Protect your most precious asset with top-up health insurance in France!
Our health has surely got to be the most important thing in our lives and yet those of us who live, holiday or plan to settle in France, are not always clear on the very complex issues of financing health cover, or the enormous bills awaiting us if we are not fully covered. In this article we discuss top-up health insurance in France.
Many people are unclear about whether they need top-up health insurance in France. Here’s some useful information to help you make up your mind.
In 2016 the EU Commission stated that France was breaking EU rules by making early retirees moving to France complete five years legal residence before becoming part of the French health system. In response, France introduced the ‘protection universelle maladie’, or PUMA, which simplifies health insurance for foreigners in France. Whether you are unemployed, retired or pre retired, an EU citizen or not, PUMA guarantees your right to reimbursement of around 70% of all your health costs (although you may have to make social security contributions). If you are not already in the French healthcare system, find out how to apply here. The Ameli website also has some useful information in English.
Of course the introduction of PUMA is great news but it is still advisable, and in some cases essential, to take out a top up insurance policy (a ‘complémentaire santé’ or ‘mutuelle’) to cover the remaining 30%. Here’s some information to help you decide whether you should take out top-up health insurance in France.
Why do we need top up insurance?
A complémentaire santé (a mutuelle is an old fashioned way of saying the same thing) is a policy which reimburses medical costs not covered by the Social Security. Depending on the policy chosen, it will cover some or all of the remaining percentage NOT reimbursed by the state. This can be an enormous amount if you need hospital or emergency treatment as hospitalisation, a private room and ambulance costs are expensive and refunded only minimally, or not at all by the Sécurité Sociale (la Sécu). New legislation introduced in 2020 has lowered the cost of optical and dental care.
Choosing your ‘complémentaire santé’
It is worth exploring different insurers and policies in order to find the right one for you and your family. Some insurers now offer ‘made to measure’ flexible packages where you can choose to add or subtract what is more, or less relevant to you personally. For example, if you know that you have regular problems with your teeth, but your eyes are mostly fine, you might choose a higher level of reimbursement for your dental care than your optical needs or you may wish to put the emphasis on a policy which reimburses routine care such as GP or osteopathy and ‘dépassements d’honoraires’ (charges exceeding the ‘Tarif de Convention’, standard fee set by the state) but less on actual hospitalisation…..
Basically, you don’t need to pay for what you are unlikely to use, but may add on to the policy each year, if you feel it necessary.
Whatever you choose, the monthly premium is surprisingly low compared to British health insurance policies, although be aware that this does not entitle you to queue jump, or private health care – it simply pays the bills for what is already available from the French health service.
If you are on a very limited budget for healthcare, you can take out a top up policy for hospitalisation only, the greatest expense.
What are the conditions to take out a complémentaire santé?
Age is obviously a factor, but different insurers have different age criteria. On average, you should have no problem taking out a policy up to 85, after that it is negotiable.
Importantly, unlike English health insurance policies, there is no medical questionnaire and you can take out a ‘complémentaire santé’ in all circumstances, even if you have a pre-existing condition, without it affecting your premium.
Some rough figures
A ten day stay in hospital would cost you around 3,000 euros, excluding ‘dépassements d’honoraires’ and private room. The state would reimburse a maximum of 2,400. A good ‘complémentaire santé’ would cover the rest plus the extras.
Beware – 100% reimbursement does not really mean 100%!
Reimbursement of 100% of the ‘tarif de convention’ (standard fee) does not mean that you will be fully reimbursed! It means that you will be ‘topped up’ to the full amount reimbursed by the securité sociale, which may only be a tiny amount. To be sure of receiving full payment for treatment that is poorly covered by the state, you should be looking at policies that reimburse 150% upwards.
….if there is an initial period during which you will not be reimbursed (some insurers do this in order to stop clients taking out insurance only when they become ill)
….if you can benefit from the ‘tiers payant’ system (payments made directly by your insurance company to the healthcare provider), meaning you do not have to pay upfront out of your own pocket.
Any basic policy should offer partial or total refund of all hospitalisation costs, primary care expenses, i.e. medical fees, tests, and drugs at the same rates as the French state healthcare system. Beware policies that may be introduced at short notice in response to new legislation, as they may not be “tried and tested”.
Do not wait until you are ill to take out top-up health insurance.
Frais médicaux – médical expenses
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