Good evening everyone.
My name is Tony MASON and I work for a well established independent insurance broker based in Bordeaux specializing in expat health care in France. I have been contacted by one of your members to see if I can help. All of the answers given so far are or have been correct but some rules and traps still apply. Please note that all translations of official French documents have been done for information only. If you wish to read the French document, it is visible on my website, see my personal info.
You will probably find this very boring but it is VERY important to understand what is going on.
Let’s start with a little history to explain how we all got into this mess,.
The CMU, (Couverture Maladie Universelle) originally put in place for the French population with limited resources. The CMU gave everyone access to minimum health cover via the CPAM (Caisse Primaire d'Assurance Maladie). The CMU made it possible for expats having lived in France for at least three months to get Social security cover and be legal in France.
In November 2007 the French CMU was taken away or refused from thousands of expats living in France. Many insurance companies took advantage of this wave of panic by proposing expensive “FULL COVER” private insurance policies replacing the R.O, (Régime Obligatoire (minimum state social health cover)) and possibly “Top-Up” depending on the level of cover chosen. Clearly this decision by the French government made the EU Commission react and on the 1st April 2008, the majority of expats where let back into CPAM or CMU.
However, not everyone was let back in and new rules were put in force:
1. If you were not in the French system on the 23rd November 2007.
2. Your S1/E106 or S1/E109 has run out and is not renewable.
3. You have not yet reached state of origins retirement age and have no other long-term benefit from the UK - S1/E121.
4. You are INACTIVE! Not working, nor do you have a student status.
5. You have not officially lived in France for 5 years.
If you did not comply with these rules then you were in “SITUATION IRREGULIERE” and were obliged to replace your R.O.
Undoubtedly, the best way to get your R.O back, was, and still is by working, either salaried or self-employed. Not everybody can or even wants to work having taken early retirement in France.
On another hand, some “Full Cover” private policies have proven to be less time consuming and even less expensive than the CMU for some that had larger incomes.
An example: About 215€/m for a couple of 55 years for 150% Hospitalisation NA cover (NA-Non Assujettis (special cover using the French “base de convention” recognized by the French system)).
The EU Commission and many expats still living in France without R.O cover were rejoiced last June when the CIRCULAIRE N°: DSS/DACI/2011/225 from the “Direction de la Sécurité Sociale” stated “…inactive residents habitually in France could be granted the CMU subject to a case by case examination”. This meant that expats that were expecting their S1E106 documents to expire on the 31/12/2011 or newcomers could gain or maintain their CPAM rights by moving onto the CMU.
At first, this was great news for hundreds of our clients all over France as it meant the nasty FULL COVER quote that we had sent then the week before could go in the bin.
Gradually, I realized that clients were coming back to me saying that CPAM had refused their CMU applications on the basis that they didn’t comply to the “5 year rule and that the foreseeable expiration of an S1E106 could not grant access to the CMU”.
Regrettably, a second text destined to the French CPAM officers in January reinforced these refusals by quoting other documents about habitual residency being 5 years.
There are still ways in to the French system on a “case by case” study but the majority have given up.
To be able to stay in France and even be considered by the CPAM or CMU, without valid S1 forms the new texts are clear:
“Inactive European citizens will have the right to stay in France for more than 3 months if they dispose, for themselves and for family members… …« sufficient resources as to not become a burden to the social system and have health insurance ». “ the text goes on to say “Their affiliation can also come from permanent French residency obtained after 5 years of stable and regular residence, or from particular situations for people affiliated before the 23rd November 2007. “
But! “2 – The rights to the CMU can be accorded, in certain situations, to an inactive European citizen that until now fulfill the regular stay conditions, before the 5 years of stable and regular residency. “
There is also a VERY IMPORTANT part regarding your choice of NA FULL COVER.
This will probably limit your choices to just a few companies but don’t worry, they are not the most expensive ones.
“1.3. – When the parties concerned claim to be in possession of private health cover, contracted in France or abroad. In this case, the medical acts must be verified to be « comparable » to the benefits offered by the French health and maternity insurance. The essential criterion to examine is that there must not be any health categories, products or benefits excluded from the policy…”
“It must be understood that « comparable » does not signify « identical », the CPAMs will appreciate with tolerance slight differences, the principle is to protect the persons themselves so that the medical acts is taken care of by the policy signed up and to avoid creating a load for the French public finances. “
Cover has to REPLACE the CPAM « TARIF DE CONVENTION ».
NO financial LIMITS. CPAM has an UNLIMITED % reimbursement basis.
NO CATEGORIES OF ILLNESS OR TREATMENT
NO RESTRICTIONS or EXCLUSIONS for existing Health problems.
« SITUATION IRREGULIERE ». Loss of future French Social advantages.
As you can see we are back to square one!
Everyone has different needs and different backgrounds. I hope this has helped and I promise that it is not a sales technique but you should never trust an insurance salesman!
If anyone needs help I am available and my help is FREE.
You will find my site details in my personal info. If you do make an enquiry please make sure that you say you heard about us from the SFN.