Expats in French Health Cover Lottery
Tuesday 15 June 2010
Our recent exclusive on the EU investigation of French health rules provoked an interesting reaction from both readers and health insurance professionals.
One of the widely made comments concerned the difficulties faced by those with a pre-existing medical condition, both amongst those hoping to relocate to France and already resident.
Chris from Worcester wrote to us advising that he is planning to relocate to France, but due a recent stomach operation was concerned that he might not be able to find private health insurance.
‘When we do relocate we will have a modest income, so we cannot afford to pay large sums each year for health insurance,’ he stated.
Some of you had also applied for to get private health insurance, and had been turned down.
Adrian Metcalfe stated that he suffers from high blood pressure, for which he is undertaking medical treatment to keep it under control, but that was enough for the private insurer to whom he made application to turn down his request for health cover.
‘The result is that we fear we may actually have to return to the UK, as there is no way we can stay in France without having some form of health cover.’
However, it does seem all is not lost for those with a pre-existing medical condition.
Tony Mason a health insurance specialist states that for those with a medical condition there is a route of entry into the French system.
'If someone makes an application to us for insurance, and we refuse due to a pre-existing medical condition, we will provide the applicant with a letter that they can use to make application for entry into the CMU', he stated.
'Under the rules of entry, those who are resident in France through an E form, can make application to join the CMU when their cover expires, provided they have been refused private health insurance.'
'Indeed, we have numerous applicants who have taken precisely this route and they have been successful.'
'The only downside is that it is unlikely in the future you would be able to obtain a mortgage or secured credit in France, as your application for life insurance would probably be refused', he stated.
Strictly speaking, admission to the Couverture Maladie Universelle (CMU) because of the refusal of private health insurance only applies to those who developed a medical condition after they relocated to France, although it is clear the local health authorities are not necessarily applying this interpretation of the rules.
Given the unclear position, Peter Owen of Expathealthdirect.co.uk says people need to act with caution: 'If you are affiliated via E106 and during this period you have an illness and subsequent claims relating to this condition were excluded by a private insurer, then on expiry of the E106 it is possible, even probable, affiliation via the CMU would be granted, as a CPAM would judge this an accident de vie.'
'But', he continued, 'it is less certain if affiliation via CMU would be extended on expiry of E106 if you arrive in France with a pre-existing condition. A CPAM office could well argue this is no accident de vie at all, and may (harshly) judge this as somebody engaged in medical tourism, which the new rules intended to extinguish.'
In his view: 'Individual CPAM offices have always varied in their interpretation of regulations; it is a fact of life. As a result I would never advise a client that once an E106 has expired, affiliation via CMU would be automatically extended because of a pre-existing condition being excluded by a private insurer.'
Lack of Consistency in Rules
The differences in interpretation of the rules was also commented on by a number of readers.
Thus, several months ago we heard from Jane Stewart in the Dordogne who told us that she was unable to obtain private health insurance as a result of an illness developed in France, but she received a blank refusal from her local CPAM for health cover.
At the time, we advised her to appeal against that decision, as is her right.
Following our article, she wrote to us last week to say: 'My application did not even go to the appeal panel, as the local CPAM director simply decided to sign off the application for me to be admitted to the Couverture Maladie Universelle (CMU)!'
A similar picture emerged from a conversation with Ron Wright a health specialist in France who pointed out to us that, in his experience several expats he had come across had actually been admitted to the CMU, even though they did not qualify under the rules of the French government circular of 23 November, 2007.
‘I know of three cases in three different health authority areas where the local CPAM have decided to admit them into the CMU, purely on the basis that they had been resident in France for more than 3 months in a stable and regular manner and had no other health cover', he stated.
‘There seems not rhythm or reason why this should have happened, and it all seems a bit of a post-code lottery. CPAMs seem to be making up their own rules, with some taking a hard line and others willing to admit you.'