This is often the number one preoccupation for people moving to France on a permanent basis and how you enter the system and how much you do, or do not pay, all depends on your personal situation.
The process can be long and frustrating and you will need to be armed with reams of paperwork and a lot of patience, however once in the system you will find it is often rightly praised for the quality of the treatment and the level of accessibility it offers to patients.
We offer your registration in the system as part of our services and although we cannot guarantee to speed up the process, we can take away the stress from dealing with the administrative services.
Health care in France has a dual system of health insurance:
• A State controlled health insurance social security system called l’assurance maladie
• A separate voluntary health insurance system called assurance complémentaire provided through mutual organisations and private insurers (top up health insurance).
You cannot be legally resident in France without health cover even if you want to take the risk.
Today, France guarantees everybody an access into the state health system under the PUMA law (protection universelle de maladie). In order to apply you must be a legal resident in France which means:
European citizens need to have been resident in France for at least three months and only need to prove their residence with a property deed, utility bills or other evidence for a permanent residence.
Non-Europeans need to apply for a residence card (carte de séjour).
The different entrance doors into the French state health system:
If you are employed by a French company you will enter the main health insurance called the Régime Général.
If you are planning to run your own business you will enter the health care system for the self-employed called the Security Social des Indépendants (SSI) formerly known as the RSI which was separate until January 1st 2018 and is now attached to the Régime Genéral.
If you set up a business in France you and your family have automatic health cover.
A micro-entrepreneur has no minimum turnover requirements for the first two years but you need to be able to demonstrate, if requested, that you are engaged in trying to establish a business.
If you are retired and claim a state pension, your home country should edit a document called S1. The S1 form means that you will get access to health care in France on the same terms as French nationals, except that you will not need to pay French social security health contributions for the duration of the S1. Whilst the UK has voted in a referendum to leave the EU, the S1 arrangements remain in place until they actually do leave and those who have an S1 will continue to be able to use them after Brexit.
If you are an early retiree: Since 2015 early retirees from the UK are no longer eligible for an S1 certificate. You have the choice to make an application to (a) join the French health system and pay cotisations (b) take out a private health insurance or (c) set up a business.
What does it cost to be covered by the French state health system ?
Employees have social security contributions automatically deducted from their pay (generally around 24%)
People who are self-employed pay social security contributions based on their turn-over (micro-entreprise) or profits. (% depends on your activity)
If you are entitled to an S1 you pay no contributions.
In all other cases, you might have to pay contributions to the “PUMA” at the rate of 8% based on a part of your income (interests, dividends, rental income etc.).
Do you need top up health insurance?
The health service cover in France for routine treatment pays a percentage of your medical costs and the percentage level of reimbursement will vary depending on the type of treatment received and from whom.
Seeing a doctor and basic health care fees and reimbursement levels are fairly straightforward, but specialist services can get a little more complicated and expensive.
The social security system will normally pay for about 70% of official doctor fees and 65% of prescribed medication under condition that you have registered with a GP (déclaration de médecin traitant)
The level and scope of reimbursement depends on the type of treatment, the type of illness, your circumstances, and the cause of the illness.
If you want to be fully insured and have the majority of your fees and costs reimbursed, then you will need to take out a top-up health insurance.
Top up health insurance will pay most, but not all, of the residual costs of medical care, so you will still be left with a small amount to pay yourself. The amount will depend on your policy, your circumstances, and the nature of your treatment.
You need to determine the level of cover you seek and pay the appropriate premium.
Aquitaine Lifestyle Solutions work with an independent advisor who can give you several quotes from different insurers depending on your needs and circumstances.