French Healthcare - Explaining France’s ‘E’ numbers

If you are planning to make the move to France this year, it may help if we go through the stages of preparation for moving and alert you to some of the healthcare changes that have occurred during the past year. As a visitor or a settler healthcare arrangements fall under the regulations regarding free movement of citizens throughout the EU. These regulations are implemented through ‘E’ forms. The most important of these and their main uses are the E106, which is for early retirees and their families. This is issued to those who have worked and paid national insurance contributions during the two years before taking early retirement. It covers the holder and his/her dependant family for up to two years by affiliation to the French NHS.

Retirees
The E121 is for retirees and their families. This is issued to those who have reached the official age of retirement in their home country and are in receipt of a state retirement pension (OAP). It covers the holder and his/her dependant family without time limit by affiliation to the French NHS.

Families
The E109 is for a family or family member going on ahead to live in France leaving one of the family members resident in the UK, working and paying NIC. Cover by affiliation to the French NHS is maintained while the family member remains employed in the UK.

Holidaymakers
The EHIC has replaced the E111 and already more than 100 million have been issued. It is intended to provide healthcare for individuals on the move throughout Europe including long-stay visitors who have holiday homes. The guarantees are much better than the old E111, being ‘for any necessary medical treatment arising during a temporary stay in another member state’. It cannot be used in another member state where the journey has been made specifically to obtain treatment such as an operation.

The time limit for use of the EHIC is 180 days in each year. The constraints are the risk of becoming resident and tax resident by passing the 183-day limit in another member state. Furthermore, you can lose your NHS rights in the UK by being absent for more than six months within any one year. The EHIC is invalid if a person becomes resident in France or comes with the intention of settling.

Fall-back options
The options that have been mentioned do not apply in every case. Early retirees may not qualify under the E106 rules; the E106 may expire leaving a gap until the qualifying conditions for the E121 are satisfied. Such cases may be covered by the fall-back option, which is the last resort if all else fails.

The option is Couverture Maladie Universelle (CMU). This is French Law No. 99-641. CMU came into force on 1 January 2000 with the intention of providing proper healthcare for impoverished French citizens who previously had only emergency cover. Almost as an afterthought all residents of France were included, being allowed to pay a reasonable subscription for affiliation to the French NHS, subject to showing proof of regular and stable residence for not less than 90 days, and evidence of identity.

The foregoing options cover most situations except for people seeking employment or intending to set up a business. This can be complicated. I shall not attempt to deal with it here but can provide information and references to official websites on request.

If you are resident in France, joining the French NHS is obligatory under both local and EU law. Private health insurance is illegal and cannot compete with the cover offered by the state system, which asks no medical questions and imposes no claims excesses. Generally there is little or no delay in obtaining treatment.

The cover provided by any means of affiliation is basic French healthcare. This meets about 70% of medical bills and this does not change as you grow older. For a reasonable price you can buy top-up insurance that bridges some or all of the gap between the cost of treatment and the state’s reimbursement. This can be serious if you are hospitalised; in certain circumstances you could face a bill for some thousands of pounds.

The E forms are not issued to residents and if you have obtained one it amounts to confirmation that on leaving you are no longer resident in the UK. When you register the form in France your NHS rights will be transferred. Along with this goes tax residency and you should be aware of this and take the appropriate steps to stay within the law.

Exclusive Healthcare Tel: 0121 288 2363 (from the UK). 0870 449 283 or 0870 449 175 (from France) for free advice helpline Email: exclusivehealthcare@wanadoo.fr Web: www.exclusive healthcare.com

---