French News Archive

Healthcare in France

Early Retirees Access to Health System Confirmed

Tuesday 12 July 2011

A new circular confirms early retirees from Europe have access to the French health system, although not always on an automatic basis.

The guidance* states that, subject to sufficient resources and existing health insurance cover, inactive early retirees can be admitted to the Couverture Maladie Universelle (CMU) on a ‘case by case’ basis.

The November 2007 circular, which barred early retirees from access to the health system unless they had five years legal residence, has now been withdrawn.

Right of Residence

It is clear from the new guidance that the French authorities have been obliged to withdraw the earlier circular due to non-compliance with EU rules on the right of free movement of persons within Europe.

A residence permit (carte de séjour) is not required to reside in another Member country so any EU national is entitled to relocate to France, provided they have sufficient resources and that they hold health insurance.

Indeed, after 5 years legal residence there is an automatic right of permanent residence, irrespective of these two qualifying criteria.

The minimum level of resources to be ‘sufficient’ in order to be legally resident is stated in the circular to be the equivalent of the Revenu de Solidarité Active (RSA) minimum income support level.

The level of the RSA per month depends on household size, as follows:

RSA 2011
HouseholdChildren Under 25 (or dependents)
No Child1 Child2 Children3 ChildrenAdditional child or dependent
Single person€467€700€841€1027€187

The health insurance requirement would be met by either possession of an 'E' form (such as E106/S1), or through a comprehensive private health insurance policy.

Accordingly, provided on application to the local health authority (CPAM) an applicant meets these requirements, then they can be admitted to the health system at the expiry of the 'E' form cover (normally two years).

Private Health Insurance

Nevertheless, this right of admission is less automatic for existing early retirees in France whose current insurance is provided by a private health insurer.

The same hurdle also arises for future early retirees who are insured privately. Some early retirees have no alternative to private health insurance as they do not have enough national insurance contributions to obtain an E106/S1.

The circular states that unless this private cover has been lost, or is otherwise unattainable, they could well be refused access to the CMU.

It states:

‘Sous réserve d'un examen au cas par cas des circonstances dans lesquelles la couverture maladie nécessaire pour résider régulièrement en France a été perdue, les personnes qui démontrent avoir établi leur résidence habituelle et stable sur le territoire et disposent de ressources « suffisantes » peuvent se voir accorder le bénéfice de la CMU…’

The circular gives examples of those cases where access to the CMU may be granted to those with private health insurance:

  • A reduction in income making it impossible to continue with private insurance;
  • The cost of the private insurance becoming too onerous by the necessity to receive treatment for the insured or a member of their family;
  • Loss of cover due to loss of employment, death of spouse or partner, or divorce;
  • Other unspecified reasons outside of the control of the applicant that led them to lose their current private health insurance.

It is clear from the tone of the circular that the authorities are obsessed about 'health tourism', so the circumstances of each applicant will be examined in detail.

As reasonable as this may seem, there is likely to be concern about the lack of clarity on the admission criteria into the CMU for those with private health insurance. At what point does private health insurance become ‘too onerous’? Without a cost to income threshold figure being stated there are likely to be widespread differences in the application of the law.

The local health authorities in France will almost certainly demand greater clarity from the government, for they are obliged under the guidance to provide anyone who is refused access to the CMU a written statement of the reason(s) for refusal of their application.

Low Income Households

The circular does, however, confirm the right of early retirees on low income to free health insurance through the CMU-C, a right that also applies to self-employed persons who meet the income criteria.

If you meet the low income criteria (currently €11,656 pa for two people), the circular states you can obtain access to the Couverture Maladie Universelle Complémentaire.

It was abuse by expats of the CMU-C that led the French authorities to tighten the regulations in 2007.

So it is not surprising, therefore, that the circular makes it clear that all applicants for both the CMU and the CMU-C will be required to satisfy the authorities on the level of their income.

In the case of the CMU this will be to determine the level of their contribution, while in the case of the CMU-C to assess their eligibility for free health cover.

It can be anticipated that anyone seeking access to the CMU-C, in particular, will have their income and lifestyle thoroughly examined.

The circular infers that low income alone would not necessarily grant access to the CMU-C if the applicant possessed a valuable home or other wealth.

*Circulaire N°DSS/DACI/2011/225

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