English speakers ? If you need information about your French health insurance rights, call the special Advice Line provided by Ameli :
If you are insured (or a beneficiary of the insured) under the social security system of an EU member state, Iceland, Liechtenstein, Norway, or Switzerland, you may be covered for any medically necessary healthcare you receive while visiting France, regardless of whether you are working, unemployed, a resident or a retiree.
Legislative framework :
Before your departure, you should apply for the European Health Insurance Card (EHIC) with your local health insurance fund.
The card will ensure that you have access to healthcare in France without having to complete any formalities with the local French authorities. As regards the services provided, you will be treated in the same manner 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, your local health insurance fund can issue you a Provisional Replacement Certificate (PRC). This document provides the same cover as the EHIC, but for a limited period of time.
Benefits in kind include medical care, medicines, dental care and prosthetics, hospitalisation, laboratory analyses and examinations 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.
As a non-resident insured in another state, you are not subject to French "healthcare pathway" laws that require patients to appoint a médecin traitant (primary care physician) from whom they must obtain a referral before seeing a specialist. To prove that the healthcare pathway isn't applicable to you and avoid paying any additional charges, 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 getting a prescription from 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 will be printed on the feuille de soins that the chemist will give back to you with the prescription. You pay the chemist directly.
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.
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 may seek treatment at the public or private facility of your choice.
If you see a doctor prior to being hospitalized, your practitioner can recommend a facility that will meet your needs, with consideration for quality of care.
You are advised to check the rates of the hospital you are considering as well as the amounts you will be reimbursed as some facilities charge extra fees that are not covered by the French social security system. Please also be aware that there are a few clinics that are not "conventionné"; i.e. that do not adhere to the national agreement between practitioners and the national health care system. You can check the website ameli direct to locate a facility and find information on its rates.
As a general rule, the Caisse will directly cover 80 % of your hospital expenses and in some cases 100 %. If you showed your EHIC or a provisional replacement certificate when you were admitted, you will not have to pay upfront and will only be responsible for the copayment, which is 20% if you have 80% coverage, plus an 18 € fee for each day you were hospitalized. If you have 100% coverage, you will have to pay the 18 € daily fee.
Extensive medical treatment costing 120 euros or more, or procedures assigned a coefficient of 60 or above, are reimbursed 100%. However, you will need to pay an 18-euro flat-rate charge for one or more procedures performed by the same practitioner during a single visit, whatever the actual cost of the procedure. This 18-euro co-payment applies whether the procedure is performed in a doctor's office or at a hospital.
Some people with 100% coverage may be exempted from paying either or both of these flat fees (those with CMU-C coverage, patients with a long-term illness, a work-related illness, or an occupational accident injury, and pregnant women from the 6th month of pregnancy).
Once you have dated and signed the feuille de soins, 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).
There is at least one CPAM in every French department (or CGSS for the overseas departments). You can determine which CPAM or CGSS to apply to for your reimbursement by doing a department-by-department search on the CNAMTS (National Health Insurance Fund for Salaried Workers) website.
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, 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. For information purposes, 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 Fund will reimburse €15.10 and you will cover 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 %, 30 %, 65 % or 100 % of the sales price, or of the reference price for medicines included in reference-priced generic groups:
The €0.50 charge per item of medicine will be deducted from the amount reimbursed.
Legislative framework :
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 advise them of your incapacity.
If you are admitted to hospital, the hospital admissions department will hand you a "bulletin de situation" (status report) that will double as a medical leave certificate. When you are discharged from hospital, their administrative department will give you a bon de sortie (discharge authorization) and the medical leave (bulletin de situation) will no longer be valid. If necessary, the hospital doctor or the general practitioner will deliver a new sick leave certificate.
You may download the medical leave form -the first or an extension (prolongation)- along with the instructions, on the CNAMTS's website (ameli).
Any sickness benefits to which you are entitled will be determined and paid directly by the fund to which you belong in your country of residence.
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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.