4. Voluntary 'Top Up' Health Insurance in France

1. 4.1. Limits of Health Insurance Cover
2. 4.2. Cost of Voluntary Insurance Contributions
3. 4.3. Getting Voluntary Insurance

4.1. Limits of Health Insurance Cover in France

Whilst there is universal health service cover in France, for routine treatment the social security system only picks up a percentage of your medical costs.

The percentages carried by the social security system in individual cases will vary, depending on the type of treatment received and from whom.

The GP system and basic health care fees and reimbursement levels are fairly straightforward, but specialist services can get a little more complicated and expensive.

Thus, the social security system will normally pay for about 70% of official GP fees and 65% of prescribed medicines. In cases of major illness or low income, then it will reimburse almost 100% of the costs.

However, beyond this general statement the level and scope of reimbursement depends on the type of treatment, the type of illness, your circumstances, and the cause of the illness. More information is provided in later pages.

If you want to be fully insured, and have most of your fees and costs reimbursed, then you will need to take out voluntary health insurance cover, or ‘top-up’ health insurance as it is sometimes called.

The additional cover does not allow you to jump the queue as it may do in other countries – it merely reimburses that part of the cost not paid for by the social security system.

Voluntary insurance cover will pay most, but not all of the residual costs of medical care, so you will still be left with a small amount to pay yourself. The amount will depend on your policy, your circumstances, and your treatment.

Thus, for example, voluntary insurers are specifically forbidden by the government to provide insurance cover for the €1 surcharge that now applies to all medical consultations, and there are restrictions on cover for those who do not proceed via their family doctor for medical treatment.

You will also find that most policies exclude insurance of illness or accident arising from certain 'dangerous' sports, with potential limits on alcohol or drug related illnesses or accidents. Most also limit cover for dental and ophthalmic treatment.

If the doctor or consultant charges in excess of the official rates (as some are allowed to do) you will also find many policies do not pick up this extra charge, or only pick up a proportion of it, up to a maximum amount.

Apart from the issue of the level of reimbursement, you are likely to find that most contracts do not offer immediate cover. The period of delay (called a délais de carence) may be only three months, but on some contracts it is as high as a year. Other contracts provide for a reduced level of cover during the preliminary period. Accordingly, you may well find yourself paying the insurance premiums, but having no insurance cover!

On average, individual patients are now directly responsible for about 9% of health expenditure, although, of course, nearly everyone pays into the social security system, as well as premiums to a voluntary insurer!