French Healthcare: Ensure you're on top form

Many new arrivals who contact us are relocating from other member states because they found life there was not quite what they expected. One such client arrived a few months ago. He had done nothing about healthcare so far but wanted to join the French system as he found it to be much better than his high-cost international policy. Another reason for his move was that it is still possible to buy good value property in France if you take the trouble to look around. So, he has bought two houses; he reckoned he would do better than investing surplus capital in any other way. Another significant change has been brought about by the introduction of the European Health Insurance Card (EHIC).

I once commented that it was the most important event since the foundation of the union itself, as it would provide true freedom of movement, with the right to NHS healthcare throughout your life, wherever you go in the EEA. Many people are unsure about the EHIC and confuse it with the E111 which it replaced. It may be opportune to outline the latest guidelines issued by the EU on February 7, 2007: A patient in possession of a European Health Insurance Card is entitled to all benefits in kind which become medically necessary during a stay in the territory of another Member State, taking into account the nature of the benefits and the expected length of the stay.You (the member states) must therefore provide all the types of medical care and treatment that the patient's state of health necessitate to enable him to continue his stay in your country under safe medical conditions. The key is that he should not be obliged to cut short his visit in order to return to his country of residence for treatment. However, you are not obliged to provide certain kinds of treatment that can wait until the patient has returned home (most types of dental treatment, for example).

The patient might well have problems obtaining reimbursement for treatment that goes beyond what is strictly necessary in the context of a temporary stay. In addition, some types of treatment extend over a period of time and necessitate follow-up, which is not compatible with the temporary duration of the patient's stay in another country. In these cases, once the patient has received ‘holding’ or primary treatment, generally speaking it is preferable for him to return to his own country of residence and his own doctor for further examinations or certain types of treatment. New rules During the last year many people have realised that the EHIC has made it possible to reside in one member state for more than six months and live in another for less than six months in each year. The transfer of your UK NHS rights to the French health service is implemented by the ‘E forms’ for residents and by the new EHIC for visitors. If you do not qualify for any of the first three E forms (see red box) the fallback option is Couverture Maladie Universelle (CMU). This is a uniquely French instrument that provides cover, subject to stable and regular residence for not less than 90 days, by payment of an income-based quarterly subscription.

Testing times Now I am going to turn to your post-arrival situation. You may have to cope with a new language in an unfamiliar environment and a different healthcare system. A few days ago I was asked: “I have an E121 but have not had to use it yet. What should I do with it?” There are a number of steps you must take: Step 1: Visit your Caisse Primaire d'Assurance Maladie (CPAM) branch. You will find the address under CPAM in the telephone directory. If possible, select a big town or city that may have an international relations department that is used to dealing with people becoming resident. Pay a visit, submit your papers, and ask for help.

Do not delay, as the E forms remain inactive until they are submitted and accepted by CPAM. If you intend to use the EHIC as a visitor with a holiday home you should submit your form, or forms, with a banker’s relevé d'identité bancaire (RIB) for reimbursements to be made directly to your bank account. This will save you time and transfer costs. The steps below do not apply to you as a visitor. Step 2: On becoming resident you become liable for tax. It is important to understand that you must declare your worldwide income, although in France you should not have to pay on any money that is compulsorily taxed at source. Many CPAM branches refuse to accept people into the healthcare system until they are satisfied that their income has or will be declared. Step 3: Since July 2005 France has adopted a similar GP system to the UK. Registration is not compulsory but failing to do so will result in lower payouts. This can be expensive, especially for visits to specialists, dentists, dermatologists and the like, who are free to fix their own fees if you have not registered with a GP. It is a formal process using a form S3704, a déclaration de choix du médecin traitant, that both you and your doctor must sign before it goes to CPAM.

• Exclusive Healthcare Tel: 0121 288 2363 from the UK or 0870 449 175 from France for free advice. helplineexclusivehealthcare@wannadoo.fr & www.exclusivehealthcare.com

E FORMS IN BRIEF...

• E106: This is for early retirees. It provides cover for up to two years and is available to people who have worked and paid NIC for the two years before taking early retirement. If there is only one person in a family that qualifies for an E106 it covers other members of a family as ‘dependant beneficiaries’ as well.

• E121: This is for retirees. It provides cover without time limit subject to unchanged circumstances. A changed circumstance might be returning to the UK to become resident. If there is only one person in a family that qualifies for an E121 it covers other members of a family as ‘dependant beneficiaries’ as well.

• E109: This provides cover for the family in France of a person remaining resident, working and paying NIC in the UK.

• EHIC: This is for visitors. A visitor is a person residing in a stable and regular manner in the UK for more than six months and visiting France for less than six months in a year. The position can be reversed depending on which of the two countries you select as your country of residence.

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