3. Couverture Maladie Universelle (CMU)

The CMU was established by the Government in 2000 to ensure those all persons regularly resident in France were eligible for medical cover, whatever their circumstances.

As originally enacted, this included those from abroad who had a permanent right of residence in France.

However, as we set out in the previous section, the rights of early retirees from the EU to join the CMU have now been severely restricted.

Nevertheless, those with at least 5 years residence in France, those eligible on medical grounds, or other 'accident of life', and those who become involuntarily umemployed, can still join the CMU.

Accordingly, the following notes have been prepared for those who retain a right to join the CMU.

1. 3.1 Contribution Level into CMU
2. 3.2 Registration Process
3. 3.3 CMU Protection Complémentaire
4. 3.4 Assistance with Voluntary Insurance

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3.1. Contribution Level into CMU

So, you will pay 8% of your net income above this figure - your income after deduction of eligible allowances as determined by the tax authority.

The income figure used for determining the amount you pay is the revenu fiscal de reference as advised on your French tax return.

The reference period for determining your income depends on the date in the year when you make your application.

If your application is presented before 30 Sept, then the reference period is the current year, minus two years; if presented after 30 Sept, the reference period is the current year, minus one year.

Thus, for an application made after between 1 Oct 07 to 30 Sept 08, the reference period will be the calender year ending December 2006.

Payments are made quarterly with the first payment due in the quarter following your registration. The payment is collected by the social security contributions collections agency, called URSAAF.

If your household income is below certain thresholds, then affiliation to the CMU is free.

In this event you need to apply for CMU Protection Complémentaire.

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3.2. Registration

In order to obtain health cover through the CMU you need to register with your local health insurance fund, the Caisse Primaire d’Assurance Maladie (CPAM) who have a large number of offices throughout each region. The local office will be found in the telephone directory, or ask at your mairie.

You will need to produce your passport and proof of residence, e.g. electricity and telephone bills. You will also need to supply your French bank account details as reimbursements will be paid directly into your account.

If you are claiming on grounds of 5 years residence, then you will to be required to produce evidence of 5 years residence, probably best evinced by obtaining a residence permit from your préfecture.

If you are seeking admission on medical grounds, or other 'accident of life', then you will similarly need to produce appropriate evidence. In particular, those seeking admission on medical grounds will need to produce evidence of a refusal of private health insurance.

Processing of your application may take up to three months and, until you are issued with a plastic health insurance card, (carte vitale), you will be provided with a formal notice (attestation), which you will need to use to pay and then reclaim each time you use the health service.

When your carte vitale arrives it will also include with it a new attestation that you are in the health system. This formal notice is sometimes required to be presented when you need hospital or specialist treatment, so it is useful to keep both available at all times.

If you consider your application is not being processed with due alacrity, (notably if there is no news within three weeks), then you are entitled to invoke a conciliation procedure, which you can do by writing to the Conciliateur at the CPAM.

If you do get a decision, and it is a negative one, then you are entitled to write to the appeal body of the CPAM, called the Commission de recours amiable (CRA). These appeal bodies are quite interesting, for they include lay assessors on them.

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3.3. CMU Protection Complémentaire.

The CMU Proctection Complémentaire (CMU–C) provides free health insurance cover for those on a low income, including the employed and self-employed.

If you are in receipt of CMU Complémentaire then, as a general rule, all medical and dental costs are fully covered and you will have no costs to pay, provided you always pass through your family doctor for medical services.

Doctors and specialists who treat you are required by the government to only charge the basic, official fee. There is evidence that some specialists do not always honour this rule and that some CMU-C patients are being asked to pay additional fees, or simply refused treatment. In either case, this practice is not permitted, and such instances should be reported to your local Caisse.

The current annual income thresholds for entitlement to CMU–C are as follows:


Table: CMU-C Income Thresholds - (Jul 07 - Jul 08)

Household	Annual Income
One Person	€7,272
Two People	€10,908
Three People	€13,090
Four People	€15,271
Each Add	€2,908

The reference period for determining your income is the previous twelve months. Unlike most other social security benefits, it is not your net income as assessed by the tax authority that is used to determine eligibility, but a tougher test based on gross income.

Your entitlement will be reviewed each year, when you will be asked to complete a test of resources.

Application can be made to your local Caisse (normally the Caisse Primaire d’Assurance Maladie) to whom you should provide proof of your income.

You can also download the Application for CMU-C

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3.4. Assistance with Voluntary Insurance

If your household income is no higher than 20% of these thresholds, then you may be eligible for a contribution towards the cost of your voluntary health insurance.

Until Jan 08 this assistance was in the form of a tax credit, but in an attempt to reduce the complexity of the scheme, it now comes in the form of a cheque, which you need to present to your voluntary insurer.

The level of the assistance depends on your age. Those aged under 26 years receive a rebate of €100; between 26-59 years you are entitled to €200 and those aged 60+ to €400.

Accordingly, a couple aged between 26-59 years would be entitled to a contribution of €400. No contribution is granted for children under 16 years.

In no case can the rebate be higher than the cost of the insurance cover itself. If it is greater then the insurance premium will be zero.

The thresholds for eligibility for these rebates are as follows:


Table: Income Thresholds - (Jul 07 to Jul 08)

Household	Annual Income
One Person	€8,727
Two People	€13,090
Three People	€15,708
Four People	€18,326
Each Add	€3,490

Application should be made to your CPAM, or to the RSI if you are self-employed.

If you do not hold a voluntary insurance policy, you can still make application for the assistance, which remains valid for six months, during which time you can take out an insurance policy.

You can download the application form

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Next: Voluntary Health Insurance