Honestly, if you have read some of the garbage in both consumer and trade media on the new health insurance rule in France, you could end up thinking that all UK expats are going to be driven home.
Let’s get rid of the three delusions first. If you are a UK expatriate in France, the changes will not have any real effect if you are one of these:
- Working
- Above UK retirement age
- Been in France for five years as a permanent resident
It will only affect you if you are no longer working and not old enough to get a UK state pensions. But anyone who is lucky enough to be in that category, with no earned income, is not likely to be poor.
Also, the exclusion does not apply to expats who suffer a setback that causes loss of income or medical cover. If your income is very low, you can still get state medical aid.
While we are at it, let’s remove the fourth delusion. You have to be employed to be working. Not true, you can be self- employed, and there is no minimum income, so maybe getting paid as a consultant or director, from whatever you did before going to France.
After a lot of posturing, the French have relented a bit. The rules will only apply to anyone in France after 23/11/2007 and so will not take away cover from those who had it then.
So, having put out the garbage, if you are or could be in the small group of UK expats affected, what is it all about and what could you do about it?
The Couverture de Maladie Universelle (CMU) was created to provide public healthcare to anyone who lived in France but could not obtain cover from any other public system. Most people living in France obtain cover from mandatory healthcare schemes through employment, self-employment, unemployment, retirement, rights carried over from another EU Member State, rights of a spouse, partner or parent, etc., leaving a small gap to be covered by the CMU.
It is in this gap that there are a few UK expats who have stopped working before retirement age and whose rights carried over from the UK in the form of an E106 have expired. When they reach retirement age, they can again carry over their UK rights via an E121.
Until 23/11/2007, they could pay a contribution to join the CMU during the years until retirement.
One awkward area is the rule on expats having acquired permanent residence by having lived continuously in France more than 5 years. There is a difference between being resident and permanently resident. The former is sometimes referred to as “resident for tax purposes” and applies to anyone living in France more than half the year. The latter is a right that originates from EU legislation according to which you must be treated as a French national after 5 years.
In theory the CMU (Couverture Maladie Universelle - Law 99-641) is a means of paying a subscription for joining the French NHS and is potentially available to all residents of France. The new rules are so confusing and interpretation appears to be dependant on the local CPAM office, who administer it. There is evidence that cover is being withdrawn from those that already have it and that they are required to return the Carte Vitale which entitles them to care.
No one knows how many UK expats could be in the gap where they have no CMU protection. Despite all the hoo-ha in the press, no one knows if it is hundreds, scores, two or thousands.
There are two basic options. Pay for care as you go, or buy insurance. Unlike the NHS in the UK where treatment is free at the point of delivery, in France you have to pay the majority of healthcare providers up-front and then be reimbursed. The French Social Security defines the cost of virtually every type of medical treatment using the ‘Tarif de Convention’ (official or conventional rate) and reimburses medical expenses at an average of 70% of this rate.
For example, the ‘Tarif de Convention’ for a consultation with a doctor is €22. If your nominated GP was ‘conventionné’, you would pay him the €22 consultation fee directly and be reimbursed €15.40 by the French Social Security.
Some healthcare providers are ‘conventionné – honoraires libres’ and charge over and above the ‘Tarif de Convention’, so if you were charged €35 for a consultation for example, the French Social Security would still only reimburse €15.40.
Treatment received from providers who are ‘non conventionné’ will not be reimbursed by the French Social Security, and if you do not have nominated GP and/or go to see another doctor without referral from your GP, they will only reimburse you on the basis of 50% of the ‘Tarif de Convention’.
By now you are probably reeling. Don’t worry, it only gets worse. French officials are very pedantic and love their processes. So you could be refused payment for not having everything perfectly completed, and by the time you do so, they may tell you that you are too late to claim. Or they could send you on a paper chase, as if it is not the correct office for where you live and/or got treatment, they will send you elsewhere. Oh, and don’ t expect prompt settlement. Paperwork can get lost or delayed, and as for during August, don’t even attempt it.
You could buy French private health insurance but this is mainly designed as a top-up to those who have CMU cover. Or you could buy expatriate health insurance.
On balance, whether or not you are covered by the French state system, it is sensible to buy private health insurance.
On expatriate insurance, there is a range of covers from very basic to luxury. If you are in the luxury end of the market, you are probably well off enough to not bother with insurance anyway. At the medium and basic end of the market you can buy a standard expatriate policy, a version tailored for France, or a special policy aimed at only the French market. As well as the insurers we list, there are other insurers scattered across Europe that offer insurance to expats, including UK ones, but not in English. There are several French insurers and specialist brokers, some of whom use English, others do not. Even if your French is excellent, insurance is tricky enough without having to translate terms.
The big decision to make is whether or not you want cover only for treatment in France, or whether you want the option of repatriation to the UK for private treatment here. The NHS will no longer automatically give you free care on your return if you are an overseas resident - being born is the UK makes no difference to this rule.
You can, like the majority of people in France, take out what is known as a 'top-up' policy (complémentaire or mutuelle).
These policies are designed to:
- reimburse part or all of the difference between the actual cost of treatment and the amount paid by the basic medical insurance scheme
- provide cover for certain types of treatment not which are not reimbursed by the French Social Security (e.g. private rooms in the event of hospitalisation)
- ensure that you receive an acceptable level of reimbursement for dental and optical treatment which are poorly indemnified under the basic medical insurance scheme.
Several companies have developed new products for France.
Exclusive Healthcare has the Platine Plans designed for people living in France who are not residents or not eligible for membership of the French NHS. They are high-level full cover policies.
Morgan Price International Healthcare has developed ExpatHealth France for people living in France. This plan, underwritten by Allianz Worldwide Care is an alternative to state healthcare.
Exeter Friendly has a new Resident Health Plan with two levels of cover designed for those who live permanently and wish to receive their medical treatment in either Spain, Portugal, Cyprus or France.
Amariz offers OPALE, a health insurance for any person resident in Europe, in France's Overseas Departments and Territories or in Madagascar, whatever their nationality.
Even if you are living and working in France and have access to state healthcare you may want to consider the option of purchasing a private plan as well either a full one or a top-up plan.
Goodhealth Worldwide offers Premiere, a top-up plan.
Many other international health insurers offer policies for UK expats in France.
Travel insurance: Hot Topic: January 2008
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