Sorry Catherine, my technical abilities are such that I'm still struggling with the dial telephone (the one with the holes and numbers)
I wonder if anyone knows if a resident but non-French pensioner is entitled to complete imbursement of health costs, or must still subscribe to a 'mutuelle'?.
I have lost track now, except that about 10 days ago I had my RAM Budget and they have reimbursed well over 20K as well, given the injury has made my income zilchish and I have paid just a couple of hundred in. Some of the specialists I have seen and treatments go at Ks a time, including brain scans that cost the best part of a K if you go privately. Most of it is the mutuelle because I pay for all the bits I am receiving and have even added for the new insurance year...
Can I check, it was really the mutuelle who coughed up 30Kplus? If that's the case I'm sold.
Steve
Again, with thanks to you both. They must have some algorithm that calculates the cost of 30% of the risk involved regarding the existing conditions. Hope fully not prohibitive.
Regarding the spectre with the scyth:
"There is good news yet to hear, and fine things to be seen, before we go to paradise by way of Kensal Green" if that is not a misquote. Can't remember whose it it. A bit trite but hopefully not patronising.
Emile, it's many years since I signed up with my mutuelle but looking back at the early documentation it is clear that I had to declare any existing illnesses. There's a clause in the agreement which says "Il bénéficie de la formule de rachat de l'état de santé comportant une majoration de cotisation" -- i.e. I paid a premium for them to cover existing illnesses. There's another clause which says that anything that is a result of an accident or illness dating from before I signed up and which I had forgotten to tell them about is not covered.
Mutuelles are private health insurances. The difference is that they don't pay for everything, only what isn't refunded by the state. The only way to find out how much they would charge you is to ask. I'm covered by April (www.april.fr) and I've been very satisfied. But there are many others out there.
Not to worry, the worst that can ever happen is the guy with the big sickle!
But yes, they take note of age and so on. Nonetheless, balance out a bankruptcy making bill and paying premiums and I know which one wins!
My fear was that mutuelle premiums would be based on existing conditions, as with private health insurances, and thus enormous premiums, 'though they must include 'advancing years increasing ills' in their calculation.
Hope all goes well Brian
Regards
Yes folk, here I am the living 2012 evidence of the value of mutuelles. Ambulances, operations, scans, x-rays, physiotherapy, several specialists and none of it cheap. I gave up counting somewhere between 30 and 40k and have lots left to go. Quite seriously, anybody who kidded themselves it will never happen should have their head tested. I had 63 years of almost nothing. Now I have had a broken shoulder treated, the possible cause of the 'seizure' being investigated by neurologists but now passing on to sleep specialists instead of epilepsy ones. In a few months I am probably going to be in the hands of a leading international shoulder specialist in Bordeaux and a team in Pau looking at sleep apnoea and epilepsy research who have a fairly high reputation beyond France. I have asked for none of this, I happen to live close enough to both for me to fall into their laps. Would I have this from the NHS? Did I resent paying the mutuelle. No and yes I did, but Freddy I am glad I do now.
Hi Terry,
Spot on, I just didn't clarify correctly when I said medication, I did mean everything to do with the permanent illness. I was just trying to point out that if you have an ALD it doesn't mean that all your other health care costs are covered 100%. Therefore, it is still important to have a mutuelle to cover the rest of your healthcare costs that are unrelated to your ALD.
Tracy, ALD (Affection de Longue Durée as I said above) covers everything to do with an illness or condition that the sécu accepts is chronic and long-lasting. The cover is not limited to medication. Only this month the sécu paid more than €4000 for my latest go-round with the vascular surgeon in a specialist clinic in Montpellier. That covered the surgeon, the anaesthetist, blood tests ... even the taxi that took me on the 380 km round trip to the clinic three times all told. The mutuelle paid only for the private room and I paid €3 for telephone calls!
But yes, I do need the mutuelle for everyday things not covered by the ALD. They picked up most of the bill for surgery to repair a quadriceps tendon I snapped a few years back after slipping on the steps of a Paris metro station. So like Andrew I also know from hard experience just how important it is to have a mutuelle. :-)
As far as I am aware if you are a pensioner you should have an e form that entitles you to re-reimbursement on the same basis as french residents. This means unless you have an ALD (don't know what is stands for but am under the impression it is a long running serious illness) then you will need a mutuelle to pay the balance of what is reimbursed. Even if you have an ALD, it is only the medication for the ALD that is reimbursed 100%, you still need the mutuelle for everyday stuff.
And for those who are unsure about what a mutuelle is or if you really need one, take a look at a real life example!
Emile, have a look at the Useful Links page http://www.survivefrance.com/page/useful-links where there's a long section on health cover including a detailed explanation of universal medical cover (CMU). It will all depend on your income. I have 100 per cent cover for some things known as ALDs (Affections Longue Durée) which covers long-term illnesses like heart problems and cancer, but for everything else I need a mutuelle to pay whatever the sécu doesn't. You will also find this has been discussed at length on the forum. Try doing a search, you should come up with something.