Not my Mum actually… I should have said “their Mum” is now out of hospital…
but thanks for the kind thought.
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Stella,
On healthcare costs I thought I’d seen something that limits the overall costs - having a look on:
Your hospital costs will be fully reimbursed if you are in one of the following situations:
- you are hospitalized for more than thirty consecutive days (your 100% coverage then begins on the thirty-first day);
There’s also a few others, e.g.:
- you are hospitalized for a therapeutic or diagnostic act with a coefficient greater than or equal to 60, or a rate equal to or greater than € 120 (measure introduced by Decree No. 2011-201 of February 21, 2011, applicable since 1 st March 2011); (who knows what that is)
Still, as you point out the first 20% could be very stiff - and there’s the 20 euro / day 600 / month - though I guess you get fed!
Good to think about. Partner has knee problems - will be getting some info on mutuelle top ups - and maybe the full cover till the S1 turns up.
There is a lot written… and a lot of it is good… the problem arises when an incident occurs which needs care outside that which is written about…
I have quoted from a case which happened this year. It was a horrific, unforeseen incident which had very serious, complex and long term medical/rehabilitation needs… still ongoing.
Which is why it was deemed cheaper to get their Mum back to the UK and get it all done and dusted for free.
In your first example the hospital costs over 30 days being free, that is just the hospital costs ie the forfait journalier of 20€, not the rest!
For urgent and emergency surgery then in general if you are in a public hospital you pay very little, if anything. However for elective or semi-elective surgery it can be very different. Say you need a heart valve replaced and prefer to go to a specialised clinic with a team that does this operation hundreds of times a year. Well the surgeon and anaesthetist may well charge a significant amount more than the social security rate - which is their right - and you can also pay for everything else, down to an extra bandage. It is common for people to tell me their mutuelle has paid 10,000€ or more. (Which is why I have hospital cover)
This is some prices for abdominal surgery at private clinic in Lyon
Chirurgie de la paroi abdominale :
255.37€ à 1065.48€
-Chirurgie de la vésicule et des voies
biliaires : 318.40€ à 3465.56€ -Chirurgie de l’estomac et duodénum :
291.49€ à 3515.65€
-Chirurgie du foie : 462.79€ à 4727.47€ -Chirurgie du pancréas : 481.62€ à
5222.57€
-Chirurgie du colon et rectum : 335.44€ à
5201.05€
-Chirurgie de l’œsophage : 269.07€ à
5774.13€
not to mention the cost of the medications to follow… as well as any nursing visits to maintain dressings etc…
And the nurse’s visits, and physio…
A little update -
phoned HMRC again, 20 days almost up. S1 not issued - have put me down as working in france at weekends! Even though box asking do you work in 2 countries says ‘No’. Said they’d sent a letter here on the 30th November saying French authorities have to decide which country responsible for health cover.
I’ve been ‘referred’ - to expect a call in 48 hours (or maybe next week)
*Fabien & co have been contacted for private health cover. Though HMRC saying the date on theS1 will still be as the original application. *
Sigh…
I would set up as many ducks on your wall as you can on this.
An ex colleague of mine is now a frontalier worker living in France and
working across the Swiss border. Early in the pandemic we compared notes
and he was worried about losing his frontalier status because he had not
been able to spend sufficient time in CH. If I have the story right,
France and CH have agreed very precise conditions which transfrontaliers
have to meet in terms of hours spent working in CH. He was afraid that
because he had not been able to meet those conditions he would be obliged
to start paying contributions in France. However in view of the situation
France and CH temporarily revised the conditions and frontaliers were
allowed to maintain their status.
I do not know if there is any such agreement between France and UK.
However you may want to clarify the rules to confirm whether having the
intention on paper to be a cross border worker is sufficient, or whether
it is actual time spent in the country that counts. I know that for tax
residency issues, decisions are normally made on how many days you
actually spent in a country. I believe that in certain cases some
allowance is being made for time you were compelled to spend in a country
because of the pandemic even though you had no reason or desire to be
there. But I think you need to find out precisely what factors will be
taken into account. Cross border status is not a thing that is granted
once and for all, it is always conditional and normally it is reviewed
each year on the basis of how many working days you actually spent in each
country during the last tax year.
It has always been mysterious to me how hmrc makes dec cisions on s1. I have seen
people refused who on the face of it were clearly eligible and vice versa. But I
suppose hmrc has info that is not apparent o n the face of it.
Good luck with it all.
Thanks for the response Geoffrey. The other ducks lined up were private health insurances. What worried me was if no insurance was demonstrated what’s one’s position re. legal residence. So I looked further into the S1 worker legislation, and what is the exact nature of UK / France agreements.
The European directives on social security co-ordination are summarised here:
Which country you’re covered by depends on 2 factors :
- your work situation (employed, self-employed, unemployed, posted abroad, working across the border from where you live, and so on)
- your country of residence - not your nationality.
You may not choose which country you will be covered by.
When working or living abroad, you will have social security cover by either your home country or the host country . In either case, you’ll need to make arrangements to make sure you stay covered after you move to your new country.
I guess if France decides I am working in France – telecommuting, then I am covered by France from the date of theS1 application. (And have to set up my employer on URSAFF- they will not be happy with that!) But if France says the telecommuting is only temporary because of pandemic restrictions then they will say to UK the UK is responsible. Either way they sort it out. (Eventually). (Theory)
In EU guidance on implementing the WA,
EU guidance note
https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52020XC0520(05)
It states: Portable Documents issued before the end of the transition period will not automatically become invalid.
The basic principle is that these documents have just a declaratory nature. They do not, by themselves, create rights to the persons concerned. The rights themselves are created by the Agreement. That might suggest the fact I am insured by paying NI contributions / registering at URSAFF and having applied for a portable healthcare document is sufficient to be ‘legal’, by definition of the agreement?
France has indicated telecommuting restrictions are suspended at the moment: there’s plenty of sources here: e.g. French Embassy in London – in English
(March 2020) An increase in the amount of time spent on French territory due to more home working (usually restricted to 25%) will have no impact on social security cover: cross-border employees will continue to be covered by the social security system of the State in which they work.
Of course they talk of EU countries here but a presumption might be as it’s in English, it also applies UK…
Incidentally it refers specifically to the France / Swiss agreements you mentioned.
Another source is the Ameli website, again talks of EU/EEA/Suisse – has the no more than 25% work in France suspended until end June.
In France, frontier working seems to be overseen by Cleiss - la protection sociale dans un contexte de mobilité internationale.
FAQ’s
- I am employed or self-employed in the United Kingdom, I am insured under the British social security system and I reside in France. From January 1, 2021, will my health insurance situation change and if so, under what conditions?
Taking into account the provisions of the Withdrawal Agreement and (with unchanged situation) [at the same time], your health insurance coverage and the conditions under which you are insured do not change. You continue to benefit from the benefits under the same conditions as currently.
Compte tenu des dispositions prévues par l’accord de retrait et à situation inchangée, votre couverture d’assurance maladie et les conditions dans lesquelles vous êtes assuré ne changent pas.
If you have not already done so, you should apply for the portable document S1 “Enrollment for health insurance cover” from the UK Social Security Fund. This document will allow you to register with the French health insurance fund in your residence. The S1 form will be valid for the duration of your residence in France and will allow you to be covered under the same conditions as an insured under the French social security system.
Which is what I’ve done! (Incidentally the FAQ now also references the trade and cooperation agreement).
I phoned the English speaking CPAM helpline and a lady said I will be affiliated from the date on the S1 and any treatments eventually refunded. Also confirmed the EHIC is not valid (for my situation).
On whether to take out the private healthcare in the meantime, for the WA deadline, I found this post
https://www.thelocal.fr/20201207/the-documents-for-british-people-in-france-after-btexit
That post says when one comes to applying for the CdS simply download an attestation de droits from your account – it will be dated from the date you request it, and upload for the CdS.
That would imply it’s not necessary to have private cover in place before the WA deadline(or it might be necessary to have an assurance cover, but the powers that be aren’t going to require proof of it before WA deadline).
Of course I don’t know whether the local is a reliable source – but when searching I also read the large post
where they did post, as did you. Perhaps I should have added my post there, though I don’t actually have one yet. Clearly though persistence and not believing the officials is a key theme.
So following that further research I’m minded not to add the private insurance duck at least at the moment, continue to chase the S1 from HMRC – and that seems to need my raising a complaint now? – and in 2 months down the line if nothing resolved at least to make the CPAM / PUMA application on the basis of 3 months residence. In short an insurance for my current insurance not necessary.
Would be pleased to read any further comments you or anyone may have on my logic, thanks and regards Dave.
I cannot offer any more advice I am afraid other than to keep chasing HMRC hard. It is shocking that they have messed you about like this for so long. What would happen if you or your family needed medical care. This would be a great worry to me.
My understanding is that if your cross border working arrangements started during transition then under EU rules the UK must issue the S1, and it will remain valid for as long as those working arrangements remain in place. If you change to a different UK employer you would not get another S1 but any arrangements that were in force before the end of transition are protected. I think that is the same as what you said in your post.
In any case I do not see how you would be eligible to take the “inactif” route of applying for PUMA after three months residency, because you are not an inactif, you are an employee. Social security arrangements for workers are a separate thing from health cover for inactifs. If for whatever reason the UK did refuse to continue covering you, you would no longer be allowed to pay NICs in the UK and your employer would have to register you with URSSAF immediately. At present HMRC seems quite happy to keep taking your NICs but not give you your entitlements.
This is a story about a posted worker rather than a cross border worker but many years ago a friend of mine applied for an S1 to cover her on a six month secondment in Spain. She heard nothing back but assumed she would have been contacted if there was a problem and she did the entire secondment under the illusion that she would be covered by an S1 when HMRC caught up with their paperwork. A full 18 months later she received a letter from HMRC saying that her application had been refused and she must affiliate to the Spanish social security system immediately. This was more than a year after she had left Spain for good. HMRC have always been hopeless with S1s, I suppose they always regarded them as stupid European red tape.
Of course! - I’d need to provide the ‘no longer NHS covered’ document to the CPAM which would be totally contradicting the NI contributions. I was thinking of my pension income -but I’d still have to give 3 months notice to my employer.
Anyway, BTW, I followed your advice to chase hard and researched the complaints process. Called again (yesterday), same story, call handler will make a referral to the team, this time I said do you think I should now raise a tier 1 complaint - he said hold back, I’m emphasising you need calling. And today I got the call - the S1 guy simply asked are you are working exclusively in the UK, yes I am - I’m issuing your S1 now, will be in the post tomorrow, yes I’ll send it to France, allow 10-15 days.
So, many thanks for the encouragement - not breaking out the champagne yet, but I now seem to have a verbal decision from a named officer (he was happy to give me his name). Regards Dave.
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That is great! I’m so very pleased for you and might even pour a glass of bubbles myself when the S1 arrives (any excuse will do, but still…) so please let us know.
If it were me I would call again in a couple of days, do not make any reference at all to yesterday’s phone call but just say Could you confirm what stage my application is at please. And if they say the form has not been issued yet but will be very soon, you will know they are fobbing you off and you should start a complaint.
But hopefully the guy you spoke to has the personal authority to issue the form and will be as good as his word.
I can appreciate that (a bit like vet bills in the UK!)
We were quoted 1200€ a month for health insurance - I think I would rather risk it and keep a hefty credit card in reserve for emergencies.
@Saints60. Look at hospital only cover…my compromise solution. So far has saved us a few thousand, so emergency piggy bank filling up.
Blimey, that’s expensive… presumably for private health insurance, not a mutuelle…
Our mutuelle through @fabien with Swiss Life is around 150€/month for both of us (including hospital cover) so I would suggest you consult Fabien to get a more reasonable run-down on what your needs are and how much you can expect to pay.
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Sounds about right for full health coverage for a couple or family, especially if age or pre-existing conditions are in play.
Also about half what I was paying for a married couple in the US recently, just for context.
Hello all,
Pleased to report the S1 finally arrived yesterday (one each in fact). So all that champagne everyone’s had on hold - sante!
In case anyone is interested, the date near the (electronic) signature was the 6th January and the start date is 29 November last year. Considering Geoffreys’ advice above - @anon51582117 (btw, curious why your name changed to anon XXX ?) I held off on ringing back after a few days - I saw my address had been changed to France on the on-line tax account. So I thought, well stuff is happening. But by the 29th Jan I thought bugger this, called again, yes it has been issued but no problem we will resend. By Tuesday last week and nothing in the post box I called and the guy went through the different methods of getting something in the post, is my post secure etc - and said allow 15 days, and advised me to raise a complaint if nothing by next Tuesday - to initiate the QA process and check nothing has fallen through the gaps. And then it arrived! It was the resent one, the letter is dated 29 Jan.
The two previous letters - no sign. But now I wonder if they went to the UK address…
So now down to CPAM, and the CdS website - from what I’ve read we can upload the S1 scans and proceed (got everything else now including the house insurance and three rent receipts).
And the joy of now working out what mutuelles to go for…
And that’s another topic!
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This is correct, you upload it in the ‘proof of healthcare’ section and make a note in the comments saying you are in the process of applying to CPAM. Some prefectures will ask you to pass on your new ss number when they get around to processing your application. By this time you should have at least had your temporary SS number through.
So you are fine- you have until June 30 so another 4.5 months!
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Hi Dave
thanks for the referral to these posts - very helpful.
ill be making some calls today and ill keep you updated
have a great day