2. Health Insurance Cover in France
- Health Cover for Self-Employed
- Health Cover for Cross Border Workers
- E121/S1 Health Cover for Retired Persons
- Health Cover for Early Retirees
- European Health Insurance Card (EHIC)
- Travelling Abroad from France
2.5. Health Insurance in France for Early Retirees
Within the context of this guide an 'early retiree' is someone who is under the State age of retirement from their home EEA country, and who is neither salaried or self-employed. That is to say, they are 'economically inactive'.
If you relocate to France as an EEA early retiree, in recent years it has become more complicated to obtain State health cover.
Between 2007 and 2014 the French government imposed a five-year residence qualification on EEA early retirees for access to the State system.
In July 2014 the UK government also ended the issue of S1 certificates to early retirees, which previously granted temporary health cover for up to two years.
Since 2015, under pressure from the European Commission, the French government have changed its administrative practice in relation to the five-year residence qualification, allowing early retirees into the system, although the law itself on this matter has yet to be changed. All the governments's public statements refer to a five--year residence qualification for EEA nationals, although it is interesting to note the residence qualification for non-EEA nationals is three months!
Thus, the website of the French health authority states:
If you are not a European citizen ……………You can make an application after three months of residency .
If you are a European citizen and you are not eligible to get a S1 form, you can't claim for the PUMa's benefits under five years of permanent residence unless your situation has changed while you've been living in France (change of income, divorce, long-term illness, etc.).
As a result, there are substantial variations in practice at a local level; many local health authorities still impose a five-year residence requirement, although we hear of many instances where this does not occur.
We suspect that the differences in the treatment of cases often occurs due to an examination of resources of the applicant(s), with some being rejected on the grounds that they may be considered to be a burden on the social security system.
In this context, it has to be remembered that under European law an economically inactive household only has the right of residence in another European country for longer than three months if they have sufficient resources not to be a burden on the social security system.
In practice, all EEA national early retiree applications are now being referred to a central processing centre by the local health authority, to ensure greater consistency in approach.
Nevertheless, there continues to be some uncertainty, and the process is not always straightforward.
The French Ombudsman has criticised the manner in which local health authorities and the central processing centre deal with applications, which we covered in our Newsletter article Access to Health Care for EEA Residents.
You need to read our Newsletter for regular updates on this issue, as it is in a state of flux.
In order to get health cover, early retirees now have the choice of:
Making an application to join the health system;
Taking out private health insurance;
Setting up a business.
You cannot be legally resident in France without health cover, even if you wanted to take the risk.
2.5.2. Application to the State System
In order to apply to join the health system you need to be ‘legally resident’, which means:
- You need to have been resident in France for at least three months;
- To have a minimum level of income and;
- To have health insurance cover.
In relation to the last point, this means you may need to temporarily take out a private health insurance policy, or to set up a business, and then apply to join the system later as an early retiree on expiry of the private policy or termination of the business.
You might be lucky enough to be able to use your EHIC card for temporary health cover, but as this card is issued on the basis that you are a visitor to France, in theory it means you cannot also be resident!
Nevertheless, somewhat bizarrely, the on-line information from the French government on this issue is contradictory, for on the website of the Ministre de l'Intérieur it does suggest that in applying for a visa the EHIC would be accepted for the first year. You can find the reference at Accueil des Étrangers.
In addition, an administrative decision of the European authorities dating from 2009 states that:
'In accordance with Article 76 of Regulation (EC) No 883/2004, Members States should cooperate to put in place procedures to avoid that, in the event that a person ceases to be entitled to sickness benefits in kind on behalf of a Member State and becomes entitled to benefits in kind on behalf of another Member State, he/she continues to use the European Health Insurance Card issued by the institution of the first Member State beyond the date from which he is no longer entitled to benefits in kind on its behalf.'
Although it is not necessary for EEA nationals to make application for a visa, all we can suggest is that you may wish to try applying to join the health system on this basis, subject to a minimum of three months residence, and that you meet the 'sufficient resources' test.
In terms of the test, those that apply to EEA nationals are as follows (April 2019):
For those under 65 years, if you live alone you will need to have a minimum of €560 a month, and a couple would need to have at least €840. The sums are higher if you have dependants.
For those 65+ the figures are €868 for a single person and €1,347 for a couple.
These figures are the minimum, and so you would be well advised if you are on low income to demonstrate capital resources.
The minimum income threshold is also higher for non-EEA nationals, equivalent to the minimum legal wage, around €17,000 a year for a household.
You should apply for admission into the health system through your local health authority, your Caisse Primaire d’Assurance Maladie (CPAM).
To do so, you will need to complete the application form S1106 (formerly 736) Demande d'ouverture des droits à l'assurance maladie/Application for membership in the French health care system. Print it off, complete it, and include all the necessary documentation with it.
Early retirees from the EEA are also asked by local CPAMs to complete a Form 710 Questionnaire "recherche de droits" Ressortissants Européens Inactifs, although the form does vary.
The legal status of F710 is a little unclear, as the main form would appear to cater for nationalities from the EEA.
You may also be asked to provide confirmation that you are no longer affiliated to the UK health system and not entitled to an S1 certificate, by providing an 'attestation de fin de droits'. You can obtain such confirmation from the Pensions Service in Newcastle, which can provide a letter (in English and French) confirming you are no longer resident in the UK/not in receipt of an S1.
You will be required to provide information on your income/resources.
Although it can only be a matter of conjecture, if you cannot demonstrate that you have sufficient resources not to be a burden on public finances in France it is possible your application will be refused.
Accordingly, you would be well advised to reply as comprehensively as possible, including details of your capital resources if your income is low, and providing such supporting documentation as you have available.
Your social insurance charge for affiliation to the health system will be based on your declaration. In subsequent years it will be based on your French tax return.
Local offices vary in their approach to early retirees applications, but if you sense any resistance you might wish to politely but clearly point out that you are applying on the following legal basis:
i. You are an EU national and are habitually resident in France. You should refer to Article 1(j) of Regulation (EC) No 883/2004 that defines ‘residence' as a place where a person habitually resides.
Article 4 of the Regulation also guarantees equality of treatment, stating: Unless otherwise provided for by this Regulation, persons to whom this Regulation applies shall enjoy the same benefits and be subject to the same obligations under the legislation of any Member State as the nationals thereof.
Give arguments of fact to support your case that France is your centre of interests. You could include utility bills, tax bills, a statement from the local mayor or whatever other evidence you deem appropriate.
ii. You benefit from the guarantee of equal treatment in Article 4 of Regulation (EU) No 883/2004, which means you should be admitted to the health system on the same terms as French nationals.
iii. It is discriminatory to require you to be resident in France for five years before you can access the health system, or to require you to have private health insurance, as these obligations are not applied to French nationals.
In August 2013, France established a centre based in Nimes for the processing of applications into the health system by early retirees, although some applications appear to be being processed locally.
Whether you want to insist your local CPAM send it to Nimes might depend on how they have received your application; if they seem willing to accept it, then perhaps you should not insist!
There is every indication that applications are being accepted by the Nimes centre, albeit some are taking many months to be processed. We considered the problems being experienced by early retirees in our Newsletter article Access to Health Care for EEA Residents.
If you should be refused admission then it is imperative you appeal against the decision.
The French health authorities are required by law to justify their decision to you, which they must do so in writing.
If the health authority is not prepared to give you a letter explaining their reasons, then you should make a written complaint to the Conciliateur of the CPAM. The CPAM will have their contact details, which is normally the local CPAM office. It is important you send the letter by recorded delivery.
If you do have a letter of refusal you have an automatic right of appeal to a local board, called the Commission de Recours Amiable (CRA).
The way the CRAs operate is somewhat opaque, but the appeal procedure is very simple. A recorded delivery letter must be sent to the CRA within two months of the (written) decision you contest. You are not required to attend a hearing. The absence of a response from the CRA with one month implies a rejection of your appeal, although some appeal panels are willing to state that a reply will be given, whatever the decision may be.
If the CRA does reject your appeal, then within two months you can take the matter to the social security and health tribunal - the Tribunal des affaires de sécurité sociale (TASS).
If you also wish to make a complaint to the EU Commission, then you can do so by e mail to SG-PLAINTES@ec.europa.eu.
If you are encountering difficulties we can assist with the application for a modest charge. You can contact us at Health Registration.
2.5.3. Private Health Insurance
There are a number of insurers who offer private health insurance in France.
Whether you also save the health insurance charge on all your investment income above €20K pa is currently unclear, as the social security collections agency (URSSAF) have told us that holding a private policy is irrelevant for the purposes of this charge. We are monitoring developments on this issue but the indications are that, provided you also receive a pension, you will be exempt from the charge. This exemption is being granted on the basis of your pension, not the private policy.
It is always important to review the small print in private health policies and in order to obtain cover and these rates you will need to complete a medical questionnaire, which will be individually underwritten, so the policies are not going to be suitable for everyone.
In the State system no pre-existing medical conditions apply, and long-term treatment for serious illnesses is guaranteed for an unlimited duration, and with 100% reimbursement.
If you are privately insured, remember also that the insurance will need to cover trips back to your home country, as you will not be eligible for a European Health Insurance Card, which is only available to those in the State system.
2.5.4 Setting up a Business
If you set up a business in France you cease to be ‘economically inactive’ and you and your family have automatic health cover, albeit that since 2016 other members of the family will need to make separate application for cover, due to the abolition of 'ayant droits'. See our article Access to Health Care for EEA Residents.
However, that business needs to be 'real', even though it may be small and something you do on a part-time basis.
Although as a micro-entrepreneur you can set up in business doing almost anything and you have no obligatory turnover requirement for two years, you still need to be able to demonstrate, if requested, that you are actively engaged in trying to establish a business. The risk that the authorities will investigate your circumstances is small, but it is not one worth taking.
You can read more in Guide to Micro-Entrepreneur Business.
2.5.5. People from Outside the EEA
If you live outside the EEA and you relocate permanently to France as a retired person, you will need to check with the relevant authority in your home country whether there are any reciprocal agreements with France.
You will almost certainly be required to take out private medical insurance, as you will need to justify you have the resources not to be a burden on the French social security system and to have health insurance cover. This cover will need to be taken out before you will be granted your long-term residence permit.
Ultimately, however, if you establish a right of residence in France of whatever duration, you will be able to make application for State health insurance cover.
The indications are that the French authorities are allowing access to the health system after three months legal residence, although we are seeing many different local interpretations of the regulations. In all cases, the period of your cover will be no longer than the period of your visa/residence permit.
Accordingly, all we can advise is that if you arrive in France with a residence permit and suitable health cover, then once you have established at least three months residence you should consider applying for admission to the health system. If you are successful, the cover should last at least for the duration of your residence permit, which may then be renewed.
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