CMU cover for a limited time even if you are below the official state retirement age and are not working in France, for instance if you have worked in the UK and paid contributions in the UK within a specified time before moving to France. You can check with the NHS Overseas Healthcare Team in Newcastle who will advise you if the S1 form will cover you – the maximum is for 2.5 years.
You should know that once you make France your permanent place of residence your UK EHIC card (European Health Insurance Card) is no longer valid for treatment in France.
Expat registration for state healthcare in France
To join the CMU you will need to sign up at your local Caisse Primaire dAssurance Maladie (CPAM) office. CPAM administers the CMU through hundreds of local offices across the country and handles reimbursements. Your local Town Hall will be able to provide details, or check the Yellow Pages (pagesjaunes.com) – type in CPAM and the town where you are searching.
If you are self-employed you will need to make payments via one of the state controlled insurance schemes for the self-employed administered to by the RSI “Regime Social des Indépendants”. Check with your local Town Hall for details, these offices are regional so you may have to use the internet or phone for direct communication.
If you are not from within the European Economic Area and want to apply to the CMU you need to demonstrate that you have a right to live in France through a residence permit (carte de séjour) which you must hold for a minimum of three months and maybe much longer according to an individual regional health authority’s interpretation.
Once you have registered for the national health service in France you will be sent a a Carte Vitale, a card which reflects your rights and entitlements and enables you to “automatic” reimbursement.
CMU reimbursement will cover a proportion of healthcare costs depending on treatment and circumstances for instance a visit to the Doctor will cost around €23 and you will be repaid 70% by the state. Most people take out what is called “top up “ insurance to cover the shortfall. Occasionally there are consultants costs that fall outside the normal reimbursement levels called Dépassements.
CPAM have an English speaking helpline service based in Normandy and they may be able to help you if you have difficulties or questions: 08 11 36 36 46
The English language CPAM helpline office is based in Normandy and staff have access to local records but outside of the region they may need a few days to access paperwork in order to help you.