French medical system
Sécurité Sociale ?
The Caisse Primaire d'Assurance Maladie refunds around 70% of medical expenses and largely less for dental, eyes and strong hospitalisation ...
An additional medical cover is advisable.
Having a E121 certificate automatically gives access to the Social Security and will issue a Carte vitale.
The card has no medical information on it.
It is important to keep the "Attestation Vitale" document on you in case medical staff, doctors, hospitals or clinics has to see it.
The Carte Vitale must be upgraded regulary especially if your situation changes . For example if you get married or are on maternity leave, long term illness ( ALD ) or if you move/relocate.
- Make sure you a have a reffering doctor (GP), if not the CPAM will charge you a penalty on each of your refund.
- Before dealing with a specialist or a surgeon, remember to ask him if he plans to charge extra fees not covered by CPAM's refund. And you must ask him if he has signed the "DPTAM" which allows your Mutuelle to refund more than the 200% limit !
European Medical card
- As an English resident visiting France, a French resident automaticaly get an access to any European health system. See more details from the famous angloinfo website.
How much will you be reimbursed by the Sécurité Sociale ?
It depends on:
- CPAM reimbursement rate, which refers to the cost of your consultation, treatment or service, determined by the Social Security system (Base de Remboursement de la Sécurité Sociale, BRSS).
- The repayment rate (taux de remboursement ) is also determined by the Sécurité Sociale and varies according to the type of care.
For example, you’ll be reimbursed 70% of the basic fee for a consultation, 65% for tablets with significant medical services.
Here is an example : Your Doctor charges € 40. Social Security reimbursement Rate (BRSS) for a GP consult is set at € 25.
CPAM will reimburse 70% of the standard fee which amounts to €25. The exceeding fee of €15 is not taken into consideration as well as the co-payment of €1 that will be deducted from your reimbursement.
CPAM repayment will be € 16.5 regarding the € 40 you paid....
A total of € 22.50 will stay at your charge….
Why a Mutuelle is advisable ?
If your top up insurance plan reimburses 150% of BRSS ( Base de Remboursement de la Sécurité Sociale )
Tables of benefits in France often present the reimbursement level as a percentage of BRSS ( Social security reimbursement rates ) .
If your top up covers your consultations up to 150% of BRSS which means that you will be reimbursed the standard fee charge multiplied by 150%, i.E. €25 x 1,5 = € 37,5.
CPAM will reimburse € 16.5 ( less €1 ) and your Mutuelle will cover the rest € 21. You will have to pay only €1 co-payment.
CPAM will always retain a fixed contribution €1
For example, your Mutuelle could reimburse up to € 500 per year for dental care .
You can choose your "cover level" depending on the amount of visits to specialists and for dental care or optical care.
Depending on how often you consult specialists and whether dental or optical care is important to you, it is crucial to choose a suitable cover level.
New : 100 % santé
If you have a top up, you can take benefit of new advantages applied since 01/01/2019
This concerns crowns, optics and earings.
If you choose a listed equipement, you will be fully reimbursed.
Waiting periods and exclusions
Mutuelle insurance providers might apply waiting periods during the first few months of your cover.
Depending on the insurer, you might not be covered at all during a certain duration or your cover could be limited.
You should carefully read the General Terms ( conditions générales ) .
No waiting period with Abeille assurances ....
Top up insurance usually covers all expenses reimbursed by the Social Sécurity.
Cosmetic surgery or thalassotherapy or Osteopath will usually not be covered. However, some Mutuelle insurers might extend their cover and offer to pay for certain procedures not reimbursed.
Be careful : A dental bridge is usually not considered as a medical treatment. CPAM and Mutuelle will not cover it !
Ao health questionnaire will not be requested when you apply for top up insurance.