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Affiliation to the French health system


 

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It is now obligatory for all legal residents of France, irrespective of nationality (except in certain circumstances) to affiliate to the French health system. The procedure is different, however, depending on your status.

If you live and work in France

(or you are not an EU national)

You need to affiliate as a resident. However, unlike with an E Form where your basic healthcare costs are without charge, residents must make a financial contribution.

This contribution is calculated as 8% of the difference between 6, 849€ and the household income after deducting allowances. The household income after deducting allowances is expressed in the form of the revenu fiscal de reference, and is stated on your avis d'impot (French income tax statement). If you have not completed a French tax return then other reasonable proof of income will be accepted. However the calculation of any contribution other than by the revenu fiscal de reference is likely to result in a higher contribution being paid.

How you affiliate depends on your profession. If you are an employee, then payments to the health system, and often a mutelle also, will be automatically deducted from your salary. Also, your employer is obligated to provide you with a French social security number, which will make you eligible for reimbursements of medical expenses under the mandatory contributions-refund system, called the régime obligatoire. You will also be issued with a carte vitale.

If you are self-employed, where you register to pay your health, and other social, charges will depend on what professional activity you do. These include:
  • URSSAFF (Union de recouvrement des cotisations de sécurité sociale et d'allocations familiales - www.urssaf.fr)
  • Your local chambre de commerce
  • Your local chambre de metiers
  • Maison des artistes (www.lamaisondesartistes.fr).
  • AGESSA (Association pour la gestion de la sécurité sociale des auteurs - www.agessa.org.)

If you live elsewhere in the EU

but you take a vacation in France.

You need to have a plastic European Health Insurance Card (EHIC), each member of the family needs one, including children under 16. The EHIC replaces the E111 and E128. It entitles you to 'necessary' healthcare and covers the same costs as if you were a contributor to the state health system. As this is not the total cost of care, and the EHIC does not cover repatriation, you may want to take out private health insurance.

Also, the card will not cover the cost of treatment for someone who decides to travel to France specifically to be treated for an existing condition.

To get an EHIC in the UK, apply online at www.dh.gov.uk/travellers or www.ehic.org.uk; or send a completed EHIC form, available from your local post office, to:

  • EHIC Applications
  • PO Box 1115
  • Newcastle upon Tyne
  • NE99 1SW
If you are in the UK and need an EHIC quickly, telephone the Prescription Pricing Authority on 0845 606 2030 (outside the UK +44 191 203 5555). In the UK you should receive your EHIC within a week, but you will immediately be given a telephone number to call if you need to travel to France before your card arrives, and you need emergency treatment.


If you do not live in the EU

but you take a vacation in France.

Private travel/health insurance is advised.


If you are a retired UK citizen and live in France


You will need to affiliate to the French health system via the Caisse Primaire Assurance Maladie(CPAM)using an E121 form. This form is issued to:

  1. Those of state pension age and in receipt of a UK state pension.
  2. Those in receipt of Long Term Incapacity Benefit from the UK.
  3. Those in receipt of Severe Disablement Allowance from the UK.
In the UK, this form is available from the Department for Work and Pensions (DWP) at Newcastle upon Tyne (Website: www.dwp.gov.uk.)

As long as you continue to be in receipt of the state pension/benefit the E121 will continue to be valid. As well, if you are married and your spouse is eligible for cover under E121, their entitlement is extended to you according to the right "ayant-droit".

When in France take your filled out form, along with proof of residence in France, your carte de sejour if you have one, although your last two EDF bills should be enough, as well as a copy of your passport, birth certificate and marriage certificate if appropriate – to your local CPAM office (most towns with have a CPAM office. For those in rural areas contact your mairie.)

If you are on Long-term Incapacity Benefit, say with a condition such as Multiple Sclerosis, you will receive almost all of your medical treatment free – doctor’s visits, pharmacy bills, routine dental treatment and hospitalisation – regardless of whether this treatment is linked to the condition that originally put you on Long-term Incapacity Benefit. You will, however, have to pay for blue-label medicines (considered non-essential), Forfait Journalier (daily food charges when in hospital), and certain defined items such as hearing aids, glasses, dental crowns and other dépassements. This, however, does not apply to your spouse, and so you will need to take this into consideration when choosing top-up insurance.


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