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
2.4. S1 Health Cover for Retired Persons
2.4.1 EEA Retired Nationals
For the purposes of this section we define a 'retired person' as someone of the age of retirement of their country of origin, who exercises no professional activity, and who is in receipt of a State Pension from their home EEA country.
If you are an EEA national and in receipt of a State pension, or you suffer from long term incapacity, then in order to register with the French health system you will need to apply for a Form S1 certificate of entitlement from the social security authority in your country.
We also include in this category people under the age of retirement, but in receipt of long-term incapacity benefit.
Those who hold an S1 certificate of exemption will only nominally be affiliated to the French health system (PUMA) for the purposes of administration, as European regulations grant them and their family members an entitlement to health cover via the certificate, paid for by their home country.
As a retired person, if you have an S1 you will continue to benefit indefinitely from free health insurance cover in France.
Holders of an S1 certificate do not pay the PUMA health insurance charge.
As well as exemption from the health charge, the use of the S1 also exempts you from the payment of social charges on your pension income. In effect, your health cover is being paid for through reciprocal arrangements in place within Europe; only those actually affiliated to the French health system pay these charges on their pension.
However, the use of the S1 does not mean you will get free health care in France. It simply means that you will not need to pay into the French social security system or to take out private health insurance in order to obtain health cover.
As the French health system only covers a percentage of basic health charges, ranging from 35% at the bottom end to 100% for major illnesses, if you wish to ensure all your costs are met you will need to take out voluntary ('top up') health insurance.
Even then, you will be responsible for paying some residual costs that are not picked up by either the social security or most voluntary health insurance systems.
So do not assume an S1 picks up all your health costs; it does not.
The S1 form should be presented to your local French health authority, the Caisse Primaire d’Assurance Maladie, although since 2019 we have noted that the French and UK health authorities are dealing with the issue of S1s directly between themselves, so that it is not sent to the holder but to your CPAM.
You may need to present your S1 to the tax authority for exemption of social charges on your pension income.
Those from the UK should contact:
The Pension Service 11, Mail Handling Site A, Wolverhampton, WV98 1LW, United Kingdom
Telephone: +44 (0) 191 218 7777
You should ensure keep a copy, or the original if possible, as the UK authorities are reluctant to issue a duplicate.
If you propose to run a business in France, then you will not be eligible for an S1, even though of retirement age, as you will be insured through your business. An S1 is only available if you are inactive and State retired.
2.4.2 Permanent Incapacity
The rules governing entitlement to UK long-term incapacity benefit have changed in recent years, with the abolition of Incapacity Benefit and it's replacement by 'Employment and Support Allowance (ESA)'.
The benefit is exportable to France, although claimants are required to demonstrate a satisfactory national insurance record, and all claimants in France will be required to have a periodic 'Work Capability Assessment' by a French doctor.
A person on incapacity benefit is likely to be entitled to receive full reimbursement of all the medical costs relating to their condition, provided it is classified as a Affection de Longue Durée – (ALD) by the medical authorities.
Similarly, anyone who suffers from a long-term or major illness is likely to find that 100% of costs in relation to the treatment of this illness are covered by the French social security system, provided it is also on the list of affections de longue durée – (ALD).
2.4.3 'Dependent' Spouses
A 'dependent' spouse of someone reaching State retirement age is also granted cover under an S1.
The definition of just what is regarded as being 'dependent' includes all those in a married relationship or in a civil partnership. Thus, even though your spouse may have an independent source of income, they would be admitted as a dependent.
Only in the case of those not married, or in a civil partnership, would it normally be necessary to prove financial dependency.
The decision as to who is dependent is not made by the French authorities, but by your country of origin. Some local health authorities in France have been known to contest dependency status, but the cases have been rare, and generally not upheld.
In the event that the holder of an S1 dies before their 'dependent' younger spouse reaches retirement age, then the surviving partner will continue to retain health cover through the S1 for 12 months.
However, use of this arrangement may not be necessary, as you would normally be granted automatic and permanent access into the French health system through 'accident of life' provisions. You can read more about this rule at Health Cover for Early Retirees.
You would be required to pay the health charge if you are not of retirement age, but these would be related to income, and those on a low income are entitled to free cover.
On this basis a dependent younger spouse of a retired person should always be able to obtain State health cover in France.
If one of partners in a household works or is in business in France, while the other is retired and in receipt of a State Pension, then three possible scenarios open up, with the rules a little unclear and application of the rules varied.
The first is and most likely approach is for the retired partner to obtain cover through an S1, while the other partner continues to be affiliated to the health system through their business or employment.
The second is that the local health authority accept both being insured through the S1. We consider this scenario unlikely (but not inconceivable) as the S1 is for use by retired persons living abroad in Europe. It is incompatible with a professional activity.
The third is where the local health authority in France insists that both be insured through the employment or business. However, it is questionable whether the French authorities could insist on this approach. Indeed it would not be financially advantageous for them to do so, as with separate insurance for each partner they receive two insurance premiums, one paid by the social security agency of the S1 recipient and the other directly by the business owner.
2.4.4. Non-EEA Retired Persons
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. Indeed, there are increasing signs that the French authorities are insisting that once you become legally resident in France you opt in to the State system; even if you do not, you may still be liable for the health insurance charge.
Accordingly, all we can advise is that if you arrive in France with a residence permit and suitable health cover, once you have established at least three months residence you should consider making application 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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Next: Early Retirees
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