Early Retirees Being Accepted for Health Cover
Tuesday 07 October 2014
Although it is a mixed picture, your e-mails indicate that many local health authorities are continuing to accept early retirees into the health system.
Whilst in in theory the door has been firmly shut to early retirees from the EEA with under 5 years residence in France, in practice the 5 year rule is not one that is universally being applied by the French local health authorities.
A number of you are reporting to us that you have been successful in your application to the Couverture Maladie Universelle (CMU), despite not having lived in France for at least 5 years.
Much of the explanation for the differences in treatment is due to the decentralised nature of health authority management in France, and to the discretion left to officials under the terms of the formal guidance.
Johanna Matthews of health partners Exclusive Healthcare comments that, "It is quite possible that the more sympathetic local health authorities and officials are making use of the wriggle room that the guidance grants them to breach the 5 year rule and allow affiliation to the CMU in individual cases."
A key factor in whether or not your application will be successful is likely to be the level of determination and proficiency you can demonstrate in the application process.
Making an Application
In order to obtain access to the CMU you need to make a formal application to your local health authority, the CPAM, using the form that is available for this purpose. You will need to ensure you enclose all the supporting documentary evidence.
Unless there are overwhelming medical criteria, you should make your application on the basis of 'condition de résidence stable et régulière', under Article L380-1 of the Code de la sécurité sociale.
This requires that you have lived in France for at least three months and that you have sufficient income and existing medical insurance that enables you to live in France legally.
In the absence of temporary S1 cover, now no longer available to early retirees, you will need to have a private health insurance policy in place, notwithstanding that it may have a forthcoming expiry date.
If you go on to the website of the CMU three months residence is all they continue to require; there is no reference at all to a 5 year residency rule, despite the fact that the law excluding economically inactive early retirees from the EEA has been in place since 2007.
As to discriminate in this way against those from the EEA is contrary to European regulations it is not surprising the French authorities do not wish to publicise it in such an overt manner.
Perhaps that is also why the administrative guidance issued to the local health authorities by the French government states that in order to avoid discrimination there must be a detailed examination on a case by case basis - 'un examen approfondi de la situation de la personne afin de concilier les conditions du droit au séjour et le principe de non-discrimination.'
Strictly speaking, under an agreement the EU Commission has reached with the French government, this 'case by case' examination should then be undertaken by a central processing centre at Nimes, Languedoc Roussillon, that has been set up to deal with early retiree applications.
Nevertheless, not all CPAMs seem to comply with this procedure as some applications are continuing to be assessed locally.
Clearly, if the local CPAM are sympathetic there is no need to change course, but if it appears they will reject your application you should insist it is referred on. Many of you appear to have been successful when the application has been considered by the Nimes centre.
If you are refused affiliation to the CMU by the CPAM at Nimes, or your local CPAM, you must ensure you obtain their decision in writing, something to which you are legally entitled.
You then have two months to make an appeal to a local panel, called the Commission de Recours Amiable (CRA). You can use the following guidance from the EU as your grounds for appeal.
You are not required to attend the CRA hearing. The absence of a response from them within one month implies a rejection of your appeal, although in practice we are finding the process can drag on for longer, often with a successful outcome. Johanna Matthews says that, "It is taking time to get a reply from CPAM. In one recent case we saw, as much as 8 months, so it is imperative that you have in place some short-term comprehensive cover during this period."
If the CRA do reject your appeal, then within two months you can take the matter to the social security and health tribunal - the Tribunal des affaires de sécurité sociale (TASS). Some of you have done just this and before the court hearing has taken place the local health authority have conceded. We can only assume they had done so because they do not consider they have sufficient legal grounds to win the case.
Simultaneously with these steps, we also strongly recommend that you make a complaint to the EU Commission, which you can do so at EU Citizens Complaints. You can also e-mail to SG-PLAINTES@ec.europa.eu. The EU are taking up complaints they receive, and although it may take months for a decision to appear, all the evidence we have received suggests they invariably get a result.
In short then, whether directly through the local CPAM, the central processing centre at Nimes, through a legal challenge, or a formal complaint to the European Commission, it is clear early retirees with under 5 years' residence can still obtain access to the French health system.
Do continue to write to me on this matter, as the information you provide is invaluable in helping us to arrive at an overall assessment of what is happening on the ground. You can contact me at firstname.lastname@example.org.