4. Voluntary 'Top Up' Health Insurance in France
- Limits of State Health System
- Level of Voluntary Insurance Premiums
- Obtaining Voluntary Health Insurance
- Assistance with Health Premiums
4.1. Limits of State Health System in France
While there may be universal system of health cover in France, as a general rule the social security system only picks up a percentage of your medical costs.
The percentage level of reimbursement will vary, depending on the type of treatment received, and from whom.
The GP system and basic health care fees and reimbursement levels are fairly straightforward, but specialist services can get a little more complicated and expensive.
Thus, the social security system will normally pay for about 70% of GP fees and between 30% and 65% of prescribed medicines, and only using the official regulated base figure for reimbursement.
In cases of specific major illnesses, or for someone on a low income covered by the CMU Protection Complémentaire (CMU–C), the system will generally reimburse 100% of the costs.
Beyond this general statement the level and scope of reimbursement depends on the type of treatment, the type of illness, your circumstances, and the cause of the illness. More information about actual reimbursement levels is provided in later pages.
However, the main point here is that if you want to be fully insured and have most of your fees and costs reimbursed, then you will need to take out voluntary health insurance cover, or ‘top-up’ health insurance, as it is sometimes called.
This insurance is referred to in French as l'assurance complémentaire santé.
The additional cover does not allow you to 'jump the queue' for treatment – it merely reimburses that part of the cost not paid for by the social security system.
Voluntary insurance cover will pay most, but not all, of the residual costs of medical care, so you will still be left with a small amount to pay yourself. The amount will depend on the terms of your policy, your circumstances, and the nature of your treatment.
Thus, for example, voluntary insurers are specifically forbidden by the government to provide insurance cover for the €1 surcharge that now applies to all medical consultations, and there are restrictions on cover for those who do not proceed via their family doctor for medical treatment.
You will also find that most policies exclude insurance of illness or accident arising from certain 'dangerous' sports, with potential limits on alcohol or drug related illnesses or accidents. Most also limit cover for dental and ophthalmic treatment.
If your doctor or consultant charges in excess of the official rates (as some are allowed to do) you will also find many policies do not pick up this extra charge, or only pick up a proportion of it, up to a maximum amount.
So you need to determine the level of cover you seek, and pay the appropriate premium.
Apart from the issue of the level of reimbursement, you are likely to find that most 'top-up' contracts do not offer immediate cover. The period of delay (called a délais de carence) may be only three months, but on some contracts it is as high as a year.
Other contracts provide for a reduced level of cover during the preliminary period.
All policies are not the same, so you need to read the policy to be clear about what is and what is not covered.
Does it make sense to take out such a policy?
In considering this question, remember that whether you are retired, or you run your own business in France, the French social security system reimburses only a proportion of your health charges, around 70% for routine treatment.
However, in the case of major or long term illness, your costs are covered at the rate of 100%.
On this basis if you were only using the health service for occasional minor ailments it is unlikely that it would be worthwhile to take out voluntary insurance.
However, the picture is a complex one, and one that is in a process of change, for the trend in France is to push a higher level of responsibility for medical cover onto individuals and voluntary/complementary health insurers.
Moreover, not all major illnesses are covered at the rate of 100%. The list of such illnesses is strictly defined in law and there are many costly medical treatments not on this list.
There is also a need to consider your age and medical circumstances. Most expats who relocate to France are aged 50+, with medical needs that are likely to reflect this level of seniority. You may also find it more difficult to get voluntary insurance the older you become.
Accordingly, it is by no means self-evident that not taking out a top-up health policy makes economic sense. Aside from the cost, you also need to consider the psychological benefits of having full cover, giving you the peace of mind you may need to enjoy your life in France.
That said, if you are prepared to pick up routine medical treatment yourself, you might find it more economic to take out a ‘hospitalisation’ plan. Such policies are up to 80% cheaper than a general policy.
These policies are not widely advertised by the voluntary insurers, nor are they offered by all of them, probably because they are not as lucrative as the more general policies. However, read the small print with care, as hospital out-patient treatment is not normally included.
For a fuller consideration of the question you can read two articles we published in our Newsletter - Is Top-Up Insurance Necessary Part 1 and Is Top-Up Insurance Necessary Part 2, although these articles were published several years ago.
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