If you travel to Switzerland while pregnant

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Important:

  • If you are a Swiss cross-border worker who has opted for membership in the French health insurance system, special provisions have been adopted to guarantee continuity of care in Switzerland under certain conditions.
  • Directive 2011/24/EU on patients' rights in cross-border healthcare, which incorporates EU Court of Justice legal precedent on the free circulation of services (including the Kholl and Decker rulings), is not applicable in this country. This means that standard (non-emergency) ambulatory care cannot be covered.

This section applies if you are pregnant and a member or the beneficiary of a member of the French health insurance system. If you travel to Switzerland, you may be eligible for coverage of any medical care related to your pregnancy, regardless of your circumstances (salaried or self-employed worker, unemployment benefits recipient, resident, pensioner, etc.)

However, your coverage will differ depending on the reasons for your travel to these countries: exclusively medical reasons or non-medical reasons.

 

I – Travel for exclusively medical reasons

Before you leave, you must apply for prior authorization of coverage  (S2 form).

The following types of care are subject to prior authorization:

If approved, you will receive a portable S2 certificate for coverage in the country you are visiting. If you pay all or part of your medical expenses upfront, you can apply to your local health insurance fund for a reimbursement when you return to France.

- The portable S2 certificate

Legal framework :

The portable S2 certificate, "Entitlement to scheduled treatment,"authorizes you to travel to another EU or EEA member state or to Switzerland to receive medical care. It means that your care will be covered as provided by local law and according to local rates. Indeed, you will receive the same care as members of the local social security system.

You will need to request this document from your French health insurance fund. Your application must specify the type of care you are planning to receive and list the medical reasons behind your request to receive care abroad, including a doctor's opinion if necessary.
You must apply for your authorization far enough in advance so that your local health insurance fund can process it before you leave.

Your authorization will not be granted automatically. Indeed, the following conditions apply:

In the member State you are visiting, you will need to show your S2 certificate either to one of the local health insurance fund or directly to your health care provider so that your care is covered locally pursuant to local law.

- Requesting reimbursement of your health expenses

If you paid upfront for scheduled care for which you had prior authorization, you can submit your paid invoices to your health insurance fund to request reimbursement.

The fund will examine your request for reimbursement. In particular, it will check whether prior authorization had been granted and whether the conditions for reimbursement provided by French law, such as the requirement for a prior agreement or a medical prescription, were met.

Legal framework :

Important: certain types of care or treatment may be subject to prior authorization from the French system (outside of the S2 procedure):

Before you leave, ask your health professional in France if prior authorization is required. If so, it is also required if the care is provided outside France.

Where applicable, the fund will reimburse you for your care based on Social Security rates in the country where the care was provided or, if you so request, based on French Social Security rates up to a maximum of actual expenses.

A supplement can be considered if the foreign rates are lower than the French rates for the same treatment: the French health insurance fund will issue a supplementary reimbursement, up to a maximum of your upfront expenses. For example, for a procedure billed 150 euros, if you were issued a 100-euro reimbursement in the foreign country and the French social security rate is 150 euros, you may receive a 50-euro supplement from your French fund.

II – Travel for another reason (non medical), during which you received necessary care

Legal framework :

As a member or beneficiary of a member of a French social security scheme, you are entitled to coverage of care which becomes medically necessary during a temporary stay in another European Union or European Economic Area country (e.g. during vacation, business trips, or foreign-language programs). This care is covered by your European Health Insurance Card (EHIC). The EHIC is proof of your entitlement to coverage under the French health care system. However, you may still need to pay for your care upfront.

The EHIC covers all care that becomes medically necessary during your stay: all unscheduled or emergency care, including hospital care, regardless of whether it is provided in a public or private facility in the country you are visiting.
If you paid for your care upfront, you will need to submit your paid invoices to your French health insurance fund. The fund will then consider your request for reimbursement as if the care had been received in France.

In particular, the fund will check whether the conditions for reimbursement provided by French law, such as the requirement for a medical prescription, were met.

Legal framework :

Important: certain types of care or treatment may be subject to prior authorization from the French system (outside of the S2 procedure):

Before you leave, ask your health professional in France if prior authorization is required. If so, it is also required if the care is provided outside France.

Where applicable, the fund will reimburse you for your care based on Social Security rates in the country where the care was provided or, if you agree, based on French Social Security rates up to a maximum of actual expenses. For example, if you pay 150 euros for a procedure and receive a 100-euro reimbursement in the country you are visiting while the French Social Security reimbursement rate is 150 euros, you can get an additional 50-euro reimbursement in France.