Guide to French Health System

Index

1. Structure of French Health System - A brief description of the main structure of the health system, comprising the l’assurance maladie and l’ assurance complémentaire, of the main insurance fund, the Protection Universelle Maladie (PUMA) and of the local health authorities, the Caisse Primaire d’Assurance Maladie (CPAM).

2. Getting Health Cover - A substantial chapter reviewing the application process for obtaining access to the system, for expat pensioners, early retirees, the self-employed, and cross-border workers. The chapter also considers health cover for tourists via the EHIC and GHIC.The chapter considers in particular the rights of EEA pensioners to an S1 certificate, and the difficulties encountered by EEA early retirees to obtain access to the them. It also considers the implications of Brexit on UK residents.

3. Protection Universelle Maladie (PUMA) - A description of right of universal insurance cover via the Protection Universelle Maladie (PUMA), who pays the charge and how much you pay, together with the application process.

4. Voluntary (Top-Up) Health Insurance - A review of the voluntary health insurance system in France, often called ‘top-up’ insurance or ‘mutuelle’, but formally called assurance complementaire. We consider whether you need to take out this health insurance policy, the different types of policies and how much you might expect to pay. We also consider how you can terminate your ‘top-up; health policy.

5. Getting Assistance with Health Costs - A review of how you can obtain assistance with health costs through a scheme called the Complémentaire Santé Solidaire (CSS). We consider who is entitled, the level of the assistance and the application process.

6. Your French Health Card - You French health insurance card is called your carte vitale, which you present to your doctor on a consultation. Although not a payment card, it enables you to avoid direct payment via a system of ‘tiers payant’.

7. Your French Family Doctor - You need to register with a GP doctor in France, called a médecin traitant, with your local health authority, the Caisse Primaire d’Assurance Maladie (CPAM). That also enables you, via the parcours de soin, to avoid higher consultation and prescription charges. We also consider what you will pay for a consultation with your doctor.

8. Prescription Medicines - Prescriptions in France are called ordonnances.There are different levels of reimbursement, depending on their efficacy, but some are not reimbursable. Prescriptions are delivered through the substantial network of local chemists/pharmacies in France.

9. Using Consultants - You will normally be referred to a specialist health consultant by your doctor. Their fees are substantially higher than for your GP, and they can charge above the statutory rate, through dépassements d’honoraires. There are however, a number of exemptions from the higher fees.

10. Hospital Treatment - There are both public and private hospitals in France, whose charging system vary slightly, although not substantially. As a general rule, you will receive at least 80% reimbursement of your costs, often 100% for a major illness or if you are otherwise exempt. Normally, no payment is necessary as is it all done through your carte vitale.

11. Accident and Emergency - We set out in this section the arrangements for accident an emergency treatment, including the emergency telephone numbers, and the emergency services SAMU

12. Treatment of Long Term Illness Major or long-term illnesses in France are called Affection de Longue Durée (ALD). As a general rule all costs for such treatment are fully reimbursable although there may be minor costs to pay.

13. Maternity Care - In this section we provide information on pre and post natal examinations and the costs of hospitalisation.

14. Travel and Transport Costs - We set out in this section the circumstances that might entitle you to claim for your transport costs, normally for serious illness and/or long distance. Prior authorisation by your GP or consultant is necessary.

15. Dental Treatment in France - In this section we consider the charges you will face for dentist care. You are free to choose any dentist you wish. Their charges vary, but those for routine work are controlled by the government. You can also use your ‘top-up’ policy to cover some of the costs. We also outline the arrangements for ‘100% Sante, granting free treatment.

16. Opticians & Ophthalmic Treatment - You can choose to use any optician you wish, and that is the same for an ophthalmologist. Charges vary for glasses, although there are controls on prescription spectacles.

17. Breast Screening - If you are a female aged between 50 and 74 years of age you are entitled to receive breast screening free of charge every two years.

18. Health Complaints System - In this section we consider the complaints system, with various routes you can take, either directly to the local health authority (CPAM), a mediator, or to an appeal panel of the health authority. There is also a health ombudsman.