Peter Brooke - French Healthcare
 There has been much discussion and some speculation about the new proposed reforms that Mr Sarkozy has announced with respect to the provision of health care for British and other EU nationals currently residing in France.
The current changes to the French healthcare system are a knock-on effect of EU directive 2004/38, which has been brought into the French administrative system by law 2006-911 (24/07/06) and decree 2007-371 (21/03/07).Click here for the full statement (in French)
What exactly will this reform mean?
In the past expatriates arriving in France without the UK forms E121 (given to those who are officially retired) or E106 (given to those who had fully paid their National Insurance contributions, and valid to a maximum of two years) were able to join the French healthcare system by paying a subscription (cotisations) to CMU (Couverture Maladie Universelle) which entitled them to a carte vitale which is the little green card for accessing the medical reimbursement system.
Now any EU expat not officially retired and not working (described as “economically inactive”) in France will have their right to French state healthcare taken away. This means they will not be able to have a carte vitale.
THE FACTS:
If you are over the legal retirement age (60 for a woman & 65 for men) then you are completely unaffected, as part of reciprocal agreement between EU member states the UK E121 guarantees this.
If you are under the legal retirement age, working legally and continue working in France (at least 60 hrs per month) and have been paying cotisations (Similar to NI contributions) you will be unaffected.
If you are under legal retirement age and are not working, but currently hold a valid UK E106 you will continue to be covered by this until its expiry … after this you will be affected, unless you reach retirement age during this period.
If you are under the legal retirement age, and are not covered by the E106 because it has expired then you will be affected until you reach the legal retirement age and the E121 takes over. Even if you have been voluntarily paying cotisations and currently hold a Carte Vitale you will still need to purchase private healthcare. Securite sociale confirmed (24/09/07) that expatriates who are already in the French healthcare will continue to be covered by the French health service system until 31st March 2008 to enable them to find a suitable private policy to cover their healthcare needs from this date.
If you are planning on permanently moving to France new arrivals will now have to register with their Marie (Town Hall) within 3 months of arriving, and provide evidence that they have medical coverage from either an E106, E121 or a private healthcare policy as well as evidence of sufficient financial resources to live on after which you will then be given a Certificate of residence.
This new law brings France into line with other EU countries, such as Spain and Portugal, who have tightened their provision of healthcare cover to EU expats after a ruling in the European Court of Justice.
Continued discussion… the following issues are still being resolved and discussed before the exact implementation is announced.
One issue that still remains unclear is what the situation will be if one of the couple is at state retirement age and the other is not. We know that if the husband has reached state retirement age and has an E121 that the wife will automatically be eligible for a carte vitale, but if the wife has reached state retirement age but the husband has not it is still unclear as to whether the French government will be willing to accept that the husband is a dependant of the wife and be issued with a carte vitale.
Another point that has not been confirmed is what the situation regarding access to the state healthcare system would be if an expatriate was to gain French citizenship which can be applied for after 5 years of uninterrupted residency.
An obvious discussion point with respect to qualification will be the definition of “economically inactive” and we are still awaiting more updates on this point.
Existing medical conditions. It appears that the main option for people affected by this reform is to take out a Private Health Insurance though for those with existing medical conditions this could be impossible to obtain or exorbitantly expensive. It is believed that there could be a ‘case-by-case’ clause added to the reform to ensure that such people could still be covered by the CMU.
SO WHAT SHOULD I DO?
Check the facts above… if you are affected by this change you have the following options and you have until March 2008 to find a solution:
1. Take out private health insurance
How much does it cost?
What excesses must I pay?
Exactly what is covered?
What is the quality of the claims service?
What is the attitude to pre-existing conditions?
2. Start working, even part-time and therefore contributing to the system, resulting in a carte vitale and its advantages.
As an employee you must work at least 60 hours per month.
As self-employed there is no minimum income. Theoretically you can register as an Enterprise Individuelle, earn no money and only pay your healthcare contributions - about 1,300€ a year - and get a carte vitale. There are associated costs to running your own business in France (legal, accountancy, business taxes) and over the long-term this practice may be frowned upon by the government. Plus, in France payments are calculated retrospectively so for the first year of trading you will have to pay the full cost of social charges - about 3,500€ - and then wait for them to be reimbursed.
Even with a minimum income you will need to pay significant cotisations (social charges). If you considering being self-employed seek professional advice first.
3. Reconsider your permanent move to France or your timing of retirement.
peter.brooke@spectrum-ifa.com
Tel: +33 4 93 00 01 13 Mob: +33 6 87 13 68 71 Fax: +33 4 93 00 01 14
Skype: pbrooke
Post: The Spectrum IFA Group, Mediathel, Routes des Cretes, 06560 Valbonne, France
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