Inside

Health, Doctors, Hospitals and the Medical System in France

Find out what to expect from the French medical system if you're moving there to live and work or to retire. Understand how to register with the system and what to do in the event of an emergency.

All residents in France are 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 (Caisse Primaire d'Assurance Maladie). Those who do not qualify will have to take out private health insurance.

CPAM French Health Insurance Advice Line (English-speaking) open Monday to Friday 09:00-18:00
- Tel: 0811 363 646 (from France)
Comprehensive information from CLEISS (Centre des Liasons Européennes et Internationales de Sécurité Sociale) in English: Click here
Ameli (Assurance Maladie en Ligne) has clear information in English: Click here

Expatriates who have come to live in France need to prove their income to CPAM. This is most easily done with a French tax return. However these tax returns are submitted one year in arrears, in May each year, so those who have not declared themselves as tax residents need to show evidence of income. This can be another country's tax return, or evidence of income such as pay slips, pension statements, or earnings from capital such as bank deposits, coupons from government bond holdings or share dividends.

Joining French Social Security

Visit a local CPAM office - or arrange a meeting with a Social Security officer making a regular visit to the local Mairie - and ask for affiliation. Affiliation should then take place that day either as attestation provisiore if not all the documents are available, or as attestation d'affiliation.

Claims from that day forward are covered by CPAM to the percentage appropriate to the applicant's status.

The following may be needed when completing the form (declaration en vue de l'immatriculation d'un pensionné, ou de sa veuve, ou d'un orphelin):

Proof of identity: passport or Titre de Séjour
Details of place of birth (and for partner and children)
Proof of address in France with proof of ownership (deeds) or rental agreement
Date of permanent arrival in the departément
Proof of having lived in France for at least three months (three months' utility bills, rent statements, or mortgage payments or a notarised statement of home purchase)
Marriage and birth certificates, if partners are to be included
A RIB (Relevé d'Identité Bancaire) provided by the bank
Evidence of income for at least the previous 12 months, whether in France or elsewhere or an avis d'imposition or latest French tax bill

The Carte Vitale

Once affiliated to the social security system, a Carte Vitale (green card) is issued. The Carte Vitale is the national insurance card issued to anyone eligible aged 16 and over. It gives evidence of membership and rights to French health insurance - an affiliation to CPAM.

It contains all the administrative information necessary for the refund of care:

Social security number
Details of health insurance scheme and top-up insurance
Details of the relevant health insurance office
Full name and date of birth of the card holder and their dependants
Details of any exemption or reduction that apples to payments or entitlement to supplementary universal cover

The Carte Vitale does not carry personal medical information.

The Carte Vitale should be handed over at every health appointment (doctor, clinic, hospital, pharmacy) that is equipped with a computer able to read it. The patient will generally receive reimbursement for treatment or medicines directly into their bank account within five days. Reimbursement is made according to income level and the Tarif de Convention (or "approved treatment cost") currently in force.

A Carte Vitale has no expiry date but must be updated annually inserting it in the green box at town halls and some hospitals and pharmacies.

A person without a Carte Vitale eligible for state health insurance will receive a feuille de soins (a brown receipt form) from the doctor, pharmacist or hospital staff. This is recognised by CPAM as a legitimate medical payment. It should be signed and posted to CPAM (along with the doctor's prescription if medicines were issued) for reimbursement.

The new Carte Vitale

The "nouvelle Carte Vitale" is a new, upgraded version that is being issued to card holders across France. A form is sent, to which a recent identity (ID) photograph must be added, the form signed and returned in the envelope provided, along with a copy of ID (resident's card or passport).

Private Healthcare and Top-Up Insurance (Mutuelle)

CPAM repays only a percentage of medical costs and modern dental and optical treatments are often very much higher than the Tarif de Convention.

Private health insurance (santé complémentaire) is available from any medical insurer. Rates vary depending on the degree of cover required and status of the applicant. Policies may range from 100 to 200 percent of the Tarif de Convention. A person with a "Carte Blanche" top-up insurance card has the treatment recorded and the appropriate balance reimbursed by their mutuelle.

Policy prices vary and generally provide an option for 100 percent cover or more. This means that the percentage charged for medical services over the official limit (barême) is reimbursed. There are various schemes, each providing for different needs.

Note: Not all mutuelles cover people over 70 years and some have an earlier cut-off date of 65 years of age.

Private health cover

There are many international companies providing health insurance to foreign residents.

Cancelling Top-Up insurance

A contract cannot be cancelled "midstream". There are therefore two cancellation options:

At least three months before the policy renewal date, notice of cancellation must be given by registered letter.
Alternatively, the insured has up to 20 days after receipt of the renewal notice in which to cancel by registered letter with recorded delivery (Lettre Recommandée AR). It is the stamp on the envelope which is the final proof of the correct notice period. The envelope should be kept as it protects the consumer - the insurance continues until registered cancellation is received.

A policy is automatically ended by the death of the insured.

Note: The Loi Chatel of August 2005 does not apply in this instance; neither does it apply on any "life" policies or professional policies.

Contacts

Information from the French Government Web site (in French)
AMELI Assurance Maladie en Ligne
CNAM French Health Service English-language service
Tel: 08 11 36 36 46
CLEISS Helpdesk for international mobility and social security
At: 11 rue de la tour des Dames, 75436 Paris cedex 09
Tel: 01 45 26 33 41

Contacts for UK Citizens

Information in English from the French Embassy in the UK: Click here
UK Citizens: DWP Overseas Medical Benefits helpline International Pension Centre
At: Room Tc001, Tyneview Park, Whitley Road, Newcastle upon Tyne, NE98 1BA
Tel: +44 (0) 191 218 1999 (Monday to Friday 8am - 5pm)

Hospitals, Clinics and Pharmacies

Emergency units (services d'urgence) are available in most hospitals and in some private clinics.

In an emergency, call for an ambulance, Tel: 112
Go to the services d'urgence entrance at the hospital or clinic

For treatment, patients can choose between state hospitals and private clinics. Hospital fees are paid by the CPAM, whether at a hospital or a private clinic. However, after the first 24 hours of hospitalisation, a patient must pay a daily fee (forfait hospitalier) which is not reimbursed. Anaesthetists and surgeons in private clinics may charge additional fees (dépassements d'honoraires). These fees are not reimbursed by social security. Some mutuelles reimburse part or all of these fees, however, prior approval is generally required.

Pharmacies and Medicines

Prescription medicines are distributed in pharmacies on presentation of the Carte Vitale and the prescription. The patient pays a percentage of the cost. A mutuelle generally covers the remaining percentage, depending on the level of reimbursement of the product. Not all medicines are reimbursed. Medicines for certain chronic medical conditions and fertility treatments are reimbursed at 100 percent.

In an effort to reduce health costs, generic medicines are becoming more readily available. If a pharmacy has a generic medicine in stock and the patients refuses this, the CPAM will only reimburse the percentage of the cost of the generic medicine.

For information on the amount reimbursed for medicines: Click here (in French)

Pharmacies are generally open from Monday to Saturday from 08:30 to 19:30. Many pharmacies close between 12:00 and 14:00, although in shopping centres and large towns, pharmacies will stay open all day.

At least one local pharmacy is open on Sundays and public holidays - the "duty pharmacy". Night pharmacies can also be found in some large towns. Details of, and schedule for the "duty pharmacy" are posted in pharmacy windows, in local newspapers and at the local police station.

To find a duty pharmacy, Tel: 32 37

Further Information

AMELI Assurance Maladie en Ligne
CNAM French Health Service English-language service
Tel: 08 20 90 42 12
CLEISS Helpdesk for international mobility and social security
Tel: 01 45 26 33 41

Finding a Doctor

Foreigners in France will find English-speaking general practitioners, dentists and opticians in most large cities. Doctors are established in private practices, either alone or in a group. To find a doctor, search in the French yellow pages (Pages Jaunes) for "médécin". Medical practitioners may not advertise in France.

Every person of 16 years and over living in France and benefiting from social security should nominate a medical doctor to be their attending medical practitioner (médecin traitant). This doctor is responsible for their patient's direct care and all referrals to other medical practitioners and specialists.

While it is not obligatory to have a médecin traitant, medical consultations and treatments referred by the médecin traitant are reimbursed by social security at beneficial rate.

Note: It is not necessary to get a referral for visits to an ophthalmologist, paediatrician, dentist or gynaecologist.

For information on registering with a doctor, see AngloINFO INFOrmation Page, Attending Doctor in France, the Médecin Traitant.

Doctor's fees and payments

When consulting a doctor, fees are paid upfront. A person without a Carte Vitale will get a treatment form (feuille de soins) to send to the local CPAM. The Social Security then reimburses around 70 percent of the standard rate (tarif de convention) within five days; optional top up insurance (mutuelle) takes care of the majority of the remaining amount. For each consultation (for over 18s) a contribution of one euro is paid by the patient. This is referred to as the participation forfaitaire.

The amount of the reimbursement depends on whether the doctor is in secteur 1 or secteur 2. Tariffs in secteur 1 are fixed (tarif de convention), whereas doctors in secteur 2 can charge the price they want (and the patient will still only be reimbursed for a percentage of the standard rate). Visits to a specialist without a referral are reimbursed at a lower rate.

Doctors are obliged by law to post their fees on the wall in their surgery. It must be clearly stated if the doctor is in secteur 1 or secteur 2.

Certain consultations with a doctor are reimbursed at 100 percent (minus the participation forfaitaire), for example, after six months of pregnancy, compulsory children's check ups and if the person benefits from Couverture Maladie Universelle, CMU (Universal Health Insurance Coverage). CMU is granted to a person with little or no income and to people with a serious illness or health condition.

For more information on CMU from Service Public: Click here (in French)

Medical treatments

Some treatments require prior approval (demande d'accord préalable) in order to be reimbursed by the CPAM. These include:

Physiotherapy
Certain orthodontic treatments (under 16s only)
Long distance medical transport (over 150 Km)
Certain laboratory tests
Prosthesis

In all cases, the doctor informs the patient if this approval is required and provides all the necessary forms.

Ordre National des Médecins

The Ordre National des Médecins is the overseeing body for all medical doctors working in France. The website can be used to search for any discipline of medical practitioner in any part of France (searching for "English-speaking" doctors is not possible).

To search for a doctor by discipline: Click here (in French)

Note

The rules of the Ordre des Médecins prohibit us from publishing a list of English-speaking doctors and medical practitioners. We apologise for not being able to bring you this service.

Dental Procedures

Dental care is reimbursed at 70 percent of the standard rate. Some visits to the dentist are reimbursed at 100 percent, for example some children's check ups. The parent receives a form from the CPAM inviting their child to consult a dentist within the next 12 months, which must be presented to the dentist at the visit.

Orthodontic treatments that begin before a child's 16 birthday are also reimbursed. In order to benefit from any reimbursement, prior approval (demande d'accord préalable) is required. Reimbursements are only paid at the end of the treatment, which may be six months after payment to the orthodontist has been made. Orthodontists are free to set their fees, but most provide the patient with a written quote before any treatment is undertaken.