The European Health Insurance Card (EHIC)
This replaces the former E111 document and is available from Post Offices and online via the DWP website and provides necessary treatment for those on temporary visits to other EU/EEA states and Switzerland. It does not mean that treatment and its costs are based on UK NHS practice, i.e. free at the point of delivery. Treatment received and its cost would be based as it would for any other French citizen, which in turn will mean a level of personal contribution from the patient.
French Health Insurance
Like other countries, France uses taxation to fund health care for residents but unlike Britain for example, France operates an insurance system. The system is complex with allowances that vary, depending on a person’s status, and procedures that can be overly bureaucratic, but with benefits that are outstanding in delivery and quality. This is a mixed system with the bulk of cover coming from State assurance, and top-up cover coming from mutuelles or private health care insurance companies. All medical facilities are part of the State system but the patient is free to choose their own doctors, dentists, specialists, medical facility or hospital. All residents in France are accordingly obliged by law to have health insurance. Most qualify for the state health insurance (sécurité sociale); in local terms, this means affiliating to the CPAM or Caisse Primaire d’Assurance Maladie. See:
- CPAM French Health Insurance Advice Line (English-speaking) open Monday to Friday 09:00-18:00: Tel: 0811 363 646
- Comprehensive information from CLEISS (Centre des Liasons Européennes et Internationales de Sécurité Sociale) website in English
- AMELI (Assurance Maladie en Ligne) website has clear information in English: www.ameli.fr/l-assurance-maladie/connaitre-l-assurance-maladie/getting-informed-about-health-insurance/index.php
The French Social Security system means that on average 70 percent of the cost of medical treatment will be reimbursed, although the exact figure received depends on the treatment needed and its costs; and the income of the patient. Expatriates who have come to live in France will need to prove their income level to the CPAM. This is most easily done with a French tax return. However because these tax returns are submitted one year in arrears (in February each year), those who have not declared themselves as tax residents need to show some other evidence of income. This can be non-French tax return, or evidence of income such as payslips, pension statements, or earnings from capital such as bank deposits, coupons from government bond holdings or share dividends.
Registration with CPAM via E106 and E121 (see below) does not come within the scope of the CMU legislation so no financial contribution is required apart from the inherent top up element that characterises the funding of healthcare in France.
Changes to the law in 2007 affected “inactif” people from EU member states who are about to become resident in France. An inactif person is one who is not engaged in economic activity on an employed or self-employed basis in France. They are classed as inactif regardless of whether they receive income from inside or outside France (from a pension, investments or other source).
Retirees – Form E121
EU expatriates resident in France qualify for retirement when they reach the retirement age as established in their home country (not at the retirement age set in France). Retired people receive benefits and pay nothing provided that they have a Form E121. This puts an expatriate in France onto exactly the same legal basis as a French national. E121 should be obtained from the former country of residence.
A UK National of state retirement age and in receipt of a state pension should obtain an E121 from the DWP in Newcastle-upon-Tyne. With this form registration with CPAM is allowed. In the case of a couple (including Common Law marriages) only one of the partners needs to fullfil this age and receipt of pension requirement for the other to be included. As with E106 (see below) both routine and emergency healthcare will be covered but again a contribution will be required either by payment direct or via a top up insurance policy.
Non-retirees – Form E106
EU expatriates below retirement age or who do not qualify for a state pension may be entitled to a Form E106. This may give full state cover, depending on the individual circumstances, but probably not for more than one to two years. After that, all entitlement to any State medical cover is lost until the qualifications above are met (official retirement date and receipt of a State pension).
Form E106 is defined as “A certificate concerning the right to receive sickness and maternity insurance benefits in the form of services by a person residing in a different country to the competent country”. It is issued by the health service of the country of residence and is issued to (for example) people working in France who have declared their place of residence in another country. It gives the holder the right to receive medical care on the same terms as a French citizen while also retaining the right to receive all types of medical care in their country of permanent residence.
If a UK National comes to live in France but is below the UK state retirement age then it is possible to obtain an E106 from the DWP in Newcastle-upon-Tyne. This form will entitle the holder to healthcare in France for a limited period. The actual length of time will depend on the amount of National Insurance contributions paid during his or her working career. However unlike the E111 it will be necessary to register with CPAM and this form should be produced along with other supporting documentation such as passport, proof of residence etc. Both routine and emergency healthcare will be covered but again a contribution will be required either by payment direct or via a top up insurance policy.
A English specialist in this field is Peter Owen of Expathealthdirect – 04 94 85 15 50