French News Archive

Healthcare in France

PUMA Health Charge to be Overhauled

Monday 08 October 2018

The government have announced that the law on the PUMA health charge is to be changed, but it is unlikely there will be further clarity for early retirees.

Last month we published a newsflash concerning a judgement of the French Constitutional Council (CC) on the legal status of the PUMa health charge, called the cotisation subsidiaire maladie.

The article, which we have since updated, can be found at French Health Charge Court Judgement.

The case was a complicated one, but in essence it turned on the liability for the charge and the formula used in determining the amount payable.

As we indicated last year, the law has been poorly drafted and with the dispute procedures that have been launched, and the legal challenges that are taking place, it was only a matter of time before some changes would need to be made.

Unusually, in coming to their judgement the CC went against the advice of their legal advisor, and it is quite possible that the swift action now being taken by the government is the result of behind the scenes assurances that took place prior to the hearing. Those who sit on the CC are distinguished former politicians.

In the draft social security finance bill that has recently been published the government state that:

"With a view to providing legal certainty and fair treatment between self-employed workers and other workers, the cotisation subsidiaire maladie will be adjusted to eliminate its current inconsistencies.

In this respect, self-employed workers and farmers will be exempt from this contribution if they are otherwise subject to social security contributions because of their professional activity at least equal to the minimum contribution level.

In addition, the method for calculating the contribution will be simplified and rationalised, while a ceiling will also be introduced'.

No details of how this will be accomplished have yet been published, but, as can be seen, it does seem from the statement that business owners and salaried employees on a low income will no longer be liable for the charge, and that a capping mechanism will be introduced.

It remains to be seen if other aspects relating to the charge not considered at the CC hearing will feature in the changes, such as the liability of those holding a private health insurance policy, and the status of early retirement pensions.

Brexit and PUMA

There remains a continuing lack of clarity about the entitlement of early retirees from the EEA to actually obtain cover under PUMA, although this is unlikely to be changed in the planned revision.

In law, PUMA grants a right of access to the French health system to anyone who is legally resident in France, stating:

"Toute personne travaillant ou, lorsqu’elle n’exerce pas d’activité professionnelle, résidant en France de manière bénéficie, en cas de maladie ou de maternité, de la prise en charge de ses frais de santé (...)."

Nevertheless, it appears that this universal right does not exist to early retiree EEA nationals, who, strictly speaking, can only access the system after 5 years' legal residence.

Thus, on the government health website, it states that whilst non-EEA nationals have a right to health cover after three months legal residence, nationals from the EEA must be resident for 5 years, as follows:

'If you are not a European citizen ……………You can make an application after 3 months of residency.

If you are a European citizen and you are not eligible to get a S1 form, you can't claim for the PUMa's benefits under 5 years of permanent residence unless your situation has changed while you've been living in France (change of income, divorce, long term disease, etc)."

The reason for this difference relates to the tests of 'stable et régulière' as they apply to economically in-active European nationals. There is a great deal of legal controversy about it.

In practice, most EEA early retirees obtain access to the system, provided they are able to show they will not be a burden on the social security system.

Moreover, whilst it is quite possible that the income test for UK nationals seeking to move to France will increase with Brexit (minimum circa €18K/couple), somewhat ironically, it may well also be that early retirees from the UK with 'sufficient resources' will have easier access to the French health system than is currently the case!

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