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HEALTHCARE IN FRANCE

by

Peter Owen
www.expathealthdirect.co.uk

FORWARD PLANNING

Too many expats living in France, and particularly those from the UK, just do not plan and prepare for their healthcare provision in France.  It is while boarding the ferry or even waiting until illness befalls them that the subject is addressed.  The result is administrative worry at best and possible financial penalties.  It is essential therefore that you investigate healthcare options some months before you depart your home country.  France, despite recent bad press, still offers some of the best healthcare in the world for its citizens so it makes sense to take full advantage of it.

E Forms.  Affiliation via E Forms should be the first option that should be considered.  E111 is OK for emergency treatment on temporary visits but it is totally inappropriate for the permanent resident.  Those that believe E111 plus a travel insurance is a realistic option are deluding themselves.

 E121.  For those of state pension age and in receipt of a state pension E121 can be obtained from the Department for Work and Pensions (DWP) at Newcastle upon Tyne.  You will be able to affiliate free of charge and also your dependants.  E121 will be valid for the rest of your life.  Regardless of age those in receipt of Long Term Incapacity Benefit (which will usually continue to be paid on moving to France) can also obtain E121 and will be valid for as long as you remain in receipt of that benefit.

 Qualification and validity of E106 is the form that can cause the most headaches.  It is issued to those who come to live but not work in France.  It is normally valid for up to 2 years but most expats find that it is for a lot less.  This is because they do not understand the rules of its issue.  For example; assuming the correct NI contributions have been paid, someone arriving in France in November 2004 will usually have an E106 valid unil December 2005.  If that same person delays the arrival in France until January 2005 the E106 will be valid until December 2006.

E121 and E106 are the main forms but there are others which enable affiliation to the system in particular circumstances eg; students.

Affiliation under residence criteria.  If affiliation via E Forms is not possible or, for example the E106 has expired, then doing so by purely residence criteria is possible.  But this does involve a financial contribution for basic healthcare whereas via E Forms does not.  The timing of any affiliation by this means is even more vital.  For example you would want any contribution, if possible, to be based say, on pension as opposed to final year of salary.  To avoid the latter it may be better to have private insurance for a while.  Although it is obligatory for all residents of France to affiliate, under certain circumstances private insurance can be both appropriate and legitimate.  But as with E Forms planning for all this should be done well in advance of a move to France.

PERSONAL CONTRIBUTION

Whether affiliating via E Forms or residence criteria only a proportion of healthcare costs are covered (typically 70%) but can be higher or lower depending on the specific treatment received.  There are 3 ways by which the difference can be funded

        1.  Personal payment direct.  Fine but impossible to predict what you may have to pay.

        2.  A very comprehensive "top up" insurance.  This will be expensive and the benefits may be surplus to requirements.

        3.  A mixture of the above.  An example would be if someone is in general good health they may seek hospitalisation cover only (and benefit from lower premiums) and the occasional visit to the doctor and any prescribed medication can be funded out of their own pocket.

There is no doubt that some people have the wrong insurance.  It is not that the policies are bad but that they are inappropriate to their financial and/or health circumstances.  There are a large number of providers on the market so if  ever there was a case of "shop around" this is it.

Understanding the benefits of most providers is certainly a problem if you do not have a reasonable knowledge of healthcare in France. Many benefits are defined in terms of the "Tarif de Convention" (TC) and "Ticket Modérateur"(TM).  In the former case a common benefit will be 100%.  Unfortunately 100% of the TC does not necessarily mean that the full difference will be paid. Professional advice should be sought.

CONCLUSION

Do plan your healthcare provision well in advance of a move to France.  Any effort made will certainly reduce bureaucratic problems in France and in the medium term could have financial benefits.  Once affiliated you will have access to some of the best healthcare in the world but accept with good grace that a personal contribution will be required.

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