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A guide to health care in France - including information on getting a carte vitale, health insurance and CPAM
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.
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?
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.
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 (www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/about-the-ehic.aspx). Alternatively you can call 0300 3301350.
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.
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/S1 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 you get 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/S1 runs out. When registered in the French system, you will obtain your carte vitale (see below), though it must be noted that a carte vitale is not issued at all in some departments to people who are on E106/S1. ** SEE UPDATE BELOW **
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 its new title of Employment Support Allowance or ESA), you need to apply for a form E121/S1. 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/S1 cover, you should apply for your carte vitale before your E121/S1 runs out (see below). (Retirement in Perpignan, Retirement in France.) ** SEE UPDATE BELOW **
The carte vitale is your passport to health care in France, and is an ID card and means of automatic notification to the central system for reimbursements. It is given along with a paper attestation, which must be presented with the carte vitale at all times. Those who may apply to join the French health system and get an attestation and 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 incapacity benefit (now ESA) 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 **
Please note that a carte vitale must be updated regularly. It is also worthless if membership to the French health system ceases, for example on expiry of an E106/S1 or a change of circumstance for holders of an E121/S1 (ESA withdrawn for example).
To gain acceptance into the French health care system you must prove your entitlement from Britain. This should be done before your E106/S1 or E121/S1 cover runs out. You can register for French health care by going to your local French health care and social security (CPAM) office. Your membership and your entitlements in the French health care system are attested on a paper attestation, which comes along with the carte vitale when your application has been accepted.
And a note for those who already have an old style carte vitale, you will need to update it to the new photo card. It looks pretty similar to the old one, but with the addition of a passport style photo. To apply for your new card (you don't have to return the old one with the application, so as long as it is still working you can continue to use it until the new one arrives) write to your chosen health insurer or CPAM. You also need to update your mutuelle if there have been any changes in the number of people insured, for example, if your children have left France to go to university or to work in another country and are placing themselves in the UK health system.
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/S1 and E121/S1 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.
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, as mentioned previously, 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. In fact the carte vitale is actually worthless without a supporting attestation. The attestation is often asked for by specialists and others who are not linked to the carte vitale system. And while the carte vitale is a payment card, unless updated and supported by an attestation as to your current and existing rights and entitlements, it is completely worthless.
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 entered into the French system immediately and sent a carte vitale. 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.
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.
Top up policies are bought in order to cover the extra 30% that is not covered by the EHIC, E106/S1 form, E121/S1 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.
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.
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.
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.
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 **
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:
Benefits in France for UK ex-pats
Tax in France
Banking in France
French Education System - Schools 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.
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.
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.
Changes effective from November 2007 now mean that non-working immigrants into France from the UK who are under state retirement age will not be eligible for affiliation to CPAM (Caisse Primaire d'Assurance Maladie) if they do not have one of the various E forms issued by HMRC or the DWP, until they have been fully resident in France for five years. The E forms, usually E106/S1 or E109, are issued on the basis of your recent NI contributions record. This means that there is likely to be a gap of at least three years after the E form expires when private health care will be needed.
But 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 CPAM, have a carte vitale and thus health care.
Added July 2011
The following article addresses changes that are occurring in French health care for ex-pat early retirees:
Health care in France - another U-turn by Sarkozy
Joanna Simm moved to the Languedoc area of south-west France in October 2004 having found her property through French Property Links. Information in this article was also provided by Rob Hesketh.
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?
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!
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.
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.)
Are you able to help me? We had a business in France but retired from it two years ago. We obviously already have a carte vitale and we intend to stay living here in France. Is it true that we have to apply for an extension to our carte vitale or does our carte stay with us indefinitely. Thanks for your help, if possible.
Thanks for contacting us. From what I understand, I would expect that if you are French residents and retired, your carte vitales would be valid indefinitely. But as I am not an expert in this matter, I would advise you to contact your local French health care and social security (CPAM) office.
I have also been in touch with my colleague Joanna in France to see if she knows more, but she just has the following to say:
"I don't know for sure, but I had thought that if you stop a business in France, then you lose your carte vitale. However, I don't know how it works when you retire. I believe retired people are eligible, as long as they meet the regulations... which have recently changed. Trouble is, they keep changing the rules on this one...but I am sure you will be eligible for one as you have been in France a while and been working... so I should have thought that normal retirement rules apply."
I am sorry we cannot be of more help.
Further to the above, my colleague has received some information which may be of use to you, sent in from a friend:
"Not sure how it works with a business but whilst you are working you contribute to the system for medical services via ASSAF (I think) then top up with insurance. When you reach retirement age (65 years) a letter from Pension department in England is required. Then there are no more contributions to be made just the normal insurance top up. You keep the same carte vitale."
A visitor to the site has kindly provided the following information:
Once 65, make sure your CPAM account has been modified to show you are covered by the English system - check with the English Speaking service. (The paperwork to be presented to CPAM is a frustrating replica of the things they already have from the first application!) Write to and phone URSSAF and tell them that you have been included in the UK system and no longer have to pay. Write to your bank cancelling the direct debit to URSSAF. It took me the best part of six months to get the ducks in a row, but I got full reimbursement of overpaid charges. Check with your top up insurance to make sure they don't have to change any details. Make sure that if you have any dependents they have been included by the UK system with you as the principal. (Our situation was complicated by the fact that I was the principal and my husband the benificiary until he reached 65 when it all swopped over.) Wait at least a year for an EHIC card from the UK - they have a massive backlog. They will issue you with a document if you are abroad (from France) and need medical help in the meantime - you need your NI number to hand.
Hello - I have read your page on health care in France and have a question which hasn't been answered.
We have been in France for 20 months and each have a carte vitale on the strength of my husband's E106 but these are due to run out at the end of this year. I started an "auto entreprise" on the 1st Dec and assumed that when I make any money and pay my 20-odd % "cotisations sociales" this would entitle us to keep our cartes vitales on the strength of my earnings.
I have just been to CPAM and been told that we won't be covered after the end of the year and I have to contribute to a mutuelle, but that is not what the auto entrepreneur information says. How do I keep my carte vitale (or other form of health cover) and if I don't earn anything and therefore don't pay anything, do I still get health cover? If not, what do I have to do to make sure that I and my husband have adequate health cover.
I have a friend who told me that auto entreprise didn't entitle me to a carte vitale but that isn't my understanding of the situation. The problem is that I can't find anybody to give me a definitive answer!
I hope you can help. If you can't answer the question directly, please can you advise me where to go to get the whole thing explained.
Thanks for contacting us. I have been in touch with my colleague who lives in France and she has the following to say:
"This sounds so typical of any new system here in France... nobody knows how it is going to actually work, let alone the French authorities! I would have thought that the carte vitale would come along with the auto enterprise, but as you say, if you haven't declared any earnings or paid any cotisations I have no idea what will happen. The system is so new, I don't think the authorities have worked it out at all yet.
Perhaps the best placed to advise would be your insurance company who should know what you will need, as presumably you have taken out top up cover to complement your existing carte vitale.
CPAM are notoriously confusing. We didn't understand our position here in France until we went to the insurers after registering our business.
The other person who may be able to explain things is your doctor in France, ours is very helpful in all these aspects."
I myself am under the impression that as long as you earn some money within a twelve month period, under the auto entrepreneur scheme you would be entitled to a carte vitale, but you would still need to supplement this with top up cover or mutuelle, as you need to do anyway with cartes vitales. If you didn't earn money within this period, you wouldn't be entitled to health care in France, via this scheme.
I'm sorry we cannot be of more help, but perhaps your insurance company and/or your doctor may be able to help, as my colleague suggests?
The visitor to our site who asked the above question has very kindly provided us with an update:
It is the RSI (Régime Sociale des Indépendants) who deal with the carte vitale for auto entrepreneurs. You pay your social contributions for the "régime obligatoire" to a mutuelle who then pay the RSI and that's how you get your carte vitale. CPAM are only for salaried people.
I spoke to a very helpful man in our local Secu office who gave me a local (Carcassonne) address for RSI which turned out to be the office of Aude Mutuelle (AM). However, they sorted me out.
When you sign up as an auto entrepreneur online, there is a drop-down list of mutuelles from which to choose. The one you choose is then your "regime obligatoire" organisation but it seems that it takes up to three months for them to register you with the RSI and get in touch. Unfortunately, I just chose the first one on the list which was RAM and their nearest office is in Montpellier, which is not very close to me. Because I opted for them I have to use them for the first year but after that I can change to AM who are more local for me. If you want to change, you have to give three months notice so AM said they will be in touch in September. However, you don't have to use the same mutuelle for the "regime complementaire" so I signed up with them for that.
Because I pointed out that my carte vitale was about to run out, they directed me to the RSI office in Carcassonne who were also very helpful and (having also said it takes up to three months for the mutuelle you choose to do the necessary) said they would relaunch my RAM dossier and in the meantime I should simply keep any "feuille de soins" and reclaim any costs once RAM have updated my carte vitale.
In a nutshell, if like me you feel your French is good enough for face to face but not over the telephone, I think it's worth doing a "dummy" sign-up to get the list of "official" mutuelles you'll be offered when you sign up, then find out where they have offices so that you can pick a local one (the RO contributions are the same whichever one you choose). Above all, be aware that it takes up to three months to get your carte vitale in order when you sign up as an auto entrepreneur.
Hello, I wonder if you can advise. My husband and I moved to France earlier this year 2010 at which time our son, Joe, was at university in the UK. He has been studying languages and has been lucky enough to get a job in the tourism industry in France starting in December (difficult to get a job in the UK at the moment). Until then he is staying with us. We are informed by the relevant authorities in Newcastle On Tyne that he is not entitled to any health care in France as he has not paid any NI contributions yet only just having completed his full-time education. There is a gap where he has no carte vitale until he starts work here. Can he apply for his carte vitale before he starts work in France, how soon after starting work will he be issued with a CV and will he have to apply or does it happen automatically? All the advice I've read seems to apply to people in the process of retiring or who have previously worked in the UK and are entitled to E106/S1. He will be working for French company in a ski resort and will of course want to be covered medically as soon as possible. Thank you very much in anticipation.
Thanks for contacting us. I have asked my colleague Joanna in France about your son's situation and am still awaiting a reply, but in the meantime a few thoughts occur to me:
1. If your son is still a UK resident, is he not eligible for an EHIC, which would cover a certain amount of French state health care? A top-up policy would also be needed though. (https://www.ehic.org.uk/Internet/home.do)
2. If not eligible for an EHIC or any other E form due to him not having paid any NI contributions, then private medical insurance or travel insurance would be the only options I can think of which would cover him until he can get his CV.
3. I understand that he can apply for a CV through the French company he is working for once he has worked 40 hours in a month for them. This should be done by them, though it would be perhaps sensible for him to make sure it is applied for and received.
I am sorry I am not able to help further, but should my colleague be able to offer any additional advice, I will of course be in touch.
I'm not sure if you can help me but I'm currently living and working in France and I have a valid carte vitale. I was just wondering if this card covers normal visits to the dentist as well as any work that might have to be done when you are there (cavities, cleaning ect.) without another type of insurance.
Thanks for contacting us. I have been in touch with my colleague in France who says:
"We have been told that the carte vitale covers the usual percentage of the fee, and the mutuelle top up is needed for the rest. I imagine if you don't have a mutuelle, you can just pay the difference."
I would also say that I understand that it very much depends on what work is being done. If it is standard treatment as you describe, I believe 70% of the cost would normally be covered, but if it is specialist treatment then sometimes none of this is covered. You would need to check with your dentist I think, if you think you might need any more extensive work done.
My husband and I applied for cartes vitales on 7/12/10 when we took all paperwork to a CPAM office and were assured everything was ok. We received on 26/1/11 an attestation because they said there was a problem with the fabrication of the cards. I have now been asked for certified translations of our birth certificates. Two friends that I spoke to were not asked for this. What are the rules on this? We are both British. Hoping you can be of help.
Thanks for contacting us. I have been in contact with my colleague Joanna in France who says:
"This seems to be a new thing. I know a lot of folk who have been asked for certified translations for various things like birth certificates, that never used to be needed. I would try to get away without getting it certified and supply an ordinary translation, but if you have to do it, I'm afraid you will have to accept it and provide one."
Sorry if this was not the answer you were looking for, but good luck with sorting it all out.
Thanks for your response. I have since managed to find a telephone number for the CPAM advice line in English. The person was very helpful, unlike the local office, and assured me there was a free inhouse translation service. She is going to contact the local office and get back to me in under five days. The number is 0811363646 available 9-18.00 hrs.
I have lived with my husband and children for seven and a half years. We recently divorced, I am now living with my children. My ex husband worked and we had a carte vitale card etc and no worries. Now I have not worked here and need my own carte vitale soon. Would you know if I could actually get one, if so, who do I ask and how do I apply. The children are registered with me at the moment on the marital carte vitale which will cease one year after the divorce. Hope that all makes sense and I look forward to your reply.
Thanks for contacting us. I would suggest you contact your local French health care and social security (CPAM) office to find out how you go about getting a new carte vitale. I would think that as you have been a resident in France for more than five years, this shouldn't be a problem.
Hello - I am retired and have had a carte vital for five years. I recently married a retired Canadian who has no carte vitale. As a married couple can we claim using my carte?
Thanks for contacting us. I think that your husband will have to check with your local French health care and social security (CPAM) office, as to his eligibility to health care in France. Just because he is now married to you does not mean he is covered by your carte vitale automatically. Criteria have to be met and it is CPAM who makes these decisions.
Hi, I wonder if you could help me. We are thinking of coming to France for either a three month period or a longer term. We intend to keep our property in England and there are several health issues we have and wondered if you could advise where best we could turn for advice. There is an area or medical area which we need to address prior to our visit to France. My wife has Arthritis which needs to be monitored on a regular basis. She is only 58 and although she is retired now I believe does not qualify for free health care in France. Can you advise where we can go to get advice?
Thanks for contacting us. In the first instance, for temporary health care cover in France, I would suggest you look at the Department of Health's website about EHICs (http://www.dh.gov.uk/en/MediaCentre/Factsheets/DH_123856) and also the NHS website (http://www.nhs.uk/NHSEngland/Healthcareabroad/Pages/Healthcareabroad.aspx), which has a number to call if you would prefer to talk to someone about the cover provided.
If you are thinking of moving permanently to France, you may wish to also call an English speaking CPAM (French health care) service on +33 8 20 90 42 12 for advice.
And finally, you may also wish to read (if you haven't already), our article " Health care in France - another U-turn by Sarkozy" (http://www.frenchpropertylinks.com/essential/health-care-in-france.html), which outlines recent changes in the health care laws in France.
As a retired British couple currently living in South Africa, where we have remained for over 30 years, we are giving thought to re-locating to France. We both have UK Passports and receive part Retirement Pensions, and would welcome any advice regarding our eligibility for access to British National Health and other Social Security Benefits.
We would be most appreciative of any help you may provide in this regard.
Thanks for contacting us, though in your situation I would advise that you contact the Department for Work and Pensions (DWP) in the UK to find out exactly what you would be entitled to, and how you go about getting access to health care and other benefits in France. Their details are as follows:
International Pension Centre
Newcastle upon Tyne
Phone +44 191 218 7777 (Monday to Friday 8am-8pm)
Hi there - very interesting website. I am one of the early auto entrepreneurs now retired and having to go through the the re-application of my carte vitale. I am now 65 years of age and became an auto entrepreneur for around just under two years (July 2009 to Feb 2011 - I had a carte vitale at that stage as a UK pensioner). I was initially worried about rocking the boat re: this as the business was only to be a short term solution. I officially retired in February 2011 and although I have the carte vitale provided by the RSI until January of next year, I decided to pay a visit to CEPAM to see what the situation is. My French is not good - I have been told that I must fill in a form, take my birth, marriage and bank details to CEPAM and the form E121 or its equivalent. Surely I do not have to go back to Newcastle again for this form as I have already been through the process. I have lived in France since the end of 2003 and been registered since the first month. I have paid all my taxes etc. to date. She also asked me if I had a French pension. Any help you can give me would be much appreciated.
Thanks for contacting us. It does seem odd for you to have to produce your E121/S1 form, having lived in France since 2003. Have you tried the English speaking CPAM (French health care) service on +33 8 20 90 42 12 for advice, if your French is limited?
You could also contact the following agents, who may be able to help, as I understand they know all about cartes vitales:
Claire Martinet or Frank Haloche
1 rue Louis Blériot (formerly 37 Rue Amiral Courbet)
Tel: 02 43 05 21 82
They speak excellent English and explain things clearly at all times and are very helpful. I wish you luck with sorting this out.
After I emailed you I found the telephone number of the CPAM English helpline. She said I had to re-apply formally and I needed the marriage and birth certificate, utility bill, application form filled in and E121 (I still have the original) and finally my bank details (which they already have,) so pensioner auto entrepreneurs who are already registered with CPAM, and are now with RSI or similar - have all this to go through again on "retirement" - she reckoned that I should get the new card in around three weeks. The worse thing about France is the amount of repetitive admin you have to go through to do simple things, no wonder they get snowed under - and of course the new laws relating to auto entrepreneurs have caused so much confusion - it was a simple idea but sadly nothing is simple in France. You see it everyday in the forums, eg: initially AE's were promised three years free from taxe professionelle providing they paid their tax up front as I did, but now everyone, myself included are getting bills for this tax and well within the time limit promised.
Hi, we lived full-time in France from 2004 till 2010, had cartes vitales etc. We had to return to UK for family reasons but now wish to consider returning to France permanently. Would we still be entitled to apply for cartes vitales and be covered as before?
Thanks for contacting us. I have been in touch with my colleague who says she can't see why you wouldn't be entitled to apply for a carte vitale again, but obviously according to existing rules and regulations.
We have been living in France for five years now and have cartes vitales. We are considering going back to the UK for a few months as we have sold our French property. As we are both in our fifties, what would happen to our membership of the French health care system if we wanted to return to live in France in the near future?
Thanks for contacting us. If you are returning to the UK for only a few months, our advice would be to keep your cartes vitales going and continue to pay your top-up policies/mutuelles. If treatment was needed however, this would mean you returning to France.
For further advice on continuing with mutuelles, perhaps you could contact the agents mentioned above.
Can you please help me if possible? We now live permanantly in France, I have not worked for 10 years due to a medical condition, but still receive a proportion of my salary via a permanent health insurance scheme, and still pay regular NHI contributions. If I get proof of these and took them into the CPAM office would I be considered for a carte vitale? Hope you can help with this.
Thanks for contacting us. Though I am afraid I cannot answer your question. Your best bet would be to contact your CPAM office and see what they say.
MY husband and myself have bought a house in Gourdon, France. It is in my maiden name of Cooper. We both have British Euro Passports as he has a father born in Northern Ireland and I was born in Stratford London, West Ham. We also have Australian passports. How do we get French health care in France? What would be the procedures? We are both pensionable age (69 & 72) and receive a small part pension from the Australian Government. Can you help?
Thanks for contacting us. I am unsure as to all your details, but if you are wanting French health care I would assume you will be living in France full-time. If so, and you are becoming French residents, I would think health care should not be a problem. But whatever your circumstances, I would suggest you contact your local French health care and social security (CPAM) office. They would be able to give you accurate advice and advise you of the procedures to follow, or if you are in Australia then perhaps ask the French Embassy there.
I have just set up as an auto-entrepreneur and am applying for my carte vitale as part of my tax-paying status. However, I also am paying taxes in England as well. Am I entitled to health care in both countries?
Thanks for contacting us. My colleague Joanna says:
"I don't think you should be paying taxes in both countries, what with the existing tax treaty etc. You only pay taxes to your main country of residence. I would query this with your tax office. And with regards to health care, I guess you would probably get away with getting it in the UK if you haven't de-registered, but this would obviously stop once you get your carte vitale."
Where can I find a list of local doctors?
Thanks for contacting us. My colleague Joanna says that Pages Jaunes would be the best bet, available online, under Medicins traitant she thinks. You could also ask at the Mairie, though most people find a doctor after speaking to other local people or ex-pats.
I have read all the above and several more sites that talk about how the health service works. But how exactly do you get the the carte vitale in the first place please? We have been in France since February 2012 having bought a house and gite and have managed to get the temporary numbers from CPAM thanks to a social worker when I was hospitalised. We have now chosen our doctor and the relevant forms have been obtained, signed and stamped by said Dr. But how do we get the full carte vitale, who do we ask or what dept do we go to or what other forms do we need and where do we obtain them? This sounds like a simple system until you are here and just don't understand it. Please help with simple as possible answers for me please.
Thanks for contacting us. I have been in touch with my colleague Joanna, who says that her doctor advised her on how to apply for the carte vitale. So I would suggest you ask your doctor how to go about it. Or surely your local French health care and social security (CPAM) office can advise?
Hello, I have been researching health care & other issues in preparation for long term living in France. My dilemma is that I had travel insurance, as still permanent resident in UK, and was involved in a car accident last June requiring surgery. My concern now is, as insurance have not re-imbursed me (accident after 30 days, my fault for not checking duration of individual of cover within multi-trip annual cover), what extent the bill could be for the surgery. I have paid for all other treatment as it occurred. With this in mind what do I need to apply for if I am not entitled to a Carte Vitale as I am not currently working? Thank you for your guidance.
Thanks for contacting us. I would think that you might have to pay for private medical insurance, or just pay your bills privately, but I would suggest you contact the agents, Schreinemachers, who are always very helpful with all kinds of issues:
Alternatively, if you have worked in the past and have paid National Insurance, you could contact 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. They should be able to tell you what you would need to apply for.
Or indeed an English speaking CPAM (French health care) service on +33 8 20 90 42 12. There is also a website and helpline for France's centre for European and International Liaisons for Social Security, or CLEISS (http://www.cleiss.fr/, tel: +33 1 45 26 33 41).
I have been trying for almost a year to get my card. I have registered as an auto entrepreneur and am getting nowhere with RSI. I have sent all the certificates that they want and the translations of them. Now they say that they can't read the signature on my birth certificate and I need to have my birth verified. I told them that it has been accepted by all who have needed it in the past. Today I got an email advising me that any bills I get can be sent to RAM. I have lived here permanently since September 2011, am of UK retirement age but hope to eventually earn some money here. I do not draw my pension from the UK, choosing to let it accrue to next year when I am 65. I'm told by the UK that I can't have the S1 form as I am not taking my pension. Can I use my European card still and for how long? Can I get an S1 form? What do I do next to get a carte? I do hope you can help.
Thanks for contacting us. This sounds very confusing. Perhaps, as above, you could contact an English speaking CPAM (French health care) service on +33 8 20 90 42 12 for advice. There is also a website and helpline for France's centre for European and International Liaisons for Social Security, or CLEISS (http://www.cleiss.fr/, tel: +33 1 45 26 33 41).
Or maybe the agents, Schreinemachers, might be able to advise, or at least point you in the right direction. They are always very helpful with all kinds of issues:
While waiting for our first cartes vitales we were given an attestation by CPAM. I was recently attacked and bitten by a dog and needed emergency treatment including an ambulance. The duty doctor told me that I was not insured as my attestation had expired (lasted only for six months). Luckily I had 60 Euros cash to pay the doctor's fee. I was pretty distressed anyway and was shocked to be told I was not insured. The doctor refused to give me an expense claim form. I had already contacted CPAM a couple of times for advice on progress and they told me not to worry as the cards would be delivered within two to six months ie: within the period of the first attestation. However it has now been nine months. I have sent them two faxes since the emergency but had no response. What will happen if there is a major emergency and we cannot pay? I cannot call into my local CPAM office until the end of January as I am travelling. Is there anything else we can do?
Thanks for contacting us, though I am afraid I cannot be of much help. My colleague Joanna says that she thinks this is quite a common problem and that going to see CPAM in person usually sorts it. If you can't do this as you say until the end of January, a phone call might help, they can too easily ignore faxes. We are not sure why you were not given a claim form by the doctor who sorted your dog bite though, this would normally be given.
In the meantime I would certainly keep all bills you have paid, and if you are very uncertain of being able to pay with a major emergency, perhaps you should consider temporary private medical insurance?
Thanks for reply. Sensible thing for CPAM to do would be to issue the attestation for a longer period eg: one year and be realistic about how long they will take. The reason they gave for delays before was that they had to translate the S1 through the formal govt. translation service. Again it would be sensible to use bilingual forms for bilateral arrangements.
Regarding the doctor, I suspect her reason was financial - she wanted to charge the higher fee (private). I presume she could not do this if she went for the claim option. Not nice for the victim. I am sure we will have no problems with our own GP but it is the emergency situation which worries us. We do have travel insurance and our EHIC cards (excludes home country). Our only problem is if we have an emergency at home in France which is of course all wrong.
I will let you know the outcome around the end of January. There might be some useful advice for others.
I'm planning to move to France soon, to look for work. I take medication for a kidney transplant and liver health. I will need a repeat prescription if I run out of medication. How long does it take to get a carte vitale, if I need it to get a repeat prescription?
Thanks for contacting us. I have been in touch with my colleague who says that from her experiences, getting a carte vitale can vary from place to place, and from person to person, so there is no way in knowing how long this will take. It is often at least a few months though. (If you get a job, your employer is supposed to apply for this for you.)
So she advises you to get as long a prescription as possible from the UK, and get as much information from your UK doctor as you can, about what you can do in France, should you need a repeat prescription. Once you are in France you could perhaps ask a French doctor how to speed the process up, and also contact your local (or the nearest) French health care and social security (CPAM) office for advice, as soon as you arrive. (You could also try contacting them from the UK, prior to your departure.)
But if you do need medication or need to see a doctor in France before your carte vitale comes through, make sure you obtain a form called "feuille de soins", which is what you will need to submit in order to be reimbursed, once you have your carte vitale.
I am sorry we cannot be of more help.
Hi - my soon to be husband works in Toulouse as an aircraft contractor. After we get married my son and I are hoping to live there for twelve months. The only problem is I have just started a new and very expensive drug called humira for my arthritis and severe psoriasis I'm just wondering how I would go about making sure I can still receive the same drugs there, as it was quite hard to get the treatment itself in the UK. I would be grateful for any advice. Oh, I don't get the treatment from my GP it's directly from my dermatologist.
Thanks for contacting us, though I'm afraid I cannot help you with this, as each individual case is different. I would suggest you ask your dermatologist how you can receive these drugs in France. If they don't know, perhaps you could check with your GP here in the UK, or the Department of Health, or better still, contact your husband to be's local French health care and social security (CPAM) office in Toulouse.
On arrival in France (Jan 2013), we visited the local CPAM office with our S1 forms covering us for two years and all the necessary papers. They were sent away - we were not given an attestation or a provisional social security number, however I chose to trust the system. We have heard nothing, not even an acknowledgement. In the meantime we are both set up as auto entrepreneurs and have just received a social security number from URSAAF. My question is - are we still covered by our S1 or has our registration as auto entrepreneur usurped this? Should we still expect our carte vitale from CPAM? Or will URSAAF deal with it? If so do we need to contact them with papers etc? We no longer have the S1 forms as CPAM insisted on taking the originals - but I do have copies. I have heard that if we are covered by an S1 we will not necessarily receive a carte vitale - if this is true? How does this work in practice?
Thanks for contacting. I am afraid I cannot answer your questions as cases seem to differ all the time, but I have been in contact with my colleague Joanna, who used to live in France, who says:
"I would advise you to go to URSSAF if you are registered as self employed. You may have to do a lot of legwork, nothing comes easy in France when it comes to the system. If you have a helpful doctor he might advise, but there's never a straightforward answer. I remember chasing all over to sort our health care, being sent from pillar to post."
I'm sorry not to be of more help.
Should anyone reading this be able to offer advice, please do get in touch.
I am 53 years old and looking to move to France with my early retired husband who is 63, who had an heart attach 10 years ago. This is why the early retirement with a private pension at the moment. How would we fair with health cover or where do we start to find out how to be fully covered while living in France?
Thanks for contacting us. I understand some cover is now given to ex-pats, depending on individual circumstances, for those who have retired and are living in France before state retirement age. But there will still undoubtedly be private cover you will also need.
As mentioned in the above article, to clarify your position, I would suggest you speak to a French health care and social security (CPAM) office, preferably one local to where you will be living. If you don't yet know where you will be living, you can call an English speaking CPAM (French health care) service on +33 8 20 90 42 12 for their advice. There is also a website and helpline for France's centre for European and International Liaisons for Social Security, or CLEISS (http://www.cleiss.fr/, tel: +33 1 45 26 33 41).
I have just been told to get an extension on my S1 as it runs out in three weeks. I am due to have an operation on my arm in the next six weeks. What if the paperwork has not been sorted by then or I am unable to get an extension? I have no money or work. I care for a disabled gentleman in return for food money. What should I do? I have lived in France since September 2012. Thank you for any advice.
Thanks for contacting us. I'm afraid I can only suggest you contact your local CPAM office and the DWP in the UK to find out what you do in your situation.
I am 76 years old and my wife is 71, we are thinking of moving to France. Do we both need "top-up" health insurance, or is there another way to pay for the extra 30% not covered by the CMU?
Thanks for contacting us. I understand that unless you or your wife has a major illness or you would both be on a low income and so able to claim CMU Protection Complémentaire (CMU?C), then top-up health insurance would be necessary. (Though if you would be on a modest income, you may be able to get help with this top-up health policy.) Perhaps it would be worth contacting the DWP for further information about the procedure involved and what you would be entitled to in France:
Department for Work and Pensions
Telephone: 0191 21 87777
Or you could try the English speaking CPAM help line 0033 (0)8 20 90 42 12.
We've owned our house here in France for eleven years and in October 2010 decided to move over here to renovate it and live off our savings. We still kept a house in the UK but in August of last year sold it. Having no UK address anymore. In November of last year we employed a translator who used to work for the French Civil Service to help us with obtaining the Care Vitale, so we filled out all the forms and provided all the paperwork to be told that we need to show proof of income for 2012 only, we were renting our UK property so I got copies of my UK bank statements showing the rental income. Our translator made an appointment with the CPAM and we went armed with this info to be greeted with a shrug and told we need an S1 form. I duly went away and called Works and Pensions in the UK to finally be told that we are no longer entitled to UK health care contributions, since Aug 2013. They provided a letter to state this, so we had another apt with the CPAM who then asked if we'd lived here for over five years. When we said no he then said that we would have to apply for the Carte Vitale, it may cost money and the application would have to go to Paris to be approved and he didn't know how long this would take.
I can't believe that we can just be left in limbo with no cover even though we are EU citizens. I have a form of Diabetes for which I need medication to live. We still have EHIC cards which don't expire til 2017 are we still covered? Are there any other ways to get interim cover apart from private healthcare which we can't afford? It seems we are told many different things by lots of different people!
Thanks for contacting us. I would think that if you have a valid EHIC card this should suffice until you have lived in France for five years, which would take you to 2015, though I did think your main residence would still have to be in the UK, which in your case it obviously isn't. So as I am no expert in these matters, I would suggest you contact the English speaking CPAM help line 0033 (0)8 20 90 42 12 for advice about your options. The worst thing to happen would be if you suddenly needed cover, only to find you didn't have any.
Hi - my husband aged 55 and myself aged 53 have decided to move to France. We will keep a property in England that my husband's son will live in. In France neither of us will work and we will live off our savings. What type of medical insurance will we require? I have tried to read up on this but have found that it has confused me and now I don't know what we are meant to do.
Thanks for contacting us. Health rules seem to change constantly, though the above article does cover what currently happens. It says that 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 S1 Form. 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 you get lasts up to two years or so, though this time limit does vary, depending on the amount of NI contributions made to date. This will cover up to 70% of health care costs, the remainder can be paid with a top up policy. Then as of 2007, once your cover under your S1 Form runs out, until you have been in France for a full five years, you will need to pay for private health care. But once a French resident, and having lived in France for an uninterrupted period of five years or more, you will be entitled to affiliate to CPAM, have a carte vitale and thus health care.
I would strongly suggest you contact the DWP to confirm your eligibility before leaving the UK, as there is also talk of the S1 entitlement being withdrawn for early retirees this year.
Hi - my husband and I are planning to go to France in October 2014 to live for a period of up to twelve months. We aim to rent a property or properties (probably initially a holiday one) and have sufficient cash saved up to cover our costs of living etc. I contacted the DWP/Pension Service to establish if we needed what was the S1 form and have been advised that the form S1 is for individuals who are working in another EU country and have been issued with form A1 to remain UK insured. The document which may assist with healthcare in another EU country is SED S041. The S041 must be requested by the authorities of the EU country involved using the application form S040.
The alternative is to become privately insured abroad. Based on information I've read on the DWP website and comments in your article it seems that we may be covered by the EHIC if we are not residents. Are you able to comment on anyone with a similar scenario to us? We both work in the UK just now and have paid NI contributions. Thanks.
Thanks for contacting us. I would think that you would indeed be covered by the EHIC, so as mentioned above, would suggest you look online for information about this (www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/about-the-ehic.aspx), or call 0300 3301350. As we also say in our article, 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."
We are moving to our house in France at the end of August. I am a stay at home mum and have two children (aged three & one). My husband will continue to work in UK returning to France to work from home two days a week. Where do we stand in terms of applying for a carte vitale? We currently have EHIC cards for the whole family and a UK address, however we are aware that we will need top up insurance and that this will only be valid for a limited amount of time. Any advice greatly appreciated.
Thanks for contacting us. I understand that if you move to live in France before retirement age, you are entitled to affiliate to CPAM, have a carte vitale and thus health care once you have been living in France for an uninterrupted period of five years or more, and are French residents.
Though before you are eligible for this, 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 S1 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 you get 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. Once this runs out, if it cannot be renewed then you will need private health insurance, until you are able to affiliate to CPAM.
If your main residence will still be the UK, I understand you are covered by the EHIC until this runs out, when you will either need to renew it if possible, or pay for private health insurance.
But as I am no expert in these matters, perhaps it may be worth speaking to a French health care and social security (CPAM) office, preferably one local to where you will be living. Or you can call an English speaking CPAM (French health care) service on +33 8 20 90 42 12 for their advice. There is also a website and helpline for France's centre for European and International Liaisons for Social Security, or CLEISS (http://www.cleiss.fr/, tel: +33 1 45 26 33 41).
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