Access to Healthcare in France for an EU visitor

The European Health Insurance Card (EHIC) ensures that you have access to healthcare in France without having to complete any formalities with the French authorities. As regards the services provided, you will be treated in the same manner as anyone covered under the French state system.
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The French health system does not usually cover the entire cost of treatment. Part of the cost, known as the ticket modérateur, is borne by the patients themselves. Various other charges are also at your expense :

Using the EHIC in France


The place to contact for information about conventionné doctors (working within the state health system) and conventionné and agréé (approved) hospitals and medical facilities is the Caisse Primaire d’Assurance Maladie (CPAM) in mainland France or the Caisse Générale de Sécurité Sociale (CGSS) in the overseas départements. You also apply to the Caisse for the reimbursement of medical costs. Each département has at least one CPAM (or CGSS). To find the local CPAM or CGSS where you are staying, you can do a search (by département) on the website of the Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAMTS).

Benefits in kind include medical care, medicines, dental care and prostheses, hospitalisation, laboratory analyses and transportation.

Medical and Dental Care

Before making an appointment with a doctor or dentist, make sure that they are conventionné. Conventionné practitioners fall into one of two categories :

- Secteur 1 conventionné practitioners who charge the official social security rate
- Secteur 2 conventionné practitioners who charge an extra fee on top of the official rate.

In both cases, the local CPAM (or CGSS) will reimburse a fixed portion of the official social security rate.

You can find a healthcare professional in the area you are staying by consulting http://ameli-direct.ameli.fr/.

As a non-resident insured in another state, you are not subject to French laws governing the parcours de soins (coordinated medical consultation procedure) where patients are required to appoint a médecin traitant (“acting doctor”) from whom they must obtain a referral before seeing a specialist. To prove that the parcours de soins isn’t applicable to you and avoid paying any additional charge, you should show the doctor (whether a general practitioner or specialist) your European Health Insurance Card or Provisional Replacement Certificate.

You pay the doctor directly and the latter will fill out a feuille de soins (treatment form) and a prescription if necessary.

As the parcours de soins doesn’t apply to non-residents, you can consult a specialist directly without going through a general practitioner.

Paramedical services provided by allied health professionals (nurses, physiotherapists, etc.) are covered if prescribed by a doctor.

Medicines

You can obtain your medication from any chemist (pharmacy) on presenting the feuille de soins and the doctor’s prescription. The price of the medicine is printed on a second feuille de soins that the chemist will give back to you with the prescription. You pay the chemist directly. The vignettes (stickers) on the medicine packaging must be removed and stuck on the feuille de soins in the space provided.

Transportation

If you have to travel to receive medical treatment, the health insurance system will in some cases cover the cost of transport prescribed by a doctor.

Reimbursement

Once you have dated and signed the feuille de soins and attached the vignettes, you should send the form to the local CPAM (or CGSS), together with the prescription and a copy of your European Health Insurance Card or Provisional Replacement Certificate. You should also fill in the feuille de soins with your permanent address and give your bank details (name of bank, address, SWIFT code, account number and IBAN or BIC).

The French health system does not usually cover the entire cost of treatment. Part of the cost, known as the ticket modérateur, is borne by the patient themselves. Various other charges are also at your expense :

- A €1 charge for a visit to, or procedure performed by a general practitioner or specialist, as well as for X-ray examinations and laboratory tests. These charges may not total more than €4 per practitioner or laboratory in any one day, or €50 in any one year. You should keep the statements of reimbursement to request an exemption from payment of any amount exceeding the €50 annual limit.
- A charge for paramedical services provided by allied health professionals (nurses, physiotherapists, etc.) as well as medicines and transportation for the purpose of receiving medical treatment :

  • €0.5 per item of medicine
  • €0.5 per paramedical procedure up to a maximum charge of €2 for any one day
  • €2 for transportation for medical treatment up to a daily maximum of €4
  • Such charges may not total more than €50 in any given calendar year. You should keep the statements of reimbursement of medical costs to request an exemption from payment of any amount exceeding the €50 annual limit.


For extensive medical or surgical procedures costing upwards of €120 (procedures assigned a coefficient of 60 or above), the reimbursement rate is 100%, with an €18 flat-rate charge (ticket modérateur) borne by the patient. This co-payment applies regardless of the cost of the procedure and whether it’s performed in a doctor’s surgery or a hospital.

Doctors’ and dentists’ fees are reimbursed at 70% of the official social security rate. The official social security rate is €23 for a consultation with a general practitioner and €25 for a consultation with a specialist. For a visit to a general practitioner for example, the Caisse will reimburse €15,10 and the patient covers the remaining €7.90. The amount reimbursed as shown on the statement of reimbursement is the amount payable after deduction of the ticket modérateur and €1 charge.

The cost of laboratory tests and analyses is reimbursed at 60% of the official social security rate. A €1 charge per laboratory procedure (up to a daily maximum of €4) will be deducted from the total amount reimbursed.

The fees charged by allied health professionals are reimbursed at 60% of the official social security rate. A €0.5 charge per paramedical procedure (up to a daily maximum of €2 for services provided for the same patient by the same health professional) will be deducted from the total amount reimbursed.

For transportation for medical care and treatment, 65% of the cost is reimbursed. A €2 charge per journey (up to a maximum of four journeys in any one day) will be deducted from the total amount reimbursed.

Medicines are reimbursed when prescribed by a doctor and included in the positive list of reimbursable pharmaceutical products. Reimbursement rates are 15%, 35%, 65% or 100% of the sales price, or of the reference price for medicines included in reference-priced generic groups :
- 100% for medicines considered to be “not substitutable and particularly expensive” (crossed white vignette),
- 65% for other medicines (white vignette),
- 35% for medicines used to treat “disorders not usually of a serious nature” (blue vignette),
- 15% for medicines for which the “medical service rendered” is considered to be insufficient (orange vignette).

The €0.5 charge per item of medicine will be deducted from the amount reimbursed.

Hospitalisation

If you are admitted to hospital in an emergency you should present your European Health Insurance Card or Provisional Replacement Certificate to the hospital admissions department. You may also be asked to show your passport or other valid identity document.

If you are admitted to a private hospital or clinic, you should check that it is conventionné.

The Caisse will cover 80% of your hospital expenses and in some cases 100%. If you present your European Health Insurance Card or Provisional Replacement Certificate on admission, you will not have to pay refundable costs upfront, only the 20% co-payment (including the daily hospital charge) or the daily €18 hospital charge in the case of 100% cover.

If you undergo an extensive medical or surgical procedure while in hospital, you will be required to pay the flat-rate contribution of €18 in addition to the daily hospital charge or 20% co-payment.
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For more information

More about the access to healthcare in France for a EU visitor, on the web :
http://www.cleiss.fr/particuliers/access-to-healthcare-in-france883.htm

publié le 20/07/2015

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