English speakers ? If you need information about your French Health Insurance rights, call the special Advice Line provided by Ameli :
If you are working, unemployed, a resident, or a pension recipient and insured (or a beneficiary of an insured individual) under the social security system of an EU Member State, Iceland, Lichtenstein, Norway or Switzerland, you may be entitled to coverage for any medical treatment you need while visiting France.
Before your departure, you should apply to the competent institution in your country for the European Health Insurance Card (EHIC).
The card will ensure that you have access to healthcare providers in France without having to complete any formalities with the local French authorities. You will receive the same health services as anyone covered under the French state system.
NB: If your EHIC is lost or stolen while you are abroad, or if your card hasn't been issued by the time you leave for France, the competent institution in your country can issue you a Provisional Replacement Certificate (PRC). This document is valid for a limited time and provides the same cover as the EHIC.
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 in Overseas France). 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.
Before making an appointment with a doctor or dentist, make sure that they are conventionné. Conventionné practitioners fall into one of two categories:
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 the CNAMTS website.
As a non-resident insured in another EEA member 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 (“primary care physician”) 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.
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.
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.
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:
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 18-euro co-payment applies regardless of the cost of the procedure and whether it is performed in a doctor’s surgery or a hospital.
Doctors’ and dentists’ fees are reimbursed at 70% of the official social security rate. As an indication, the official social security rate is €23 for an appointment with a general practitioner and €25 for an appointment 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.
65% of the cost of transportation for medical care and treatment 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.
All of the reimbursement rates are given on the CNAMTS website.
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 sale price, or of the reference price for medicines included in reference-priced generic groups:
The €0.5 charge per item of medicine will be deducted from the amount reimbursed.
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.
Outside of emergency hospitalizations, you can receive care at the public or private hospital of your choice.
If you see a doctor prior to your admission, s/he will be familiar with the quality of care available and can refer you to the facility best suited to your needs.
It is advisable to inquire beforehand about treatment costs and reimbursement rates, since some facilities apply a surcharge (“dépassement d’honoraires”) that is not covered by the French health care system. A few clinics are “non conventionnées,” meaning that their rates are not government-regulated.
Hospital addresses and rate information are available online on ameli direct at http://ameli-direct.ameli.fr/
The Caisse will directly cover 80% of your hospital expenses and in some cases 100%. If you have presented your EHIC or Provisional Replacement Certificate at the time of admission, you will not be charged up-front for your care. Your only out-of-pocket expense will be the hospital co-payment described above of 20% (including the daily co-payment) or the co-pay of 18 euros per day of admission if your hospital stay is covered at the 100% rate.
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.
If you become incapacitated for work while on holiday in France, you should obtain a three sheet sick note from a doctor registered in France. After filling out the sick note, you should send the first two sheets to the competent institution in your country and the third one to your employer or to the employment services to notify them of your incapacity.
If you are admitted to hospital, the hospital admissions department will issue you a "bulletin de situation" (status report) that will double as a sick leave certificate. When you are discharged from hospital, their administrative department will give you a bon de sortie (discharge authorization) and your sick leave (bulletin de situation) will no longer be valid. If medically necessary, the hospital physician or your primary care physician will issue you a new sick leave document. You can download a sample copy of the initial sick leave certificate and certificate of extension, along with explanatory notes, on the CNAMTS's ameli site.
Your home country's social security system will directly process and pay any sick leave benefits to which you are entitled.
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Ask your home country’s social security system whether and to what extent it covers health care costs incurred abroad. Visitors are advised to take out a private insurance policy to cover any health care costs you may incur while in France. A private health insurance policy is required for tourist visa applicants.