2. Health Insurance Cover in France
- Health Cover for Self-Employed
- Health Cover for Cross Border Workers
- Health Cover for Retired Persons
- Health Cover for Early Retirees
- European Health Insurance Card (EHIC)
- Travelling Abroad from France
2.6. European Health Insurance Card (EHIC)
2.6.1. Applying for European Health Insurance Card (EHIC)
Visitors to France from the European Economic Area (EEA) and Switzerland are entitled to receive reduced cost, or sometimes free, unplanned health treatment through reciprocal agreements that have been entered into between these countries.
To gain access to treatment those visiting France as tourists are required to hold a European Health Insurance Card (EHIC).
Every member of the family who is travelling will need their own card.
In the case of those from the UK, the card is valid for up to five years.
As well as travellers, the category of persons entitled to an EHIC also includes those who are employed or take self-employment in France for up to a year, provided the HMRC (for UK residents) has agreed that you will continue to be liable for national insurance contributions during the period you are in France. Your dependants would also be covered. By agreement with the French and UK authorities it is possible to continue use of an EHIC for a second year.
Students and au pairs and nannies are also entitled to an EHIC, but the latter only for a maximum of a year.
The card cannot be used if you have relocated permanently to France. However, 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.'
To obtain a card it is probably easiest to make an On-Line Application. You will need your national insurance number.
You can also obtain an application form through the post office in the UK.
The NHS also has an EHIC application service on 0300 3301350, or you can email email@example.com which also deals with lost or stolen cards. The telephone number from abroad for lost or stolen cards is 0044 191 218 1999.
Last but not least, the administration team in the NHS for the EHIC card also have a Facebook page.
There is no charge for the card, so do not be fooled by some websites into paying for it.
2.6.2. What Does it Cover?
The EHIC is not a passport to unlimited health care in France. The entitlement is to such health care as is 'necessary', on the assumption that you will be expected to receive continuing treatment when you return home.
To quote from the UK National Health Service guidance on use of the EHIC:
'Presenting the EHIC entitles you to treatment that may become necessary during your trip, but doesn't allow you to go abroad specifically to receive medical care. However, maternity care, renal dialysis and managing the symptoms of pre-existing or chronic conditions that arise while abroad are all covered by the EHIC.'
The definition of 'necessary health care' is similarly defined in European case law as 'benefits granted with a view to preventing an insured person from being forced to return home to their home member state and enabling them to continue their temporary stay in another member state under safe medical conditions.'
It will not cover the costs of private healthcare, or services that are not part of the French State healthcare system, or the costs of being brought back to the UK.
2.6.3. Reimbursement Levels
Strictly speaking, health care in France is not free at the point of delivery in the same way as it is in the UK. You need to pay for your treatment, and later obtain reimbursement.
The EHIC entitles you to reimbursement of health care on the same terms as residents of France.
Accordingly, if you need non-hospitalised medical treatment whilst you are in France as a visitor, you will normally need to pay for the treatment at the point of delivery, including prescriptions.
You will be given a receipt (called a feuille de soins), for medical consultations, treatment and prescriptions, which you can later use to obtain a refund. Make sure you get this receipt or you will not get reimbursement.
For routine medical treatment you will be entitled to reimbursement of around 70% of the costs. Prescriptions are often reimbursed at a lower level, as are laboratory tests.
If you are admitted to hospital as in-patient the process and levels of reimbursement are a little different. Around 80% of your costs will be picked up directly through the social security system, although in the most serious cases (eg cancer, heart condition, hospitalisation 30+ days) you will get 100% reimbursement. That means that for most treatments you will be expected to pay the residual 20% of costs, in the same manner as if you were resident in France.
However, it is not infrequently the case that there will be services you receive not covered by the 80% rate of reimbursement, such as a charge for a private room, television, or excess charges imposed by consultants. These latter are called dépassement d’honoraires and you may wish to ask about them before you receive treatment. In-patients also pay a daily charge of €18 not reimbursed by the social security system, although those with a right to 100% reimbursement do not pay this charge.
As these residual and extra costs may be significant you need to consider taking out travel insurance to cover them. Holding an EHIC will substantially reduce the costs of such insurance.
The level of reimbursement of dental care in France is also low, so if you need expensive emergency dental care, expect to have to pay most of it out of your own pocket, unless you have travel insurance that will cover it.
2.6.4. Reimbursement Procedures
You need to apply for reimbursement of your costs to the local office of the Caisse Primaire d'Assurance-Maladie (CPAM). You can do so by visiting them direct, or sending them the paperwork.
The contact details of your local CPAM should be in the French yellow pages, the pages jaunes, or ask at the local mairie.
You will need to send them the feuille de soins, a copy of your EHIC, including details of your home address, and your bank details (IBAN AND BIC) where reimbursement will be paid. You will need to sign and date the feuille de soins, failing which you will not obtain reimbursement.
Not all the costs will be refunded, and the precise amount will depend on the circumstances. In this respect, as we stated, you will be treated in the same manner as any other resident of the country.
If you are not able to apply for reimbursement whilst you are in France, you can do so when you are back in the UK from the NHS Overseas Healthcare Office in Newcastle (0191 218 1999).
For hospital treatment you would be well advised to obtain an attestation from the hospital which provides confirmation of the treatment you have received and the costs paid.
To be able to get a fuller picture of the levels of reimbursement that apply in France you need to read our subsequent pages on the operation of the health service in France, as the picture is a complicated one.
2.6.5. Non-EEA Visitors to France
If you are visiting from outside the EEA then you need to establish whether any reciprocal agreement exists between your home country and France. If necessary, you will need to take out private health insurance for the visit.
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