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Disclaimer
Please note that the information given in this article, whilst believed to be as accurate as possible at the time of writing, is general information only, and no liability can be accepted. Before acting on the information that follows, please ensure that you take expert advice form the relevant authorities.
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France is good for your health
France is good for your health. That's official, and it's easy to see why. In most parts of the country there's a great climate (Weather in France), with plenty of health boosting sunshine, low levels of pollution, shorter hours of work (Jobs in France) and superb, locally grown seasonal produce forming the basis of an olive oil and red wine lubricated Mediterranean diet (Buying and cooking French food). Everywhere you look there are healthy, lively people who have passed their eightieth birthdays and beyond, tending their gardens, polishing their petanque balls and, more often than you care to admit, overtaking you on their bicycles! Yes, France is a great place to live if you want to last to a healthy, ripe old age. But what if you do happen to fall ill? How does France rate then, and what do you have to do in order to benefit from the health care in place in your adopted country?
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Health care in France - a good system
The health care system in France is accepted as excellent throughout most of Europe, and it certainly looks as though, at the time of writing, it has many advantages over the English system, which has come in for some considerable criticism over the last few years. It is, in many respects, quite different from English health care, and it can take a while to accustom yourself to the way that things work. Once you get used to it, however, you will almost certainly find that the system in France is effective and simple enough to operate.
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EHIC and health care in France – for those still resident in the UK
When you initially decide to buy a property in France and to spend time there (Why buy property in France, Life in France), if you are still working and your main residence is still the UK, you need to apply for the EHIC (European Health Insurance Card). This is the health insurance card that replaces the old E111 form. There are several ways of applying for this card, but the fastest is to apply on-line using the link provided on the department of health's website, www.dh.gov.uk. The on-line option promises that you will receive your card within seven days of your application. Other ways to apply are through the post (pick up forms at your local main post office and post them to EHIC Applications, PO Box 1115, Newcastle Upon Tyne, NE99 ISW), or by telephone, on 0845 606 2030.
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What health care entitlement does EHIC offer in France?
The EHIC card will entitle you to the same level of health care that any naturalised person or a national of that country would normally benefit from. This applies throughout Europe, but the level of care offered in each individual country is different, and it is important to understand that in France, the free health care entitlement is set at around 70% of the total cost of treatment. The remainder has to be paid for privately or through a top up insurance policy, which you would also need to set up privately (see below). The EHIC card will provide the basic cover for three to five years, and remember it is only valid for those whose main residence is in the UK, not for those who have made a permanent move. Once cover has expired, you would have to re-apply for a new EHIC.
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E106 form and health care in France - for those wanting to become residents of France
If you are going to be living permanently in France ie: France is your main place of residence, you will need to apply for an E106 form instead of the EHIC. This you can get from the Department for Work and Pensions (DWP), The Pension Service, International Pension Centre, Tyneview Park, Newcastle-upon-Tyne NE98 1BA, or telephone 0191 21 87777. You must have paid enough National Insurance (NI) contributions in the last two years in the UK to qualify, and the card lasts up to two years, though this time limit does vary, depending on the amount of NI contributions made to date. As with the EHIC, this will cover up to 70% of health care costs, the remainder can be paid with a top up policy. As soon as possible, however, you need to take the first steps in becoming fully integrated into the French system before your entitlement under the E106 runs out. This means obtaining your carte vitale (see below). ** SEE UPDATE BELOW **
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E121 form and health care in France - for those receiving UK state pension or on incapacity benefit
If you have retired and are of UK state retirement age and on a UK state pension, or are receiving long term incapacity benefit or severe disability allowance, you need to apply for a form E121. This entitles you to essential health care in France, as long as your main residence is now France and not the UK. It is worth pointing out here, that if you are part of a married couple (including common law marriages), and only one of you fulfill the age and pension requirements, both of you would be covered. It is also advisable to check exactly what "essential care" means, however, as although the usual doctor's and hospital bills are covered, extras such as nursing fees may not be included in this. Routine and emergency health care is normally covered up to 70%, with the remainder having to be paid by the individual or through a top up policy. And as with those with E106 cover, you should apply for your carte vitale before your E121 runs out (see below). (Retirement in Perpignan, Retirement in France.) ** SEE UPDATE BELOW **
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Health care in France and the carte vitale - who can apply
This little green card is your passport to health care in France. Those who may apply for a carte vitale include those who have moved to France permanently and have become French residents, those who have reached the UK state retirement age and are in receipt of a UK state pension (Getting your UK pension paid in France), and those on long term invalidity benefit or severe disablement allowance. People who work in France are also eligible. So if you register a business in France (Owning Gîtes and Chambres D'Hotes (B&Bs) in France), or take employment, you will be entered into the French health care system as you will be paying your contributions in the same way as any French citizen. ** SEE UPDATE BELOW **
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Cover through the carte vitale and what you use it for
Once you have a carte vitale you will use it when you visit your doctor, when you pick up prescriptions from the pharmacy, or when you have other necessary medical treatments such as physiotherapy or if you are hospitalised (Health Care in France: a French Hospital Experience). It will cover roughly 70% of the costs of these situations, although this can vary. As with the health care cover provided by the EHIC and the E106 and E121 forms, top up insurance policies can be bought privately to pay for the remaining 30% of the fees. (There are some medicines that are not covered under the entitlement, such as those considered "luxury" medicines and items, and there are also certain situations and treatments that must be paid for by the recipient.) This state health care cover is called Couverture Maladie Universelle or CMU.
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How does a carte vitale work in France
The carte vitale is a swipe card, very similar to the credit or debit card in your wallet. It contains all the details of you and your family's medical rights to treatment and is as vital as its name suggests! When it arrives, it comes with a paper "attestation" which is also of utmost importance, so don't detach the card and throw away the paper as I did with my first one! You will need this paper part for postal claims, and in certain circumstances you can use it to prove your right to health care if you do not have the card for any reason.
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How to get a carte vitale
To get your carte vitale through the French health care system you must prove your entitlement from Britain. This should be done before your E106 or E121 cover runs out. You can register for your carte vitale by going to your local French health care and social security (CPAM) office.
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Residents of France and carte vitales
For those now resident in France, you will need proof of your national insurance payments from the last two years of your residency in the UK, and if these are deemed to have been sufficient you will be sent a carte vitale and entered into the French system immediately. If your payments have not been sufficient, you may be able to claim under the French social security system. This can be done by producing a letter from the authorities in the UK to state that you no longer have any entitlement in Britain, and that you are now the responsibility of France.
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Reimbursement and health care in France
The health care in France, whilst accurately described as around 70% free, does not work quite as you might expect. When you visit your doctor, for example, you are expected to pay the fee of €22 (this is the cost at the time of writing, it is, of course, subject to change) at the time of the consultation, and your carte vitale is then swiped. The money is reimbursed directly into your bank account, usually in the next few days. Prescriptions are dealt with according to what they consist of, and also according to the type of top up policy you have, if indeed you have one. Often you will find that once your card has been swiped and your attestation for your top up policy presented and noted, you will not have to pay any money at all.
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Top up policies
Top up policies are bought in order to cover the extra 30% that is not covered by the EHIC, E106 form, E121 form or carte vitale. The type of top up you require varies according to your situation and needs, and it is best to take individual advice on this. There are starter type top ups, that work alongside an EHIC, and which can be bought in the UK. There are many different companies offering policies, or mutuelles as they are often called, and these tend to vary according to the work that you do, if you work, with different policies for teachers, artisans, office workers etc. Top ups, also known as complimentaires, can be arranged through your insurance broker.
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Choices in health care in France - finding a doctor
France believes in freedom of choice for the individual when it comes to health care, and unlike in the UK you are free to choose the health care professional who you think best suits your needs. Therefore if you are told that you need an operation, you can stipulate the hospital and surgical team by whom you wish to be treated. This freedom of choice used to extend to the choice of GP, with patients attending one practice for one visit, then choosing to see another at the next. Recent changes however, mean that you are now encouraged (financially, with better reimbursement) to register with one doctor... or at least, one practice. You can find GPs and hospitals by asking the Mairie, neighbours, looking through the Pages Jaune and the internet. More often than not though, they are found by asking other ex-pats for English-speaking doctors.
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Different practices of health care in France - how GPs operate
GPs operate quite differently in France from in England too. They are usually extremely thorough, so if you visit your doctor to discuss a sore finger you are likely to find yourself being given a full examination, and sent for a blood test into the bargain! Blood tests are not performed in the surgery, but in a Laboratoire Analysées in a nearby town, where you walk in with your prescription and have the test immediately. If you need vaccinations, you pick up the vaccine from a pharmacy (with your prescription) and keep it in the fridge at home until you go back to the doctor.
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English-speaking emergency health service
And just a brief word about calling for a doctor or ambulance in an emergency situation. If you are not comfortable speaking in French or still find the language difficult to understand, there is a number you can ring which offers an English-speaking service. This is 112. This number is for all emergency services.
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Health care in France to change
Everything in France is subject to radical change at this time, as the new president Nicholas Sarkozy is beginning to make his presence felt (Sarkozy and French property owners). A very recent announcement has become a source of concern for certain ex-pats, as it appears that those who are neither working nor entitled to retirement care may lose their rights to health care in France. So anyone who is subsidising their life in France by working "on the black", without being declared to pay taxes or social charges, is likely to be caught out by this change. ** SEE UPDATE BELOW **
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Keep a close eye on developments to do with health care in France
At the time of writing it is still a little unclear as to what will happen, but if think you may fall into this bracket for any reason you will need to keep a close eye on developments, and if you are working unregistered there has never, perhaps, been a better reason to legalise your position and start paying into the system. (For further advice you could try the English speaking CPAM help line 0033 (0)8 20 90 42 12.) For many years the French health care system has been perhaps over generous, at its own expense, offering benefits such as tummy tucks (on the state!) for mothers of more than two children, and other similar non essential treatments. Slowly but surely the French government is rationalising the system, having realised that it has to become more self supporting if France is to survive economically. But most people need not worry, for although the health care system is liable to change in respect of its funding, due to European agreements the majority of ex-pats should be able to find suitable cover for their needs in France. ** SEE UPDATE BELOW **
Additional articles which may be of interest:
Tax in France
Learning French
Banking in France
French Education System - Schools in France
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*** IMPORTANT UPDATE FOR THOSE UNDER RETIREMENT AGE AND THOSE NOT REGISTERED TO WORK IN FRANCE ***
Added 21 February 2008
In September 2007 the French government decreed that ex-pats who had moved to France having taken early retirement and not working, would not be able to be covered by the French carte vitale system, but would instead have to take out their own private medical insurance to cover costs. Needless to say this was not just inconvenient for many, but absolutely terrifying for those who suffered from debilitating illnesses and would not be able to get such cover even if they could afford it. A lot of them were also in a "No Going Back" situation, having sold property in England to move to France, and found themselves facing the prospect of being unable to afford a decent property in the UK to return to, thanks to spiralling property prices.
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E106 + E121 form holders
As health cover was provided for those not working and retiring early, or receiving long term incapacity benefit or severe disability allowance, for up to two and a half years after the initial move through the "E106" or "E121" form system, many were covered but watching the end of their cover approaching fast, with rising panic. Fortunately, though, the pressure brought to bear on the French government has produced results. Seemingly belatedly recognising the unfairness of the retroactive policy, France changed the "no health care" ruling to cover only those who had not moved to France before November 23rd 2007.
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The important date - 23 November 2007
Thus, those ex-pats who have been in France from before this date and are in the possession of an E106 form, can apply for a carte vitale and health care in the normal way. For those who were receiving long term incapacity benefit or severe disability allowance and possessed an E121 form before this date, it is currently stated that due consideration will be given to their cases. And all who were affiliated to CMU and receiving state health care cover before 23rd November 2007 are able to remain in the system, regardless of status.
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Changes from November 23 2007
But for those who had taken early retirement and who arrived in France on or after November 23rd 2007, or who will be moving to France in the future taking early retirement and not working, these people will face having to pay for all their health care costs privately. This is until they have become French residents however. As once a French resident, and having lived in France for an uninterrupted period of five years or more, they will be entitled to affiliate to CMU, have a carte vitale and thus health care. With all these changes happening however, it would be advisable to keep a close eye on developments for the foreseeable future.
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About the author
Joanna Simm moved to the Languedoc area of south-west France in October 2004 having found her property through French Property Links.
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your questions...
1. A question about the supply of medical equipment in France (added 7/11/07)...
Have read all your articles on moving to France and found them more than helpful. We want to move next year when my niece's B&B has been completed in St Junian. And I hope we can purchase a two bed property with down stairs bedroom and shower room for my wheelchair bound husband in the village. He has got MS and has had it for sixteen years. My sister and her husband are moving with her daughter and family, so it's important for us that we are near them. We live in a bungalow and have the necessary equipment ie: electronic bed and ceiling hoist, and a shower commode chair that can be wheeled from the bedroom to the shower room. I am his full time carer, though carers do come in in the morning to wash and dress him, I take over the rest of the time. What I need to know is, would the French system be the same in supplying the equipment?
Joanna Simms, author of the above article, replies...
I have just spoken to my doctor's wife who is American and so can explain things in English. What you will need to do to put help in place is to contact the Caisse de Primaire in your main town (CPAM...), who will ask you to have an interview to which you will need to bring more paperwork than you thought ever existed. Bring every document you have ever owned relating to your husband's condition and needs. If your French isn't really good, it's worth getting an inetrpreter, as the forms and terms can confuse even the French. After this, there will be care available, equipment, home care etc. though you might have to pay a little towards it, depending on your financial circumstances. But the standard of health care is excellent and equipment state of the art in most cases.
My doctor's wife tells me that there is a new system being set up to provide more English speaking care and admin too, in France in general, and she says she will also try to contact a patient of her husband's whose wife needs a lot of home care, to see if there is any more she can tell me that might be relevant.
I hope this helps, and that all goes well for you in the move... and best wishes!
2. Help needed (added 12/3/09)...
We are in desperate need of help from someone. We have been in France since the end of 2007. Unfortunately we were a bit nomadic as the house we had intended to buy had to be sold before we had exchanged contracts on our home in England. We had in fact done quite a bit of research before we decided to come, but, obviously we did not do enough!! We tried to get the E121 form before we left England but were told that we could not get one until a month before we left. As you know, a house isn't sold until contracts have been exchanged, so this was rather difficult. However, we did phone to give a temporary address, but nothing arrived. We moved to our present address in April and once again tried to get the E121. It did eventually arrive in July and we took it immediately to the CPAM office. We had photo copied all the relevant birth certificates etc so that we could give the originals to the office. However, they said that they wanted the photo copies. Then two to three weeks later we had a phone call to say that they wanted the originals, so off we go again and do a swap. Eight weeks went by and we decided to go into the office to ask about the carte vitale, and they said that my birth certificate was not right and wanted another. E-mails to England and after many more weeks, I had a new certificate. We are still without the carte vitale.
The point is that we were told that we could not claim back any money until we had this card, and I have needed medicine and also a hospital visit which we have had to pay for - almost 500 Euros so far. We cannot find out what we should do even when we telephone England. Then someone lent us a book about France and it states that we can get "free" medicine with the E121. How? We had to leave the forms with the CPAM office, and were told that the cards which we have had for holidays in Europe were not valid after three months. We are getting conflicting statements it seems. We are both in our seventies, and live in an area where we are the only English people, so have no English people to ask questions, or to advise us.
Please, having been on the internet all morning, and having seen your site, is it possible that you can help us in any way? Any information regarding this problem would be very much appreciated.
Our reply...
Thanks for contacting us. I am sorry to hear of your problems, and have been in touch with my colleague in France who says the following:
"This is complicated and I am not an expert on health care, but I know a friend here who had a similar problem so I will try to find out what she did. I know she finally has the carte vitale... and I know that she kept nagging them for the card... he who shouts loudest gets seen first!
But I would also say this sort of long winded bureaucratic paper work is so typical in France! Also, you can get temporary health insurance. But the good news is that when you finally get the carte vitale, they are very good about repaying anything that is owed... as long as you were eligible for the cover at the time."
So if my colleague is able to find out more from her friend I will get back to you as soon as possible, but in the meantime I suggest you keep chasing the CPAM office no matter what, and keep good records and all receipts for all the treatment you have had to have. As my colleague says, this should be refunded once you get your carte vitale, it just may take time. (And may also depend on exactly what treatment you had, as roughly only 70% of costs are covered, top-up policies are usually taken out for the remaining 30% of costs.)
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