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French Health Care - the new rules
IMPORTANT UPDATE - January 2008
Healthcare reforms for non-French Nationals living in France.
This update has been kindly contributed by Peter Brooke of The Spectrum IFA Group.
After many months of discussion between the French Ministry of Health and the British embassy the rumoured amendments to the changes brought into place in September 2007 have finally been officially confirmed by the French authorities and the British Embassy via the following statements:
French government's new decision on access to the French healthcare system for inactive citizens from other EU countries
So what does this change from the last official statement in September 2007?
1. Inactive EU citizens already living in France and already registered and accessing healthcare via the CMU before 23 November 2007 will now be allowed to continue to do so.
2. After 5 years of "regular, uninterrupted residence" in France, an EU citizen qualifies as a permanent French resident and will therefore have access to healthcare via the CMU.
So what doesn't this change from the last statement?
1. All inactive EU citizens under retirement age living in France now or in future who are not entitled to healthcare reimbursement (through the E106 or E109 forms) or to access to the French health system will be required to have their own personal health insurance until they reach UK state pension age (and therefore qualify for entitlement to the E121 form), or until they qualify as a French resident (after 5 years of "regular, uninterrupted residence").
2. As previously, people already over retirement age who are holders of an E121 which is registered with the French authorities will remain unaffected.
3. The situation also remains unchanged for Inactive newcomers to France, in that those without cover from and E121 or E106/E109 will be required to have their own personal health insurance until they reach UK state pension age (and therefore qualify for entitlement to the E121 form), or until they qualify as a French resident (after 5 years of "regular, uninterrupted residence").
4. Those who are currently being covered by an E106 will also be required to have their own personal health insurance until they reach UK state pension age (and therefore qualify for entitlement to the E121 form), or until they qualify as a French resident (after 5 years of "regular, uninterrupted residence").
Although the British Embassy does state the following on its website
"We welcome and appreciate the French government's decision, following our representations, to allow inactive EU citizens living in France who already have access to healthcare via the CMU to continue to do so. This is good news which will bring relief to many British people living in France.
However, we are aware that there are also British expatriates in France who are holders of E106 forms and therefore not in the CMU system. The Embassy has been in intensive discussions with the French Health Ministry about their situation. We have been told that this group will have the safeguard of essential immediate healthcare provision, and we hope that this information will be confirmed in the next few days."
** There do however remain alternative options for those on very low incomes who fall ill as they may be able to apply for a benefit called the Aide Médicale d’Etat. And those who are facing a sudden life change – such as an illness which hinders them taking out private health insurance or possibly a marriage separation making it hard for them to pay for may be allowed to join the CMU although this would be strictly dealt with on a case by case basis.
Below is a translation of the Q & A fact sheet on the Securite Sociale website, the French version of which can be found on the following link
In order to facilitate understanding of the circular, we are offering a list of likely questions and answers:
Why are the rules being modified?
Like other EU countries, France is obliged to conform to the EU directive no. 2004/38/CE of April 29, 2004, which fixes rules relating to residence rights for EU citizens.
These rules have a direct bearing on CMU affiliation in France. This directive was transposed into French law by the July 24, 2006 law on immigration and integration, then by the March 5, 2007 decree. This transposition was also completed by the March 5, 2007 law on lodging rights in order to address the situation of those who have come to France to seek work. Finally, the November 23 Social Security Directorate circular no. DSS/DACI/2007/418 completes the transposition of the directive by clarifying certain points concerning access to the CMU. This takes effect from November 23, 2007.
How does this impact on right to the CMU?
By fixing new conditions to residence rights, the EU directive has direct consequences on access to certain kinds of social security in France. This is notably the case both for the basic CMU and the complementary CMU, to which access is based on a condition of stable and legal residence in France.
What are the new conditions which the EU directive fixes for residence rights?
Under the directive there are two conditions covering the legal right of EU citizens to live in France:
- having comprehensive health insurance, and
- having sufficient resources so as not to become an unreasonable burden on the finances of the host state.
In other words, an inactive EU citizen who comes to live in France cannot legally become a French resident if he or she does not already have health insurance.
What happens if an EU citizen doesn’t fulfil these criteria and becomes ill?
If these conditions are not, or no longer, fulfilled, this person is no longer living legally in France. If this person becomes ill and has been living in France for less than three months, they can benefit from the dispositif soins urgents (urgent healthcare measure). If they have been living in France for longer than this, they can benefit from Aide Médicale d'Etat (State Medical Aid), or AME, on certain conditions (in particular they must have a low income).
Who is affected?
EU citizens, EEA citizens and Swiss citizens, and their family members.
In particular, those concerned include inactive residents and jobseekers who have recently come to France, and who were not in the CMU on November 23. In future all people in these categories wanting to come and live in France will be concerned.
“Inactive” refers to people who do not work – workers gain healthcare rights through their work.
Can E106 holders join the CMU automatically when it expires?
No. These people, who have never benefited from the CMU, do not have an automatic right to join it.
Who is not affected?
Those who were in the CMU on November 23 2007 can stay in it because at the time they joined it, the requirement for residents to be in France legally was considered to be fulfilled without conditions.
These people can stay in the CMU after their cases have been studied by their local CPAM.
What about students and retired people?
These people also come under the directive and must have health cover. In practice students will either benefit from healthcare cover from their home country or, if they are under 28, from French student social security.
In the vast majority of cases retired people will benefit from healthcare cover from their original country if they get a state pension, and this pension has healthcare rights attached.
How long does an EU citizen have to be in France to obtain to automatic right to the CMU?
The 2004 directive states that after five years of legal and uninterrupted residence a permanent residence right is obtained. This right allows people to benefit from the CMU.
This right should be verified by the foreigners’ department (service des étrangers) of the prefecture of the department concerned.
Under what circumstances can inactive EU citizens gain access to the CMU before five years have elapsed?
If an inactive EU citizen no longer fulfils one of the conditions of legal residence (sufficient resources or health insurance) they do not automatically lose their right to live in France.
If certain circumstances are present – in particular, if the person is confronted by an unforeseeable change in life circumstances, the person and their family will be allowed to remain resident, and access to the CMU will be possible.
Examples of this are when the person is faced by unexpected circumstances making it problematic for them to access to health insurance for financial or health reasons such as separation from, or death of, a spouse; divorce; or being refused health insurance because of a serious existing illness which could not have been predicted when the person came to France.
Please keep in mind that the majority of the statement released on the Securite Sociale website is intended for the CPAM offices, so it would be advisable to refrain from contacting them for a few days to make sure all of the information has been taken on board so that the advice you receive is based on the current information.
If this affects me what should I do now?
First of all if you have not already done so you should contact the English speaking CPAM service mentioned above or the DWP Overseas Medical Benefits line +44 191 218 1999 if you are currently being covered by an E106 to confirm exactly when your current cover expires.
You will then need to source a Private Healthcare policy to cover you from when you current cover expires until you reach UK state pension age (and therefore qualify for entitlement to the E121 form), or until they qualify as a French resident (after 5 years of "regular, uninterrupted residence").
If I need a Private Healthcare Policy what advice can you give?
Rebecca Gaywood of the Exeter Friendly Society who have been providing and underwriting private healthcare policies for eighty years gives the following words for consideration:
• Make sure the Insurance provider you choose is fully regulated, if they are UK based this would be the FSA
• Read all of the small print in the policy wording paying particular attention to standard rules, benefits and exclusions
• Check any benefit limits/restrictions, especially when ‘full refund’ applies to benefits, also if there are any compulsory excesses and whether these excesses apply per claim or per year.
• Some policies include ‘no claims discounts’ and so it is best to check how these affect your initial premium and premiums payable in the future as and when a claim is made.
• Ensure any personal exclusions imposed are clear and concise so you know what you are covered for and what you are not covered for before making any claims.
• It is always useful to check claims procedures and whether direct settlement to medical providers is available.
This review of this reform was prepared by Peter Brooke of The Spectrum IFA Group, and was drawn from several sources.
This information is only provided as a guide and, if you need assistance in this area you are strongly advised to seek the help of a specialist in this field as each individual case is different.
For more information or assistance with any aspects of your financial affairs in France please feel free to contact Peter for a no cost or obligation consultation on +33 6871 36871 or by email at Peter.Brooke@spectrum-ifa.com
The information contained in this review is based on The Spectrum IFA Group’s understanding of current legislation as of January 2008 and may be subject to change. No liability can be accepted for any change of interpretation or practice relating to any tax or legislative measure or the introduction of any new measures that may affect this information.
TSG Insurance Services S.A.R.L. Siège Social: 34 Bd des Italiens, 75009 Paris « Société de Courtage d'assurances » R.C.S. Paris B 447 609 108 (2003B04384) Numéro d'immatriculation 07 025 332 - www.orias.frUseful Telephone numbers:
CPAM - The French Health Service (English language service): +33 8 20 90 42 12
CLEISS - (France's helpdesk for international mobility and social security):
11 rue de la tour des Dames
75436 Paris cedex 09
Tel: +33 1 45 26 33 41 www.cleiss.fr
DWP Overseas Medical Benefits line (+44 191 218 1999) (Monday to Friday 8am-8pm)
International Pension Centre
Department for Work and Pensions
Newcastle upon Tyne NE98 1BA
or for press enquiries: Department of Health Press Office: +(44) 207 210 5221