8. Long-Term/Major Illness in France - Affection de Longue Durée – (ALD)
If you suffer from a long-term or major illness then, as a general rule, all costs are fully reimbursable by the social security system, provided the fees and charges are made at the official rate.
You will be responsible for excess consultant charges (depassements, which is now often applied, and you will continue to remain responsible for the patient surcharges. These additional charges were discussed in Section 7.
A long term or major illness that grants this exemption is referred to as Affection de Longue Durée – ALD.
It is defined in French law as a 'condition requiring long-term care and particularly costly treatment’. The illness is one that must require medical treatment for at least six months.
The official list of illnesses classified as ALD is reviewed annually by the government.
The prescribed list of illnesses for which the State accepts full responsibility contains 30 pathologies on it.
They include cancer, diabetes (type 1 and 2), serious heart disorder, dementia, Parkinson's, grave neurological or muscular diseases, and chronic lung disease.
In addition, there exists 'ALD 31' and 'ALD 32', which are illnesses not on the list but requiring extended care or particularly costly treatment.
If your doctor considers that you have an affection de longue durée they will make application to the local health authority who will assess your case and make the ultimate decision as to whether or not you will be entitled to 100% medical cover for the illness.
Whether or not such an application will be made will depend on the attitude of your doctor. Although doctors have been issued with guidance, some are inclined to make application whatever stage the illness has reached, whilst others take the view that until or unless it reaches an advanced stage an application is not deemed appropriate.
Once your name has been added to the ALD list you need to make sure that your health card (carte vitale) is updated by the chemist, or you will otherwise receive only partial reimbursement for prescriptions.
The transport costs for patients suffering from an ALD are not automatically reimbursable, as each case is considered on its merits.
The period for which you will to entitled to ALD status is not indefinite, but is renewal at intervals of 3 years up to 10 years, depending on your illness and the assessment made by your doctor, in collaboration with the local health authority.
Those entitled to ALD status include those in France under an S1, as well as those fully registered with the French health system through PUMA, or employment/business.
Although the State formally picks up the charges for treatment of an ALD, there remain a number of charges the responsibility of the patient.
i. Other Illnesses - You will only be entitled to partial reimbursement for all other illnesses. In some cases, ancillary medication that is not directly related to the chronic illness may also only reimbursed on a partial basis.
ii. Consultant Surcharges - An increasing number of hospital consultants and other medical specialists impose charges over and above the standard fixed tariff set by the government on which reimbursements are based. These additional 'depassement honoraires' are not covered by ALD.
iii. Daily Hospital Charge - If you are admitted to hospital for over 24 hours you will be required to pay a daily accommodation rate of €18, called the 'forfait journalier hospitalier' which is the responsibility of the patient. In addition you may be obliged to pay certain other hospital charges, such as an additional charge for a single room, television and telephone.
iv. Medical Consultations - All patients are required to pay €1 for each medical consultation or analyses, irrespective of whether or not they have full insurance cover. This is called the 'participation forfaitaire'.
v. Franchise Medical - You will be required to pay 50 cents towards the cost of all medicines, except those given during hospitalisation. There is a similar charge for auxiliary medical treatments, such as physiotherapy. You are also required to pay €2 towards the cost of medical transport if needed, save for emergencies. All to the limit of €50 per year.
All of these costs, save for the €1 'participation forfaitaire', may be reimbursed by your complementary policy, although it will depend on the terms of the policy.
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