Epilepsy - medications and surgery

Hi, we have finally completed on our property in Brittany. Our plan is to move over gradually - 6 months Uk/France. This is to make sure our machinist is comfortable working on his own (we run our own business selling products online)
Our biggest worry is about our daughter. She is disabled and has daily epilepsy medication, emergency meds (for if she has a big seizure) and has a vns (pacemaker for her brain) The vns is checked regularly in the UK and the battery needs replacing every 5/6 years. Will we need to find a specialist top-up healthcare, or will she be covered under a carte vitale? She will be 16 when we move.
Many thanks,
Karen

1 Like

You need to look st the list of ALDs to see if her care will be covered 100% or whether you will require a top up insurance. The healthcare in France is excellent.

As a matter of interest David… will a youngster of 16 be taken immediately under the wing of CPAM (or whatever it is) or will there be a delay while the parents get their own situation sorted.???

You can’t be in two EU countries’ social security systems at the same time. Until you leave the UK and the NHS, the NHS remains responsible for your treatment throughout the EU, so treatment over here would be obtained either via an EHIC or some other EU arrangement. You can’t join CPAM and get a carte vitale while you are still entitled to NHS cover.
During the period you’re spending 6 months here and 6 months there, which country do you expect to be decided as your main country of residence? (You would need to look at the criteria for residence in France and take the UK statutory residence test, and take it from there. This will of course have implications on tax liability/business registration as well as healthcare.)

A good point. If it was me and considering the intention to make a slow move I would ask my current GP’s advice about care re moving to France as a family then one adult and the daughter returning to the UK ‘on holiday’ while the other adult sorts out the family healthcare in their ‘new’ country of residence. I realise it is probably entering grey areas but a situation like this is never going to be straightforward. The obvious solution would to be to get private health cover for the period covering the move to France but the cost of that might be prohibitive. One of my children has endured a lifetime of seizures but, thankfully, nothing as serious as this.

1 Like

Hmm. Not sure I would be happy with venturing into grey areas on healthcare in the OP’s position. EU policy on cross border healthcare is carefully designed and joined up to ensure that nobody falls through any gaps, but only if you do things by the rules. While the UK is still part of the EU I personally would prefer to consult with the authorities and do it properly so as to be safe, rather than trying to be clever and circumvent the rules and risk CPAM suddenly picking up on an irregularity and putting everything on hold until it’s sorted. It’s easy to come unstuck if you decide to do it your own way, e.g. if by “returning to the UK 'on holiday” you mean, officially leaving the UK and then going back as a visitor covered by a French-issued CEAM - won’t work because no way can anyone get a French CEAM before they’ve been accepted into the system. And since the OP is economically active, the correct route to healthcare in France would either be paying cotisations on professional income, which would involve registering with URSSAF, or possibly obtaining a workers S1 from the UK as a temporarily posted worker. Anything else would be irregular.

Sorry, I know, I’m dreadfully anal about these things, but I just prefer to know that everything has been done correctly and I won’t suddenly get a letter that will turn everything upside down.

Hi David, I’ve already researched and found there is a hospital and consultant in Rennes, who deals with the VNS. I’m just worried about paying for the care and replacement of it. How are your child’s seizures now? Was he/she in the French health system?

Hi Anna, we want to do this properly as we can’t risk not having cover, just in case.
I’m struggling to find my way around the health/employment systems as my French isn’t fantastic. We have our online business in the U.K., but will be able to conduct our business in France, whilst still purchasing parts from the UK and Germany. La Poste is pretty good as we post from France when we are there.
I’m not sure how we would go about transferring our pre-existing business to France.
Will our daughter be covered for care under our cover? Does this stop at 18? I’ve read that our daughter would get her healthcare covered due to her disabilities, but I’ve also seen that this may not be the case if she’s never paid into the French system or lives with us. Which of these is true? She’ll never work or live independently as she is only functioning as a toddler, is blind, has cerebral palsy and is ft wheelchair user (can’t self propel)
Sorry for all of the questions but it’s getting harder and harder to get back on the ferry at roscoff as we don’t want to return to the uk anymore!

1 Like

Yes, up to 18 she can be covered through your entitlements, after 18 she must be covered in her own right, presumably on the basis of being a resident. You would need to talk to CPAM but PUMA is designed to ensure that everyone living legally in France has access to health cover, and I trust your daughter would not be excluded. I imagine there are special provisions for dependent adults living with you. But CPAM will explain. (I think you also get tax concessions for dependent adult family members.)

As French residents running an online business from home in France, you need a French business structure. You then pay cotisations into the French social security system based on your income, and this gives you access to healthcare via PUMA, and potentially other benefits. Aside from the benefits, it’s illegal to operate an unregistered business activity in France so you don’t actually have a choice. But exactly how you set that structure up, will depend on how the business operates. You mentioned your “machinist”, is this a UK employee. Is it a UK registered company, and are you and your OH “employed” by that company? If so it could simply be a case of your company registering you both with URSSAF as employees living in France.

It’s important to make an informed decision on choosing the right structure since this can greatly affect liabilities/profitabiity. If it’s complicated, it would be a good idea to either find an accountant who can advise, or go and chat to your local chamber of commerce. Since this is your route to your own healthcare and also your daughter’s, you’ll want to get it sorted out quickly I imagine so you can switch seamlessly from the NHS to PUMA.

Another thing to look into is, will she/you still be entitled to any support from the UK? Some disability benefits are exportable under EU law, some aren’t. The UK actually has a poor record of playing fair with this and you may have to fight for any rights EU law says you should have. But it’s worth looking into. It may of course change post Brexit, this is one of the details of TM’s generous and serious offer about Citizens Rights that she hasn’t seen fit to clarify yet AFAIK.

If that sounds like an option to be looked into, you’ll find it all explained here (in English)
https://www.urssaf.fr/portail/files/live/sites/urssaf/files/documents/Guide%20Firme%20étrangère%20E.pdf

We are registered as self employed in the UK. We have looked into registering as a Ltd company, but not sure if that will just make things more complicated when we make the move to France.
We are in the process of buying a property in the UK as a safety net in case we need to return. It will be rented out.
Our machinist is self employed and not our employee. There are a couple of guys we use in the UK. We will possibly return to the UK 3/4 times a year to pick up stock.
I understand that if you’re a retailer you pay a set amount of tax on turnover and that your costs aren’t taken into account. But we are happy with that as long as our daughter can receive the healthcare she needs.

My grey area suggestion was taking human factors into consideration. I presume that the current GP would be unhappy about a long term patient with very specific needs disappearing into a void that may take six months to sort out. The alternative would be to contact a French doctor asap to get his opinion.
My son lived in Germany and England, never in France. In his early twenties he has now gained enough confidence to have made the decision to work abroad (out of the EU) for a year.

OK. The simplest French “self employment”/small business regime is micro entreprise, which I guess is what you are thinking of when you say “pay tax on turnover” (although most of what you pay is cotisations not income tax) but that doesn’t sound suitable for you for several reasons. First, it is designed to be a one-person structure, and if there are two of you working together it loses some of its advantages. Secondly, turnover is quite limited. But thirdly, cotisations are based on turnover not profit, so it works best if your expenses/overheads are kept as low as possible. If you’re paying your machinist and possibly other guys too, and taking trips back to the UK to pick up stock, it sounds as if your outgoings are going to be pretty high. But you can do the sums easily enough Assuming your activity is classed as reselling rather than manufacture (ie you buy things in, add a markup and resell them, as opposed to buying in raw materials and transforming them into a product that you sell): Max turnover for resellers = 82 000€ (though Macron may increase this in the future). Cotisations for the “micro entrepreneur” on 82k @ approx 14.2% = approx 11 500, plus CFE after the first year, leaves approx 70 000. Less cotisations for the “conjoint collaborateur”, which will depend on which option you take but say around 4k, leaves 66k-ish. How much will you pay out for stock, to your machinist and the “other guys”, on travel, shipping, warehousing, marketing etc? Maybe it will work but I would have thought there must be a better solution.

We are currently running it as 2 businesses - my husband deals with all website sales and queries.
My business is selling on ebay and Amazon. I was really struggling just being an unwaged carer for our daughter who needs constant care. My background is in accountancy and going from having a team of 8 to being home 24/7 hit my mental health. Now I have an income and responsibilities to my own customers, I’m finding life less difficult (though hard work!)
My husband and i used to manufacture all of our kits, but now buy from a couple of guys who manufacturer them. We do still package and finish them individually though.
My hubby is on target to take £70k+ and I’ll probably have £18k in year to 5/4/18

So what you’re saying is that you would each set up your own micro in France?
Of course you can do that, but you would need to be careful that your accounting is kept totally separate and the two activities don’t overlap at all, so that it can’t be regarded as a “joint” activity - ie different websites, different contact details, no common customers, no shared purchases, no shared expenses, preferably no overlap between the products you sell, etc. Two micro entreprises doing the same activity registered at the same address might attract attention, and if URSSAF or the fisc take the view that there is an ‘association’ between the two, they can requalify you as one business (with possible penalties). Discussed here
https://aide-creation-entreprise.info/Auto-entrepreneurs-associes
so you can decide for yourself whether you would be safe to do this, or whether it might be another of those “grey” areas.

Hi Anna, it does sound like we’ll need to run it as one business in France. There are kits I buy parts for and finish and others that hubby buys and puts together. But we sell both from our separate website and eBay/Amazon accounts.
It’s not a problem, but I hope they appreciate that I put in full time hours and not just a couple of hours a day.
Thank you so much for all of this help.
It’s all looking very positive :slight_smile:

One other thing to consider is that kids get their ‘own’ carte vitale in France at 16 NOT 18 although they are still covered by their parents and this cover can continue until they are 25. That’s the good news. The bad news is that despite being in the system for ten years, when my eldest hit 16, it took nearly two years for her carte vitale to arrive as the RSI demanded a translated birth certificate. I refused ( she was still covered via a paper ‘attestation’ ) because I am stroppy and pointed out that this was discrimination as French kids don’t have to re supply paperwork.
I got it in the end but if my daughter had had health problems it would have been really stressful. So just a heads up ! Hope you can make it work ! X

Up to the age of 18 a child is an ayant droit. Between 16 and 18 there are two possibilities, either they can set up their own account and get their own card and manage it all themselves (ayant droit autonome), or subject to certain conditions, they can continue to be covered on their parents’ card and their parents continue to deal with it for them; this would apply to a disabled child. After the age of 18 they are adults and can no longer be ayant droit. They apply for cover in their own right, and have their own account and their own card.

" toute personne majeure est assurée à titre individuel dès sa majorité (ou dès 16 ans à sa demande). "

In your situation I think it’s very important to talk to CPAM at an early stage and find out what support you/your daughter would be entitled to. Her disability would need to be assessed and depending on that, and on your own circumstances, CPAM will be able to work out what would be available. She may also qualify for support from AAH (Allocation aux adultes handicappés) after the age of 20. But it all depends on individual circumstances.

This certainly doesn’t apply to students though as mine are all still ayant droit, albeit with their own cards. There are also different rules for different ‘caisses’ just to make life even more interesting!

AFAIK the only adults who can be ayant droit now, are the ones who already had that status under CPAM prior to 2016, and who are allowed to stay as is under PUMA up to, I think, 2020. After that, they have to register in their own right too.

Under PUMA the cut off date, apart from as mentioned above, is 18 for everyone. Regardless of caisse, regardless of status, and including students. Honest. That’s the major change that was brought in with the introduction of PUMA. Apart from that, PUMA operates pretty much exactly as CMU used to.