Hello, coming very late to this thread and I know you had already answered queries from me on trail insurance in the past.
re : “S1 applicants would eventually be covered, but the claiming process is so tedious that we don’t want to sell a policy in such circumstances.” can you explain a bit more ? evens if very difficult to claim, I would be interested to know a bit more about(husband is with S1 from Ireland).
Thank you,
Dominique
Hi Dominique, basically if you have French social security through the S1 program you should not be covered for healtcare abroad (unlike the “native” French social security insurees). Because of that if you buy French travel insurance policy there is nothing to be “topped up” in case of a claim as the claim will be denied by French healthcare and the travel insurance provider will most likely deny the claim too. Instead you have to file the claim to the country of origin (who issued the S1), get a confirmation that they could have covered this (whatever they actually cover it or not) and then only you can be refunded. If you buy a travel insurance policy directly from a non French provider you won’t have this issue making the claim process a lot easier that’s why I often recommend buying foreign policies for S1 holders to make the claim process easier
Thanks for your reply; the problem as I see it is, the health care system in Ireland (not sure about the UK) is based on residency and not on contributions. Reimbursements of hospital costs outside of the EU is not possible within the Irish system and I would not know where and who to contact to get confirmation that these costs are not covered.
I have gone through a lot of travel insurance contracts and most do not actually specify that you need to be affiliated or covered by Sécurité Sociale in France.
Non French provider : is there anybody apart from Staysure ?
Dominique
Thanks but I think you need to be a US resident for Blue Cross as they ask for a zip code to get a quote and I cannot find anything on Mapei.
I wonder if this non cover for S1 holders by CPAM is actually legal, since you are supposed to enjoy the same level of cover for healthcare as French residents ?
Dominique
I’m going to hazard a guess that it is because the whole S1 construct is under an international agreement which sets out the responsibilities of each nation.
Outside France, French residents apply for a CEAM card which gives them cover in other EU countries equivalent to the cover given to residents of that country.
Holders of S1s issued by the UK apply for a GHIC card, which is the new name for what used to be the EHIC, the CEAM equivalent.
So whether you have a CEAM or a GHIC you have exactly the same cover, but GHIC cover is provided by the UK not by France.
I would have thought holders of S1s issued by Ireland would do the same since it is an EU-wide agreement. If Ireland is refusing to comply with the scheme then that is an issue.
But the fact that you are not entitled to Irish healthcare in Ireland, does not necessarily mean they will not issue you an EHIC. The UK healthcare system is also based primarily on residence but they comply with the S1/EHIC scheme. Have you applied?
My husband does have an S1 from Ireland; I am covered by the French system as I have a small pension in France. I claimed for some medical expenses incurred in Thailand and I was reimbursed by CPAM (based on what the costs would have been in France).
CPAM refused to reimburse my husband as they say he is actually affiliated to Ireland as a pensioner. CPAM advised me to claim from Ireland but Ireland does not reimburse medical costs outside of the EU (his European Health Card is issued by Ireland).
I think that the wording on our travel insurance policy with EuropAssistance is very misleading; their reply to my query on his cover was “La prestation “remboursement complémentaire des frais médicaux imprévus à l’étranger” de nos contrats fonctionne si l’assuré a ses droits ouverts et en cours de validité auprès d’un organisme primaire d’assurance maladie (sécurité sociale ou équivalent).
Selon le document fourni, votre mari ne bénéficie pas d’une couverture “sécurité sociale” ; notre prestation de remboursement des frais de santé ne peut donc pas fonctionner.”
Deepl translation :”The ‘additional reimbursement of unexpected medical expenses abroad’ benefit included in our policies applies if the insured person is entitled to and has valid cover with a primary health insurance provider (social security or equivalent).According to the document provided, your husband does not have ‘social security’ coverage; therefore, our healthcare reimbursement benefit cannot apply.”
My husband does have cover, it’s just that he is not affiliated to French Social Security.
I am going to pursue the matter and perhaps take it up with the ombudsman, whatever the equivalent is in France.
I am sure I won’t be the first person to try it ?
Dominique
Thanks; Europesure never came up in any of my Internet searches. It does look as if reimbursement of medical expenses does not depend on being affiliated to French Sécurité Sociale.
Have just read the whole thread from the beginning and now - finally - get it.
So basically Dominique’s husband is in the same position as Rachman (affiliated to the Sécu on the basis of an S1 with an EHIC issued by Ireland & Germany respectively).
Am still amazed the CPAM covered Thai medical costs for Dominique, though. I’d always assumed the CEAM only applied in Europe.
You can but it is a bit uncertain, as it is for medical costs for “soins urgents et imprévus”: some government websites use the term “inopinés”.
It has nothing to do with the European Health Card.
You are reimbursed on the basis of what it would have cost in France and then, if you have one, your mutuelle can reimburse the balance left over.
It is entirely up to the “médecin conseil” and there is no appeal if you disagree with the findings.
You can apply on line.
I am going to contact my insurers and point out that their T @ C do not specify you need to be affiliated to a health care programme in France; you do need a letter from somebody/agency to confirm that they will not reimburse the costs (in France, it would be CPAM).
In Ireland, with the way the HSE is structured and the fact that access to healthcare is on residency criteria, I don’t know who to contact to obtain such a letter (confirming that they will not pay the costs, so the insurance company can take over), but I am looking into it.
As I presume this will be of interest of participants on this website, I’ll keep you advised but I do not hold out much hope as I am sure somebody has tried before; also I might be dead by the time this is sorted out if it has to go through moderators and Europe
(look at UK and French inheritance laws and France forced heirship where the French government is simply ignoring the EU findings).
For Ireland, you could start with these people. I contacted them recently about getting confirmation that my husband is not entitled to an S1 from Ireland.
**
***: I HSE I Overseas Section (Institution ID.33) |1st Floor, Room 1 A I Stewart’s Hospital | Mill Lane I Palmerstown I Dublin 20 | D20 KH63 I Ireland.
Yes, good idea; this is the department I was thinking of contacting; I first need to find out exactly what documents my insurers need or will accept and get them to agree that my husband is indeed covered by social security, just no in France.
Hi, still battling with EuropAssistance; I did get this from that address :(overseas.medservices@hse.ie) ““Please we do EHIC refunds on medical expenses from this office, this scheme is for only medical expenses incurred in an E.U countries.
We do not do refund or claims on medical expenses from outside European Union””
I have sent it to the claims department of EuropAssistance along with a bunch of documents they requested, which I had already sent, but that’ s life.
I’ll let you know how I get on,
Dominique
