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What is Top-up Insurance in France?

Medical insurance FranceIf you become resident in France you’ll need to consider your healthcare options. The French National Health service is very highly rated but it is not free.

You may be eligible to join the French national health service insurance scheme for expatriates called CMU (Couverture Maladie Universelle ). For the great majority this is certainly the cheapest form of healthcare in France. The system works by reimbursement of paid at point of treatment costs.

You will also eligible for state healthcare if you work in France or are self-employed in France.

Click here for a full and clear explanation of expat eligibility for the French national health service.

Most people in France take out a “top- up” or voluntary insurance

Being registered for the national heath service in France generally doesn’t mean free treatment though there are some circumstances where it is free such as those on a low income. Most people in France take out “top up” insurance, a sort of voluntary insurance.

What it means is that you will be reimbursed a percentage of the fees charged.

The level of reimbursement differs with the treatment, the practitioner and your circumstances.

A typical doctor’s visit will be reimbursed at about 70%. If you are eligible for low income assistance or the illness is deemed serious, or long-term, reimbursement will usually be at 100%. How much you get back varies, but if you want “full” cover then the option is to have top-up insurance.

Top-up insurance – called assurance complémentaire santé in France, is designed to cover “the rest”. By the rest, we mean reimbursement up to what the Government says a procedure should cost – not what it actually costs, which could be more than the Government recommendation.

Even with voluntary/top-up insurance you may still have to pay some costs depending on your policy, treatment and circumstances.

For instance all medical consultations carry a €1 surcharge that must be paid by the individual and legally cannot be covered by the insurer. You must register with a single primary care doctor (médecin traitant) in France to receive the full reimbursement available (read more about registering with a doctor here). Some insurance policies will not cover you if illness has arisen from drug or alcohol related accidents/illness or from issues arising from listed “dangerous sports”.  Some consultants are allowed to charge more than the Government “recommended” price for treatment, the insurer may not cover the whole cost above the “recommended” price.

It pays to discuss with your top-up insurance policy provider what level of cover you require/are willing to pay for.

Be aware that some companies have a qualification period (délais de carence) ranging from a few months to a year meaning that you may have a reduced level of cover – or no level of cover until the period of delay expires – though you will still be paying premiums.

Assistance with top up insurance costs is available to those with a low household income – you can get advice from CPAM (Caisse Primaire d’Assurance Maladie), the local office network which administers state healthcare or for those who are self-employed from the regional RSI “Regime Social des Indépendants” office.

How to source the best “Top-up” insurance for you

The different levels of top up insurance

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